Jordi Sanchez-Ballester
FRCSEd FRCS Trauma & Orth
Consultant Foot, Ankle & Knee Surgeon
Fairfield Independent Hospital, St Helens
Spire Cheshire
Bone-Surgeon.co.uk
Fairfield Independent Hospital
Crank Rd
St Helens
Merseyside WA11 7RS
01744 739311
Spire Cheshire Hospital
Chris Davies
Fir Tree Close
Warrington WA4 4LU
0845 602 2500
Ankle Pain
Ankle pain is usually caused by osteoarthritis. This is where the cartilage covering the ends of your bones gradually roughens and becomes thin, and the bone underneath thickens. It can also be caused by damage from other rheumatic conditions, for example if you have rheumatoid arthritis, or if you’ve had a previous injury to the area.
This leads to pain, swelling and occasional deformity of the joint. You may need surgery if your symptoms are severe.
Osteoarthritis
As you get older or if you had a severe injury in the ankle in the past the development of, osteoarthritis is common.
Inflammatory Arthritis
There are several different forms of inflammatory arthritis which can affect your ankles and feet in different ways.
Rheumatoid Arthritis affects many joints in your feet
Reactive arthritis usually affects your ankle or the area around your heel. It may also affect your toes, causing pain and swelling.
Psoriatic arthritis can also often causes toe inflammation (dactylitis)
Gout most commonly affects your big toe joint but the ankle and some other joint might be also affected. It causes severe inflammation and makes your joint red, hot and swollen during an attack, which typically lasts one to two weeks.
Without treatment, repeated attacks can cause permanent damage to your joint and lead to osteoarthritis.
However, gout can usually be well controlled with medications.
Ankylosing spondylitis mainly affects your spine but may also affect your heels
Apart from problems in your joints, you may have inflammation and discomfort in the tendons and the other soft tissues in your feet.
The part under or behind your heel where the tendons attach to your heel bone (your Achilles tendon) is quite often affected in this way.
How Is Foot and Ankle Osteoarthritis Treated?
Foot and ankle osteoarthritis can be treated in many ways. Nonsurgical methods to treat foot and ankle arthritis include:
Steroid medications injected into the joints
Anti-inflammatory drugs to reduce swelling in the joints
Pain relievers
Pads or arch supports
Canes or braces to support the joints
Inserts that support the ankle and foot (orthotics)
Physical therapy
Custom shoes
Weight control
Exercise can help keep your feet pain-free, strong, and flexible. Exercises that can be good for your feet include:
Achilles stretch. With your palms flat on a wall, lean against the wall and place one foot forward and one foot back. Lean forward, leaving your heels on the floor. You can feel the pull in your Achilles tendon and your calf.
Repeat this exercise three times, holding for 10 seconds on each repeat.
Big-toe stretch. Place a thick rubber band around your big toes. Pull the big toes away from each other and toward the other toes. Hold this position for five seconds and repeat the exercise 10 times.
Toe pull. Place a rubber band around the toes of each foot, and then spread your toes. Hold this position for five seconds and repeat the exercise 10 times.
Toe curl. Pick up marbles with your toes.
Is Surgery an Option for Ankle Osteoarthritis?
Arthroscopy (keyhole surgery) for ankle osteoarthritis allows the surgeon to assess and treat the joint from the inside using a minimally invasive approach. Arthroscopy allows the joint to be tidied up when the arthritic process is not advanced. However, it does not cure the condition or halt the progression of the condition.
We will accesses the ankle through two or three small incisions and uses small instruments to remove loose fragments of bone, cartilage, scar and inflamed tissue. We can also smooth the cartilage surfaces of the joint.
Ankle Arthroscopy Patient Information Leaflet
Where there is severe degeneration, usually due to arthritis or trauma. The operations most commonly undertaken are:
Fusion Surgery
This kind of surgery, also called arthrodesis, involves fusing bones together with the use of rods, pins, screws, or plates. After healing, the bones remain fused together.
This is a long established surgical procedure. It is very effective at eliminating persistent pain by immobilising the painful, worn down joints and creating a single joint structure. Fusion is highly durable and suitable for younger patients who wish to remain active.
There is however some loss of mobility and fusion is only considered for patients who have tried or would not benefit from more conservative treatments.
We offer this procedure to be done through a key hole technique (arthroscopy) or by an open procedure depending on the severity of the pathology.
Joint Replacement Surgery
This kind of surgery involves replacing the ankle joint with artificial implants and is used only in rare cases. Total ankle replacement surgery, known as prosthesis, is a major procedure most commonly performed for patients with advanced ankle osteoarthritis.
The aim of an ankle replacement is to eradicate persistent pain and preserve ankle mobility.
Although hip and knee replacements are commonplace procedures, attempts to deliver the same solution for the ankle have been problematic. Devices have frequently loosened and failed, due to the pressure placed on the ankle.
However the new generation of total ankle replacements integrate much more effectively into the ankle joint with much improved results.
The best results from total ankle replacement have been recorded in older patients, typically aged over 65, because they put their ankles under less stress than a younger person.
Some younger patients have had good results from this type of surgery, but it remains to be seen how long the joint replacement lasts.
A younger or particularly active person may consider an ankle fusion operation as a more appropriate alternative.
When considering ankle replacement surgery, it is also important that there is good movement of the joint and no significant foot deformity.
DOWNLOAD: Ankle Arthroscopy Patient Information leaflet
DOWNLOAD: Ankle Fusion Patient Information leaflet
More Information is available form the BOFAS website