4 minute read
Ankle Arthritis
By Dr. Michael M. Cohen, DPM, FACFAS
Most people with ankle arthritis have a history of an injury. This would include a fracture, an acute sprain or series of sprains. Studies indicate that arthritic changes may develop anywhere from 10 to 34 years after an injury. Other causes include rheumatoid arthritis, genetic predisposition, and side effects related to oral and injectable medication such as steroids. The condition can result in significant pain and disability.
How is it treated?
There are many solutions for ankle arthritis depending on the severity of the disease. Oral steroid or nonsteroidal anti-inflammatories (Alleve, Advil) may be used if needed with the understanding that these drugs are not innocuous and have side effects. Historically physicians will inject a combination of local anesthetic and steroid into the joint to break the pain cycle and provide long-lasting anti-inflammatory effects. Frequent injection of steroid has the potential to accelerate arthritis and must be used cautiously.
Recent technology has provided safer and perhaps more beneficial options which appear to be promising for arthritis. In 2008, I coauthored an FDA approved pilot study in a well-known orthopedic journal which examined the success of an injectable compound called hyaluronic acid (Hyalgan) otherwise known as viscosupplementation in the ankle. The compound is derived from rooster combs and has anti-inflammatory effects while acting as a joint lubricant. We discovered that patients had improved symptoms based on the degree of arthritis but its effects unfortunately did not last as long as the knee.
Other injectable options include PRP or platelet rich plasma and stem cell injections which have been shown to also provide considerable benefit -at least comparable to viscosupplementation. The treatment has recently gained traction in the science of tissue repair and is now becoming part of a practitioner’s standard practice. Nutritional supplements such as glucosamine chondroitin compounds have received favorable reviews from respected medical journals; one study indicated that their use directly after an acute injury accelerated cartilage healing.
More advanced ankle arthritis may require the aid of bracing and shoe modifications although this may not be the desired treatment option for active patients or patients who are not candidates for surgery.
Treatment for late-stage ankle arthritis has otherwise been traditionally attended to surgically with fusion where worn-out joint surfaces are removed and held together with metal implants to create a stiff and painless joint. Fusion (otherwise known as arthrodesis) has been proven to be very successful in relieving pain and is a permanent solution to painful advanced ankle arthritis. Its shortcomings include a tendency to develop arthritis in the adjacent joints of the foot but has a high satisfaction rate. Finally, total ankle replacement is a technique which replaces the ankle with an artificial joint and also has a high satisfaction rate. The purpose and benefits of a total ankle replacement is to relieve pain and regain most of the ankle’s normal function. By doing so it restores a near normal gait. It is not designed to withstand running or activities requiring impact. The ideal patient for a total ankle replacement is an individual who has little to no malalignment of the ankle, good pulses and sensation, and a near normal body mass index. Poorly controlled diabetics, patients with significant malalignment, sensory neuropathy, peripheral vascular disease are generally not good candidates. Ankle replacements have an average life span of 10-15 years at which time they may be revised or converted to a fusion. Likewise, a fusion in some instances may be converted to a total ankle replacement.
Ankle arthritis continues to be a challenging condition for the foot and ankle specialist, yet we are very fortunate as recent technological advances have greatly improved our ability to successfully treat the condition.
Before and After Total Ankle Replacement Surgery
▸Michael M Cohen, DPM, is a Board-Certified Foot and Ankle Surgeon and Diplomate of the
American Board of Foot and Ankle Surgery. He is a Fellow of the American Board of Foot and
Ankle Surgeons and Board Certified and Diplomat of the American Board of Podiatric Medicine. He practices with the Foot, Ankle and
Leg Specialists of South Florida specializing in lower leg injuries and reconstructive surgery of the foot and ankle. The practice includes Carlo
Messina DPM, Al DeSimone MD, Alexander
Bertot MD, David Shenassa MD, Franz Jones
DO, John Goodner DPM and Warren Windram
DPM. The South Florida Institute of Sports
Medicine in Weston is located at 1600 Town
Center Blvd., Suite C, (954) 389-5900 and in
Pembroke Pines at 17842 NW 2nd Street, (954) 430-9901. Our practice website is www.southfloridasportsmedicine.org
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NEW PATIENT $300 | FOLLOW UP (WITHOUT X-RAY) $100 SURGERY CONSULT $350 | X-RAYS $50 PER AREA | PRP $600 STEM CELLS $800 | SHOCKWAVE (5 SESSIONS) $600 | INJECTIONS $100 ORTHOTICS $400 | CASTS $200 | LACERATION REPAIR $400
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