Osteoarthritis In The Ankle

Your Ankle May be Unique But It Is Not Immune To Osteoarthritis...

The Short Answer

There Is No Cure For Osteoarthritis. Successful treatment of osteoarthritis in the ankle means catching it quick and stopping or at least dramatically slowing its development.

In this article we review the early signs to look out for, why it develops, how to get it diagnosed and what would most likely happen if you choose to ignore the warning signs.

What Is Osteoarthritis In The Ankle?

Your ankle is one of the most important parts of your body when it comes to maintaining your mobility. Alongside your knees, hips and spine they bear the full load of your weight.

Unfortunately, just like your knees, hips and spine, they are also vulnerable to injury and likely to suffer wearing damage over time.

The ankle itself is perhaps one of the less obvious places for osteoarthritis to start – although people often end up suffering with painful, swollen ankles but don’t necessarily connect it as osteoarthritis.

According to a review in the Bone Research Journal osteoarthritis affects more than 25% of the population over 18 years old – making it the most common degenerative disease.

It should also be noted that while age is a factor, osteoarthritis can affect any adult and that, as understanding of the disease is growing, there are many other factors also involved.

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What Causes Osteoarthritis To Start In Your Ankle?

Osteoarthritis has to some extent baffled experts for generations.

What causes it to begin is somewhat of a mystery.

It used to be considered purely a disease of the cartilage being ‘worn out’. However, modern thinking and further research has shown a much more complex relationship between all parts of the joint. As published in the Annals Of Rheumatic Disease, by Brandt at al, 

“…the aetiology and progression of osteoarthritis should not be thought of as being invariably attributable to a single tissue, such as articular cartilage, but as possibly due to disease in any of the tissues of the affected organ, the diarthrodial joint, including the subchondral bone, synovium, capsule, periarticular muscles, sensory nerve endings and meniscus (if present)”

However, having said that, there are certain factors that are known to be triggers for osteoarthritis to develop in your ankle.

These include –

  • Age
  • Weight
  • History
  • Inflammation
  • Genes

Age…

Age is probably the most common risk factor for developing osteoarthritis in the ankle – not least because while ‘worn out’ cartilage is no longer considered the only cause of osteoarthritis, it is still one of the causes.

In some cases, pure overuse can lead to the cartilage (soft cushioning between your bones) wearing thin leading to bone rubbing on bone and the excruciating pain of fully developed osteoarthritis.

But this is not the only risk of growing old.

A number of studies have shown that as we age our cells start to show ‘oxidative stress’. This typically will damage your cells leading to a reduced capacity for self-repair.

The result then is more brittle bones and a much higher tendency to suffer lasting damage.

In four separate trials, random members of the public over 65 were selected and the majority of them showed some radiographic changes in one of more joints (Bone Research journal).

Weight…

As one of the key weight-bearing components of your body, obesity is a particular risk factor for osteoarthritis in the ankle.

Weight, or specifically being overweight, has long been connected to an increased likelihood of developing osteoarthritis (International Journal of Obesity

People suffering from obesity will typically develop osteoarthritis in the ankle sooner and suffer more severe symptoms as the disease advances much faster.

This is due principally to two key factors –

  • The biomechanical loading (weight) on the ankle is much greater, so any damage is hastened by an increased force crushing damaged bones together.
  • Increased ‘systemic inflammation’ was observed in obese patients (Circulation). This inflammation can actually lead to further damage on the joint and surrounding tissues, before any inflammation caused by the actual disease itself.

Sporting Injury…

Your ankle is one of the areas most prone to sporting injuries.

Although this may have occurred when you were much younger, it can still have a significant impact on the osteoarthritis developing in your ankle.

The most common ankle injuries leading to osteoarthritis in later life include –

  • Dislocating your ankle
  • Severe bruising of your ankle
  • Ligament strains
  • Cartilage tear

All of these injuries are likely to lead to inflammation and the destabilisation of your ankle.

While you may consider yourself to have fully recovered from the injury, you may not fully feel the joint long-term joint damage until later in your life.

Inflammation…

We mentioned the pivotal role that inflammation can have in hastening the development of osteoarthritis in overweight individuals.

However, in individuals that suffer with diabetes or are getting old, some systemic inflammation is also present.

Again, this inflammation not only increases the levels of pain you feel, but also contributes directly to speeding up the progression of osteoarthritis in the ankle – increasing damage to your joint.

Genes…

Family-based studies (including one in the British Medical Journal), have shown a strong predisposition to developing osteoarthritis if your parents or grandparents also suffered with the disease. 

Early Signs Of Osteoarthritis In The Ankle

Key Early Signs To Watch Out For Include –

  • Ankle Pain
  • Stiffness In One Ankle
  • Popping or Crunching Sensation
  • Uneven Walking
  • Ankle Weakness/ Instability
  • Growths/ Bone Spurs On The Ankle
  • More Pain Following Inactivity
  • Warmth/ Burning In The Ankle

Ankle Pain.

The pain may also radiate around your lower shin, or your foot.

There is no guarantee as to whether the pain will be dull and aching or sharp and infrequent.

Most often, it will be a combination of the two – a low level chronic pain, followed by much more intense stabbing outbursts.

It is likely in the very early stages, that you may only feel pain when out jogging or going for long walk.

This could easily be alleviated with basic elevation and an ankle compress.

But DON’T DISMISS IT. Catching osteoarthritis in the ankle early is essential. With no cure, treatment will successfully delay it giving you potentially many more years of activity. The greatest tragedy is to ignore it, until the disease has progressed and slowing it is much harder.

Stiffness In The Ankle When You Wake Up

Two key questions here – is it just one ankle affected or are both stiff and does the stiffness wear off quite easily in the first 15 minutes after waking up?

If both ankles seem to feel the same and the stiffness lasts a long time, then the chances are it is rheumatoid arthritis and not osteoarthritis that is causing you problems.

Osteoarthritis typically affects each joint differently, including on different sides. You also normally find that the stiffness after sitting/ sleeping wears off quite quickly.

With rheumatoid arthritis it generally takes at least 30 minutes to loosen up.

Either way, you still need to get to a doctor to get any suspicions confirmed or otherwise.

Rheumatoid arthritis is quite different in mode of action to osteoarthritis and so it fits that some of the treatments are different too.

Popping or Crunching Sensations

These are sure signs that something is not right. If you move your foot from side to side or try to point your toes forward and hear this noise, action immediately is a must.

The sounds/ sensations are a very strong sign that you know have bone rubbing against bone in your foot. The clinical term is ‘crepitus’.

The practical reality is it will feel ‘crunchy’. You will probably already be in pain by now. If not, you soon will be.

Uneven Walking

Because osteoarthritis does not attack both ankles, or even one ankle, in an even manner, it is quite common for you to unconsciously adjust your walking style to compensate. Your ‘gait’ as it is known, is your walking pattern.

By scanning your gait, professionals can tell if you unconsciously built in and unbalanced stride to compensate for the damaged ankle.

This can be a real problem, because if not picked up and rectified quickly, it can lead to further development of osteoarthritis in your foot, knee, hip or even back – as it is all being pushed out of line.

Ankle Weakness

Walking with osteoarthritis in the ankle may sometimes cause you ankle to buckle or turn.

Women should avoid high heels at all costs if you have even the slightest suspicion that you have early onset osteoarthritis.

The problem can be made better with really supportive footwear. We will be reviewing the best footwear for osteoarthritis soon.

Bone Spurs

Also known as ‘osteophytes’, these are bony lumps that grow around joints frequently affected by osteoarthritis.

They are likely to be accompanied by inflammation and pain.

Bone spurs are rarely the first sign of osteoarthritis, but are often the first visible sign, even if you have a high pain tolerance and have been ignoring the other signs.

Increased Pain following Inactivity

Another key sign of sign osteoarthritis is that it often actually worse following rest or inactivity. Rest traditionally makes muscular pain such as back sprains feel better.

In the case of osteoarthritis, a period of rest is only likely to lead to stiffness and even more pain when you do try to get mobile.

Light regular exercise/ activity is the best option. This is principally with the aim of keeping your ankle loose and mobile.

How Is It Diagnosed?

1. A review of your current symptoms to see if they match with osteoarthritis

2. A Discussion Around Your Family History to see if you have a history and therefore any potential genetic disposition to osteoarthritis

3. A Full Physical Examination to establish which joints may be affected and how badly

4. Diagnostic Tests. They are likely to start with ‘joint aspiration’ (drawing fluid from the affected joint) to test for inflammation and to rule out other forms of arthritis such as gout that leave crystals present or an infection.

This will then be followed up with X-Rays and even an MRI scan in moe complex cases where the damage or narrowing of the gaps between your bones, is not obvious with an x-ray.
For a much more detailed view on the diagnosis of osteoarthritis check out our article ‘What is osteoarthritis’.

Why You Mustn’t Ignore The Early Signs…

Once osteoarthritis progresses, it is not possible to turn back the clock. Knowing you have osteoarthritis is a big benefit because you can start fighting it.

Every day that goes by while you put up with the pain is only going to lead to faster erosion and the point at which you can no longer take part in the activities you enjoy the most will come much sooner.

Getting osteoarthritis in the ankle can lead to people ending up in a wheelchair for the rest of their lives. Even those lucky enough to have the option of ankle replacement, still need to have healthy bones around the ankle to fix to.

Playing the hero and grinning through the pain only leads to ignorance as it could be an infection that spreads and may even be fatal (in extreme cases).

Of course normally it will be osteoarthritis, and smaller changes in the early stages avoid massive changes having to be made in late stage osteoarthritis.

The Final Word –

I cannot emphasize just how important it is to get osteoarthritis diagnosed early and start making small adjustments when they will have the greatest impact.

This is particularly true in your ankle and in your knees. They probably have the greatest impact on your immediate mobility.

If you understand the symptoms you may even be able to recognise them in someone else and help them out.

The trouble is there is always a tendency to assume ankle pain is just a ‘tweak’ or a mild ‘twist’ and put up with the pain for weeks, even months – without getting it checked out.

This is possibly the worst thing you can do. If you think you even ‘just might’ have mild osteoarthritis in the ankle, get it checked, get it diagnosed and get it treated. Then read more about Treatments for osteoarthritis in the ankle.

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References Used –

1. Di Chen, Jie Shen, Weiwei Zhao, Tingyu Wang, Lin Han, John L Hamilton, and Hee-Jeong Im. (Jan 2017). Osteoarthritis: toward a comprehensive understanding of pathological mechanism. Bone Research.
2. K D Brandt, E L Radin, P A Dieppe, and L van de Putte. (Oct 2006). Yet more evidence that osteoarthritis is not a cartilage disease. Annals of the Rheumatic Diseases.
3. A Anandacoomarasamy, I Caterson, P Sambrook, M Fransen & L March. (Sept 2007). The impact of obesity on the musculoskeletal system. International Journal of Obesity.
4. Vol 116. No.11. Visceral and Subcutaneous Adipose Tissue Volumes Are Cross-Sectionally Related to Markers of Inflammation and Oxidative Stress. Circulation.
5. Tim D Spector, Flavia Cicuttini, Juliet Baker, John Loughlin, Deborah Hart. (April 1996). Genetic influences on osteoarthritis in women: a twin study. The British Medical Journal.

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