Diagnosis And Treatment Of Ankle Arthritis
Ankle arthritis is nine times less frequent than symptomatic arthritis in the knee and hip.
The ankle joint is the most often damaged joint in the body, and it absorbs the highest force per square cm of any joint.
The most prevalent kind of ankle osteoarthritis is post-traumatic arthritis.
The most recent research on ankle arthritis diagnosis and non-surgical treatments is reviewed, including physical examination, radiographic parameters, sophisticated imaging, and therapeutic methods.
The publication by R Grunfeld and colleagues from Hershey Medical Center in Pennsylvania, USA, provides a review of the most recent evidence to help clinicians diagnose and treat ankle osteoarthritis non-surgically.
Corticosteroid injections into the tibiotalar joint are among the most effective techniques for diagnostic and therapeutic purposes.
It has been discovered that a favorable reaction to an ankle injection predicts an excellent response to surgery.
These injections can be performed in the office without fluoroscopic supervision (Juliano, personal communications) or in the radiology suite with fluoroscopic guidance.
Contrast dye to define the joint may be beneficial in severe osteoarthritis or individuals with full varus or valgus deformities.
Diagnostic injections using viscosupplementation are less well established and remain more contentious.
Ankle arthritis is characterized according to its morphology and underlying etiology.
Regarding anatomy, arthritis can be global (affecting the whole tibiotalar joint) or localized (specific portions of the articular surface are concerned).
The underlying etiology of arthritis may be divided into three categories: post-traumatic, osteoarthritis and rheumatoid arthritis, Charcot arthropathy, hemochromatosis, and degenerative alterations caused by the tumor.
\Radiographic characteristics can be used to define the phases of osteoarthritis:
- Stage 0: Typical joint or subchondral sclerosis
- Stage 1: The presence of osteophytes without restricting the joint space.
- Stage 2: Narrowing of the joint space, with or without osteophytes
- Stage 3: Partial or complete loss or distortion of joint space
The Canadian Orthopaedic Foot and Ankle Society (COFAS) Classification for End-Stage Ankle Arthritis was described recently.
Studies The COFAS classification has strong inter-observer reliability and intra-observer reproducibility.
A post-operative categorization for the COFAS phases was created, with more excellent inter-observer reliability and enhanced dependability.
- Self-management: Activity changes can help early ankle arthritis. Patients can reduce discomfort by avoiding uneven platforms (subtalar arthritis) and uphill treks (anterior ankle arthritis). Weight reduction is essential.
- Physical therapy: Strength training, range of motion exercises, and increasing ankle balance and proprioception are part of ankle arthritis physical therapy. Strength training concentrates on the gastrocnemius, soleus, tibialis anterior, and peroneal muscles. Balance and proprioception exercises are cushions and wobble boards for ankle dorsi and plantarflexion. Hydrotherapy is used when severe pain or obesity hinders land-based workouts.
- Custom shoes: Conservative ankle arthritis treatment includes shoe changes. Rocker bottom shoes with a solid ankle cushioned heel (SACH) normalize gait patterns. The SACH reduces ankle and hindfoot motion during normal locomotion and stair climbing. Offloads ankle joint from heel strike to push-off.
- Orthotics: Mechanical unloading of the joint looks effective. Ankle foot orthoses (AFOs) with ankle or calf lacers can do this. Lace-up ankle support can help individuals with instability or misalignment. Rigid hindfoot orthoses restrict ankle and hindfoot mobility but enable forefoot motion. Shoe inserts can enhance cosmesis and be used in different shoes.
- Braces: Walking plaster or fiberglass short leg casts are also used for ankle arthritis. Plaster or fiberglass casts or CAM boot walkers are other options. Patient desire and financial capabilities can determine these possibilities. Immobilization mimics ankle arthrodesis by allowing mobility at the painful ankle joint. Obese individuals should be counseled on weight loss, which improves the efficacy of both conservative and surgical approaches. Physical therapy, chiropractic, and acupuncture are non-surgical, non-pharmacological treatments. These modalities have few peer-reviewed papers or reviews.
- Non-steroidal anti-inflammatory drugs: Nonsteroidal anti-inflammatory medications are most prevalent for ankle arthritis (NSAIDs). NSAIDs need prudent prescribing and use. GI bleeding, stroke, and cardiovascular risks. Recent recommendations focus on topical NSAIDs for high-risk individuals with localized osteoarthritis. Before starting NSAIDs, all patients must be evaluated for comorbidities. Clinically, NSAID effectiveness varies by patient.
- Corticosteroids: Tibiotalar corticosteroid injections are a final non-surgical alternative once NSAID medication and activity reductions fail. Lidocaine and corticosteroid are injected intra-articularly. FDA-approved drugs in the U.S. include methylprednisone acetate (Depo-Medrol), betamethasone acetate, betamethasone sodium phosphate (Celestone Soluspan), triamcinolone acetate (Kenalog 10/40), triamcinolone hexacetonide (Aristospan), and dexamethasone (dexamethasone sodium phosphate). The injection relieves pain by reducing synovial fluid leukocyte numbers and lysosomal enzymes.
The most recent evidence is reviewed to aid clinicians in diagnosing and non-surgical therapy of ankle osteoarthritis.
More study is needed to determine the efficacy of non-operative methods for individuals with ankle arthritis, such as orthotics, physical therapy, weight loss, and viscosupplementation.
The most frequent symptom of ankle arthritis is pain, although many more. Recognizing these signs can aid in prompt treatment.
Pain may be felt in the lower shin (tibia), the rear of the foot, or the center of the foot.
The pain might be agonizing and dull or severe and intense.
Walking is advised for persons with arthritis since it is low impact, helps to keep joints flexible, improves bone health, and lowers the risk of osteoporosis.
Nonsurgical therapy is the initial option for chronic, severe ankle arthritis pain for most doctors.
Activities that may aggravate your ankle joint are frequently restricted as part of treatment. Your doctor may also advise you to use shoe inserts (orthotics), an ankle brace, or a cane.