Abstract
Ankle arthritis is inflammation of the ankle (talocrural) joint producing symptoms of pain, stiffness, swelling, and often warmth. It can be caused by wear and tear (osteo- or degenerative), inflammatory arthritis (such as rheumatoid or psoriatic), or following injury (post-traumatic). The condition can be quite disabling and can be managed non-operatively or surgically.
Keywords
ankle, arthritis, fusion, management, pain, replacement, stiffness
| Synonym | |
| |
| ICD-10 Codes | |
| M19.071 | Primary osteoarthritis, right ankle and foot |
| M19.072 | Primary osteoarthritis, left ankle and foot |
| M19.079 | Primary osteoarthritis, unspecified ankle and foot |
| M19.271 | Secondary osteoarthritis, right ankle and foot |
| M19.272 | Secondary osteoarthritis, left ankle and foot |
| M19.279 | Secondary osteoarthritis, unspecified ankle and foot |
| M12.571 | Traumatic arthropathy, right ankle and foot |
| M12.572 | Traumatic arthropathy, left ankle and foot |
| M12.579 | Traumatic arthropathy, unspecified ankle and foot |
Definition
Ankle arthritis is degeneration of the cartilage within the tibiotalar joint that can result from a wide range of causes, most commonly post-traumatic degenerative joint disease. An acute injury or trauma sustained a number of years before presentation, or less severe, repetitive, minor injuries sustained during a longer period, can lead to a slow but progressive destruction of the articular cartilage, resulting in degenerative joint disease. Other common types are primary osteoarthritis, inflammatory arthritis (including rheumatoid, psoriatic, and gouty), and septic arthritis. Osteoarthritis is usually less inflammatory than rheumatoid arthritis, but can also involve many joints simultaneously.
Symptoms
As with arthritis of any joint, the presenting symptoms are pain (which may be variable at different times of the day and exacerbated by activity), swelling, stiffness, and progressive deformity. The ankle may be stiff on initial weight bearing; this improves after walking a while, but then worsens with too much ambulatory activity. The pain is often relieved with rest. Pieces of the cartilage can break off, forming a loose body, and the joint can “lock” or “catch,” sticking in one position and causing acute, excruciating pain until the loose body moves from between the two irregular joint surfaces. Another symptom is that of “giving way” or instability of the joint, which may be a result of surrounding muscle weakness or ligamentous laxity. With progression of the arthritis, night pain can become a major complaint.
Physical Examination
Swelling, pain, and increased temperature on palpation may be present. The pain is usually maximal along the anterior talocrural joint line and is typically chronic and progressive. If the patient’s other ankle is normal, it is important to compare the two. Assessing the overall alignment of the entire lower extremities, including the knees, is important. Deformity and reduced range of motion in plantar flexion and dorsiflexion (normal: up to 20 degrees of dorsiflexion and 45 degrees of plantar flexion) may be seen. The patient may exhibit an antalgic gait or a limp. Therefore gait pattern should be evaluated to determine if there are any abnormal loading patterns as the foot strikes the ground. Acute arthritis is manifested very differently. Onset is rapid with associated warmth, erythema, swelling, and severe pain with passive range of motion and may be accompanied by constitutional symptoms such as fever and rigors.
It is appropriate to examine the other joints in the lower limb, particularly the knee. The findings on neurovascular examination are typically normal. Decreased sensation in the lower limb raises the possibility of a Charcot joint causing a destructive arthropathy (see Chapter 129 ).
Functional Limitations
Pain with walking distances and difficulty in negotiating stairs or inclines are particular functional disabilities. Even prolonged standing can become intolerable with advanced joint deterioration. Night pain can lead to disturbance of sleep. Patients will typically adjust their activities or eliminate many of them, particularly exercising, because of pain.
Diagnostic Studies
Plain anteroposterior and lateral standing radiographs provide sufficient information in the later stages of the disease ( Figs. 82.1 and 82.2 ). Magnetic resonance imaging may show damage to articular cartilage and a joint effusion earlier in the course of the disease. In assessment of the radiographs, attention should also be paid to the other joints in the hindfoot because these will affect management options. Generalized bone density and alignment should also be noted.
