Treating Osteoarthritis In The Ankle

Understand It's Construction, Understand How To Build It Back Up...

The Short Answer

Your Ankle Takes More Weight Than Any Almost Any Joint In Your Body. Finding The Right Treatment For Osteoarthritis In The Ankle Is A Delicate Balance Between Maintaining Mobility And Not Damaging Your Cartilage Further.

In Our Article Below, We Review The Options Available To You And Advise On What To Look For To Get The Best Chance Of Successful Treatment.

Finding The Right Solution For You…

Finding the right treatment for osteoarthritis in the ankle can be a tricky task. Your ankle (along with your elbow) are the two most likely joints to develop osteoarthritis as a result of injury.

The means the typical age for you to develop it is younger than in your hips for example, where age is a much dominant cause, with injury much less likely.

This then brings complications because any treatment plan is now about trying to manage your symptoms for 30-50 years instead of maybe 10-20 years. Surgery, for example, has to be re-thought because an ankle replacement will only last 15-20 years and repeated replacements carry much higher risk of failure.

The younger you are, the more important your ankle’s mobility will be to maintaining an active, fulfilled life. This means fusion (another surgical option) is also far from a good option.

Then you have the impact of taking pain medications over a prolonged period of time. In the past, little attention was given to the long-term impact of taking any tablets for life. Now however, the dangers of taking common treatments like ibuprofen are much more publicised.

Again, if you develop ankle osteoarthritis in middle age (40-60), then managing it with regular painkillers is also not an optimal route, with many risks including liver damage, heart attacks or strokes.

You need then to look for ‘cleaner’ forms of symptom management. Whether that be through hypnosis, supportive equipment or specially deigned insoles, depends on what works for you.

Tragically, osteoarthritis has no cure.

Getting an early diagnosis is key, because the quicker you can start taking preventative action, the better the results are likely to be.

Finding successful treatment for osteoarthritis in the ankle relies on achieving 3 key goals

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  • Maintaining mobility
  • Reducing pain
  • Stopping it from getting worse (advancing to later-stage osteoarthritis). This is done principally by making the ankle strong and stable.

1. Self-Administered Treatments

Supportive Aids.

When treating ankle osteoarthritis, supportive aids are particularly beneficial. Indeed, they are frequently considered as a first line treatment for ankle osteoarthritis (Journal of Arthritis). 

These aids fall into two basic categories…

  • Walking Aids
  • Ankle Braces

Walking Aids.

This involves the use of either a walking stick/ cane or crutches. The goal is to reduce the weight / force that you have to put on your affected ankle.

In a study first published in The Archives of Physical Medicine and Rehabilitation, measured the weight deflection of various walking aids and concluded that while a walking cane could only offload your weight by 25%, a forearm reliant crutch could actually achieve as much as a 56% reduction. 

Ankle Braces.

A really good quality ankle brace should provide support that spreads your weight across your foot and lower leg. A poorly designed brace will do nothing but provide a warm bandage that offers no support at all.

In order to achieve good support, you need a stiff spine in the support with comfortable, non-slipping straps below and above to successfully transfer the force.

Your ankle mobility will be reduced to some extent by wearing a brace – but it has to be in order to cushion it from the weight transfer.

One solution is a form of ‘half-boot’ that provides a strong spine to support your anke.

Specialistic Orthotics.

These are specially designed insoles or fully integrated shoes that alter the way your foot transfers weight when it contacts the floor.

To give you an example – if you wear high healed shoes, your weight is driven through your heel. A custom insole though can actually rebalance your foot, causing your weight to land in different places.

The idea with ankle arthritis is to take the bulk or the force of your foot landing away from your ankle or provide spring cushioning to soften the initial crunch.

Orthotics fall into one of 3 categories –

  • Functional Orthotics. These are used to correct an abnormality in the ankle.
  • Accommodative Orthotics. These are designed to achieve pain relief because re-adjusting the foot is not possible.
  • Ankle Foot Orthotics. These are worn on the lower leg/ foot to support the ankle. They are more likely to be used in late stage osteoarthritis, where the other options are not feasible.

Hot And Cold Therapy.

Hot and cold therapy is a great way of providing temporary pain relief or comfort.

Applying a heat wrap to your ankle will soothe the muscles around it, offering greater flexibility, a sense of relaxation and temporary pain relief.

If your osteoarthritis is causing your ankle to swell, then applying an ice wrap beforehand can also help greatly to reduce the swelling.

One option for both is just to use the old-fashioned bag of frozen peas or even a gel pack, but you do need to cover the entire ankle, otherwise it’s impact will be greatly reduced.

Hypnosis or Self Hypnosis.

Giving up smoking and losing weight are two of the hardest addictions to break, but hypnosis has proven to be a very powerful tool in achieving both.

Now, increasing trials and data is emerging about the use of hypnosis to control pain. The brain ultimately transmits all pain and if you alter the way in which your mind treats these pain signals, then you will suffer with less pain.

You need only understand the placebo effect (The Placebo And Pain Relief) to know that if your brain can be made to believe it is being treated, it will actually respond as if it is. This is now a universally accepted effect in medical circles and one that could help you greatly.

Aromatherapy.

Another proven pain reliever that doesn’t get the attention that it perhaps deserves is aromatherapy.

Aromatherapy has actually been trialled in hospitals (Lavender Essential Oil For Arthritis) with intensive care patients and found to be highly effective in improving patients sleep levels through a reduction in pain.

There are of course numerous essential oils used in aromatherapy and not all of them are any use at all. But lavender oil has one of the strongest batches of clinical evidence behind it’s use.

Cognitive Behavioural Therapy.

CBT is really about achieving the most from what you have. It is, in essence, a decision-making process that aligns your emotions with your thoughts to create achievement.

In reality, this means seeing the huge obstacles that ankle osteoarthritis provides and working out routes around them through a series of small tasks that seem much more achievable than the one massive obstacle.

This can be used as a treatment for osteoarthritis of the ankle if you have certain activities that you can no longer complete. This may be a sporting or leisure activity that has become seemingly impossible thanks to your ankle pain.

By planning to tackle the pain, build up strength in your ankle and increase it’s mobility, you can over months re-achieve most things. When you write down a plan over months and work towards it, your emotions will change and this will ultimately make it happen.

Supplements.

Some supplements such as CBD oil or curcumin will have some potential effect on your pain levels.

Fish Oil.

Fish oil is believed to offer lubrication to your joints. Whether it will help your ankle osteoarthritis depends on what stage you are at.

If you are at an early stage, then it may help to provide padding to damaged cartilage and therefore increase mobility while decreasing the pain.

However, if your osteoarthritis has already progressed to the stage that your ankles are painfully swollen, then the chances are you already have a fluid build-up.

In this case, your best option would actually be to have some fluid withdrawn – not added to.

2. Physiotherapy

A good physiotherapist will work hard to manipulate and massage your mobility back too your ankle. They will also give you some exercises to do to build up strength both in your ankle and in the surrounding tissues/ muscles/ ligaments/ tendons.

3. Occupational Therapy

Occupational therapists come out to your home to assess which activities have been curtailed or stopped by your ankle pain.

They will take a very practical view to achieving specific challenges. This could include offering advice on assistive equipment (similar to what we’ve given above), amendments that you could make to your home and discussing your problems with you.

4. Lifestyle Changes

Lose Weight.

Your ankle is obviously a weight bearing joint. In actual fact, it is the one joint that takes your full bodyweight every time you step (your knee takes almost all your weight, but not all).

It is effectively your bodies own shock absorber. As a result, any weight loss can make a disproportionate effect on the level of force being planted on sore ankles (LINK)

There are also two other key advantages to losing weight as a treatment for osteoarthritis of the ankle –

  • Reduced inflammation because overweight people statistically have a tendency towards much more inflammation
  • Lack of other swelling because the heavier you are, the more likely you are to suffer swollen ankles (oedema). This fluid retention will make an ankle already suffering with osteoarthritis, significantly more painful.

Exercise.

Not all exercise is helpful though – it needs to be either strength training or non-impact bearing.

Non-impact activities include cycling, water aerobics or aqua therapy, yoga and tai chi.

Strength training would include lifting weights with your feet or a range of strength focused exercises that your physio can demonstrate.

Even though osteoarthritis is based around the concept of bones bearing worn away, it is vital to keep the affected joints mobile. This will reduce inflammation and stop your joint becoming even stiffer than it already is.

5. Medications

Over-The Counter Medications

Traditional 1st line therapy for arthritis pain relief is always acetaminophen or paracetamol.

These should provide basic pain relief, and can be taken daily if needed.

The next alternative is to try some of the over the counter NSAIDs (non steroidal anti inflammatory drugs). These include Ibuprofen and Naproxen.

These will typically provide a greater level of pain relief by reducing the inflammation in your ankle. However, they should only be used as a ‘rescue medication’ when your pain spikes – not as a daily treatment.

Especially don’t use these if you have any history of cardiological problems (strokes/ heart attacks) or are diabetic. Always consult your doctor before starting a new regime – these drugs in particular have some potentially fatal side effects if not taken safely with clinical guidance.

Prescribed Drugs.

If standard NSAIDs do not work, then your doctor could choose to try a different, stronger class of NSAIDs known as Cox2inhibitors.

6. Injections

In the case of your ankle, there are 3 basic options for pain relieving injections –

  • Steroid injections
  • Hyaluronic Acid injections
  • Platelet Rich Plasma Injections (PRP)

Steroid Injections

Steroid injections are by far the most common pain relieving injections. Corticosteroid such as cortisone is injected to reduce inflammation and pain, potentially increasing your ankles mobility.

The downside is they are quite short-term in their impact.

Due to concerns over the potential long-term damage of steroids on your joint, they are often limited to 2-3 maximum per year (depending on your country).

Hyaluronic Acid

Hyaluronic acid injections are designed to re-lubricate your ankle joint, by replacing lost synovial fluid. This is only really effective in early-middle stage ankle osteoarthritis and providing you don’t suffer with swollen ankles already.

The theory is that the extra hyaluronic acid will prevent your bones from rubbing together and therefore provide symptom relief.

Current research suggests this pain relief may last longer than a steroid injection (Surgical Technology International

Platelet Rich Plasma Injections

Platelet rich plasma injections work on the basis of taking some of your own blood, increasing the concentration of platelets and injecting back into the damaged joint.

The theory is that by doing so, the increased platelet count promotes healing in the ankle. Even if it cant reverse the effect of the osteoarthritis, it can at least heal some of the surrounding joint matrix (muscles, tendons and ligaments).

Research by Fukawa et al in the Foot & Ankle International journal concluded that PRP had…

“…significantly reduced pain in the patients with ankle OA”

Stem Cell Injections.

I did not include this option above because it is very new and somewhat controversial. The idea again is to encourage healing – but this time by collecting stem cells (from your fat tissue, bone marrow ro blood) and injecting them in your ankle.

The hope is that the stem cells will generate into cartilage cells in the ankle. These injections have become a very controversial subject though – not least because there is very little research into whether this could be an effective treatment for osteoarthritis in the ankle, or not.

7. Ankle Surgery

A foot and ankle surgeon will have 5 basic options for surgery, principally only carried out if nothing else has worked. These are..

  • Debridement
  • Arthrodiastasis
  • Cartilage Transplant
  • Fusion
  • Replacement

Ankle Debridement.

The goal of this surgery is to remove any inflamed tissue, trim away any rough jagged cartilage or bone spurs and take out any loose, floating bits of bone in your ankle.

This is normally the best solution if your pain is largely driven by the growth of bone spurs in your ankle. As noted in Orthopaedic Proceedings (Hassouna et al), 

“osteoarthritic ankles have a less favoured prognosis, with a high proportion requiring further major surgery.”

Ankle Arthrodiastasis.

This operation involves stretching out your ankle, increasing the space between the talus and tibia bones. The ‘stretch’ is held in place by metal screws for up to 3 months.

The hope is that while your ankle is held open by metal, your cartilage will get a rest and might start to repair itself, as it won’t be needed for padding.

Although the clinical data behind ankle arthrodiastasis is quite good, it is rarely carried out.

Cartilage Transplant.

If your pain is caused by a deformity in your ankle’s cartilage then new cartilage could in theory be grafted into the gap.

This only really works for a chip or dent in your cartilage, since if there is a smooth surface, there will be nothing to grip on to.

This type of surgery is very new, with the added cartilage typically being taken from somebody who is recently deceased.

Ankle Fusion (aka Arthroplasty).

This procedure involves joining or fusing several bones in your ankle joint together.

The good part is that it will increase your ankle’s stability and reduce the pain – the downside is it reduce your mobility, which will put more pressure on your knees and feet (potentially causing them to develop osteoarthritis in the long run).

Ankle Replacement.

This is a full replacement of your joint with a prosthetic one. Ankle replacement is a very tricky surgery with a lower than average success rate due to your ankle’s unique structure.

Other problems with replacement surgery include your age, because they are only forecast to last approx. 15-20 years. This is a big improvement on 20 years ago, but still means if you are young, replacements are far from ideal as they too will be expected to wear out.

The Final Word –

If you are suffering with ankle osteoarthritis, then the key is how you manage it. Good treatment of osteoarthritis in the ankle involves a heavy reliance on supportive aids with help from some self-driven therapies and lifestyle changes.

Waiting for painkilling injections or surgery is far from the best idea and will leave you in considerable pain and further advance osteoarthritis.

Furthermore, late stage treatments such as injections or surgery are only really appropriate when you are 60+ and, given how many younger people develop ankle osteoarthritis, this may not be you.

Hopefully, the commentary above has given you some food for thought. The real key is (as with all osteoarthritis) is to recognise the early signs (‘Osteoarthritis In The Ankle), get an early diagnosis and put a management plan in place.

Using the treatments above, this should not be too difficult.

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References Used –

1. Michael Greaser and John Kent Ellington. (2014). Ankle Arthritis. Journal of Arthritis.
2. James W Youdas, Brian J Kotajarvi, Denny J Padgett, Kenton R Kaufman. (Mar 2005). Partial Weight-Bearing Gait Using Conventional Assistive Devices. The Archives of Physical Medicine and Rehabilitation
3. Khlopas H, Khlopas A, Samuel LT, Ohliger E, Sultan AA, Chughtai M, Mont MA. (June 2019). Current Concepts in Osteoarthritis of the Ankle: Review. Surgical Technology International.
4. Fukawa T, Yamaguchi S, Akatsu Y, Yamamoto Y, Akagi R, Sasho T. (June 2017). Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With Ankle Osteoarthritis. Foot & Ankle International.
5. HZ Hassouna and SP Bendall. (Feb 2018). Arthroscopic Ankle Debridement: 5 Year Survival Analysis. Orthopaedic Proceedings.

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