ANKLE ARTHRITIS TREATMENT – MELBOURNE

Mr Troy Keith

ANKLE ARTHRITIS TREATMENTS – A Patient’s Guide:

Mr Troy Keith MBBS (Hons), FRACS (Orth), FAOrthA
Orthopaedic Foot and Ankle Surgeon

PATIENT CARE PROCESS – MR. TROY KEITH
Learn more about Mr Keith’s approach to your care:

FIRST APPOINTMENT

GP/Specialist referral

Patient consultation & assessment

Additional testing if required

TREATMENT PLAN
(Non-operative)

Pain management

Moon boot, bracing

Physiotherapy

Exercise / Nutrition

OPERATIVE  TREATMENT
(If necessary)

Surgical process

Hospital administration

Surgery preparation – What do you need

POST OPERATIVE CARE

Early weight bearing

Pain management

Rehabilitation

Follow up appointments

YOUR ANKLE JOINT

The ankle joint is a hinge joint that connects your foot to your lower leg. The ankle joint is where your shin bone (tibia), calf bone (fibula) and talus bone meet. It allows up and down movement.

Below the ankle is the subtalar joint (the “under ankle” joint). The subtalar joint, between the talus and heel bone (calcaneus) allows side to side movement when you walk on uneven ground.

Your ankle also contains cartilage, ligaments, muscles, nerves and blood vessels. Your ankle has to bear 5 to 7 times your body weight during daily activities, such as standing and walking.

Ankle Joint

WHAT IS ANKLE ARTHRITIS?

The major types of arthritis that affect the foot and ankle are osteoarthritis, post-traumatic arthritis and rheumatoid arthritis.

Osteoarthritis – The cartilage (the strong, flexible connective tissue that protects your joints and bones) in the joint gradually wears away. As the cartilage wears away, it becomes frayed and rough, and the protective space between the bones decreases. This can result in bone rubbing on bone, which is painful. Osteoarthritis develops slowly, causing pain and stiffness that worsen over time.

Post-traumatic arthritis is usually secondary to damage to the joint, for example as a result of previous fracture, repeated sprains of the ankle, malalignment of the joint or infection.

Rheumatoid arthritis (including ankylosing spondylitis and psoriatic arthritis) are an autoimmune disease. This means that the immune system attacks the synovium covering the joint, causing it to swell. Over time, the synovium invades and damages the bone and cartilage, as well as ligaments and tendons, and may cause serious joint deformity and disability.

Other factors that can lead to arthritis include:

  • Family history of the disease

  • Excess body weight can overload the ankle joint or worsen the symptoms of arthritis

  • Leg/ankle alignment – Anything which changes the leg or ankle alignment will alter the way the ankle is loaded and cause it to wear unevenly and more quickly (bow legs, knock knees or inverted ankles).

Mr Troy Keith

WHO IS PRONE TO ANKLE ARTHRITIS?

Anyone can get ankle arthritis. Osteoarthritis (degeneration or wear and tear) tends to become more common as we get older. Ankle trauma including fractures, repeated sprains, and inflammatory arthritis can cause arthritis at a younger age.

WHAT ARE THE SYMPTOMS OF ANKLE ARTHRITIS?

Pain – Ankle pain is the most common symptom and is usually made worse by walking.

Joint stiffness – With osteoarthritis, ankle joint stiffness or reduced movement is common. With rheumatoid arthritis, also called inflammatory arthritis, stiffness often is worse first thing in the morning.

Cracking/popping/locking – There may be little pieces of loose cartilage or bone caught within the joint causing this sensation.

Ankle weakness or giving way – This may be due to looseness of the ligaments, or secondary due to to pain. 

Swelling – Swelling may be as a result of extra bone, or fluid within the joint. The soft tissues around your ankle can also inflame and swell.

Mr Troy Keith

ANKLE ARTHRITIS DIAGNOSIS

Mr Troy Keith – MBBS (Hons), FRACS (Orth), FAOrthA
Orthopaedic Foot and Ankle Surgeon.

Depending on your situation, an x-ray of your ankle taken whilst you are standing may reveal ankle arthritis.

Special tests can help determine the extent of the arthritis, or exactly which joint in your ankle is involved including:

MRI – Can help determine the thickness of the cartilage lining the joint, and whether there are small areas of wear and loose cartilage.

CT and bone scans may also be used to investigate ankle arthritis.

An arthroscopic operation may also be performed, which allows your surgeon to see the amount of wear within the joint. An arthroscopy can sometimes be used to clean out the joint, and help in the treatment of arthritis.

Mr Troy Keith

ANKLE ARTHRITIS TREATMENT MELBOURNE

With any form of arthritis there are two forms of treatment. The first is without an operation (non-operative), and the second is with surgery (operative). Most arthritis can be treated without surgery, and only in severe arthritis cases should surgery be considered.

ANKLE ARTHRITIS – NON-OPERATIVE TREATMENTS

Modifying the way, you lead your life should be tried first. This may include:

  • Resting more when the pain increases

  • Weight loss

  • Supportive walking boots and walking sticks

  • Splints or braces

  • Low impact activity – swimming, cycling etc.

  • Pain killers such as Paracetamol or Panadol Osteo

  • Anti-inflammatories (NSAID), such as Nurofen and Diclofenac can also reduce inflammation.

Check with your general practitioner or pharmacist that NSAID’s are suitable for you, as they may have side effects, especially if you have asthma, or stomach ulcers.

For many people pain from arthritis can be eased through using an ankle brace and or a high topped, lace up walking boot with a cushioned sole. Elasticized boots commonly don’t provide a great amount of support.

Dietary supplementation with Chondroitin and Glucosamine, which can be bought in health food shops, may be effective in some patents with early symptoms of ankle arthritis. Hydrotherapy can be very helpful with pain and stiffness.

Patents with inflammatory arthritis are usually looked after by a Rheumatologist. Disease modifying ant-rheumatoid drugs (DMARD’s) are used to treat these conditions, in conjunction with painkillers and NSAID’s.

ANKLE ARTHRITIS – OPERATIVE TREATMENTS

Operative treatments for ankle arthritis include, arthroscopic debridement, ankle joint fusion and total ankle replacement. Access the buttons below to find out more:

1. ARTHROSCOPIC DEBRIDEMENT 

Arthroscopic surgery (keyhole surgery) can “cleaning out” the ankle. Under anaesthetic, an arthroscope is inserted into the joint through 2 small incisions on the front of the ankle. The ankle is washed out with fluid and the loose bits of ‘gristle’ and bone are removed. If there are any bony spurs which block movement, these can be removed at the same time.

This does not reverse the damage done to the cartilage. Pain and stiffness may decrease for an unspecified period of time. If the symptom relief is worthwhile the arthroscopy can be repeated. Please visit ankle Arthroscopy Information page for further detals.

The complications from arthroscopic surgery may include:

Failure of the pain to resolve – Approximately two thirds of people obtain significant benefit from the surgery, but in one third the symptoms are largely unaltered, or deteriorate as a result of progression of the arthritis.

Infection – This is rare, with significant infection occurring in less than 1 in 1,000.

Wound healing problems – In rare cases the arthroscopy ports can be slow to heal.

Nerve damage – Nerves in the skin can become entrapped in the scars where the arthroscope is inserted, leading to a numb area overlying the skin.

Most problems can be treated by medications, therapy and on occasion by further surgery, but even allowing for these, sometimes a poor result ensues.

2. ANKLE JOINT FUSION

Fusion of the ankle to treat arthritis is a “tried and tested” treatment for severe ankle arthritis.

The joint surface is removed and the joint is made permanently stiff, fixed with screws, allowing bone to heal across the joint. The medical term for fusing a joint is “arthrodesis.”

Fusion of the ankle is successful in 96% of cases. The pain is much reduced as there is no joint remaining. There is no ‘up and down’ movement at the ankle after a successful fusion. However, approximately 30% ‘up and down’ movement of the foot actually comes from movement at other joints in the foot, and this remains.

How is ankle fusion surgery performed?

Ankle fusion surgery can be done through key hole surgery using an ‘arthroscope’ to see into the joint. Cartilage is removed from both sides of the ankle using a burr. This creates two raw bone surfaces which are then fused together using screws under x-ray guidance.

In some cases it is only possible to correct severe ankle deformity using an open technique, and extra bone may be required at the fusion site.

As with any open procedure, there is the potential for surgical incision and wound healing problems.

Ankle Arthritis Treatment Melbourne

Advantages of this approach

The advantage of this operation is that the incisions are much smaller, and the pain is not usually as severe. Patents will spend 12 weeks in a cast, and are allowed to walk on the foot after 2 weeks in their cast with a post-operative shoe.

Alternatively, fusion can also be done with an open incision. Normally it is also only possible to correct severe deformity using an open technique. Occasionally extra bone is needed at the fusion site. This can be taken usually through the same incision. As with any large open procedure, there is the potential for wound healing problems.

3. TOTAL ANKLE REPLACEMENT 

An ankle replacement is not an operation for the young, athletic patient to return to “normality”, it is a powerful technique to be used on selected patents. Mr Keith will advise you about your suitability. Patents who are more suitable for an ankle replacement tend to be older with lower functional demands.

The main object of this surgery is to relieve pain. It will restore the same movement back to the ankle, and walking may improve; but only as a consequence of pain relief.

The principle of the operation is to remove the worn out joint and replace it with a metal surface on both the tibial (top) and talar (bottom) sides with a plastic liner sandwiched between them (middle).

The metal surfaces encourage bone to grow onto their surface creating solid fixation with the surrounding bone. The plastic liner in between is flat on one side and curved on the other. This allows the up and down movement of the ankle.

Other suitable patients may include those with arthritis involving both ankles and patents with rheumatoid arthritis. Rheumatoid patients often have other joints damaged by arthritis in their feet which may not stand up to the stresses that can follow a fusion operation.

Total ankle replacement may not improve your range of ankle movement after surgery. Long term results for ankle replacements are not as good as those for hip or knee replacements.

The success of ankle replacements for relieving pain is about 80-90%. With approximately 80-90% of total ankle replacements surviving to 10 years.

POST-OPERATIVE CARE

After ankle joint fusion or a total ankle replacement operation you will go into a plaster splint and remain non weight bearing until your 2 week review with Mr Keith. You will then have a below knee cast fitted and allowed to commence weight bearing in the cast. A repeat x-ray is taken at your 6 and 12 week reviews to confirm the joint is fusing. The plaster cast is finally removed at 12 weeks and you are able to weight bear as tolerated.

Following removal of the cast, a compression or flight sock maybe helpful to reduce swelling. It will be at least 6 months until the benefits of surgery become apparent.

In the longer term, walking and golf are possible, but only the occasional person will be able to jog. You may walk with a limp, but this is usually less marked than it was before surgery, as a result of the reduced pain.

Following surgery, there will be limitation of the height of the heel that you can wear (usually less than 3cm). Some will find wearing a shoe with a curved “rocker bottom” sole will help walking.

POTENTIAL COMPLICATIONS

The complications of an ankle fusion or replacement may include:

Most problems may be treated by medications or in special circumstances further surgery but even allowing for these, sometimes a poor result ensues.

  • Infection and wound healing problems

  • Failure of the bones to heal (non-union)

  • The bones not healing in the correct position (malunion) – This can usually be rectified by a second operation.

  • Screw removal – Prominent metalware may require the screws to be removed as a day case procedure.

  • Blood clots

  • Nerve and blood vessel damage – This may lead to numbness, pain or weakness in the foot.

  • Long term complications – Arthritis (after 10 years) can develop in adjacent joints in the foot, as a result of stress placed on it by the absence of the ankle joint.

  • Fracture of the ankle – In rare instances the bones around the ankle fracture at the time of the surgery. This is treated by the insertion of extra screws during the surgical procedure.

  • Wearing out of the bearing – This occurs over several years, and is the usual cause of failure after 10 years or more. It can be treated by either replacement of the plastic bearing, or total revision of the replacement.

  • Dislocation – This is rare with ankle replacement.

  • Failure of pain to resolve – This is usually due to one of the complications, but occasionally no cause is found.

Most problems may be treated by medications or in special circumstances further surgery but even allowing for these, sometimes a poor result ensues.

A Message from Mr Keith

These guidelines are intended to help you understand your treatment and prepare for your operation.

I understand the level of detail may cause concern or worry for some patients.

If you do have further questions, please don’t hesitate to ask me at your consultation or contact a member of my team.

We will happily address your concerns.

It is important for me that you feel comfortable and satisfied you have all the information you need before your surgery day.

 Mr Troy Keith – Orthopaedic Foot & Ankle Surgeon.

Any questions please email

 Ankle Arthritis Treatment Melbourne:
Mr Troy Keith – Foot & Ankle Surgeon

If you have any questions or would like to make an appointment, please feel free to contact my team:

VISIT CONTACT INFORMATION

Ankle Arthritis Treatment Melbourne

Mr Keith sees patients from all over Melbourne to diagnose and treat ankle arthritis. Mr Keith consults with patients from the following practice locations in Melbourne including Armadale, Heildelberg and Shepparton in country Victoria.

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