Ankle Osteoarthritis

Overview

The ankle joint is the most commonly injured joint in the body and experiences more pressure than any other joint in the body. Osteoarthritis is caused by wear and tear of joints while arthritis is a result of internal causes. Typically, ankle osteoarthritis occurs if one’s ankle has been inflicted with injuries during their earlier years. Older adults offer experience pains in the joint and chalk it up to old age and ankle osteoarthritis is hence, often left undiagnosed. If left untreated, during later stages, ankle osteoarthritis poses to be a destructor of physical activities.

Definition of ankle osteoarthritis

Anatomy of the ankle: The ankle joint is made of three bones: tibia, fibula, and talus. The ends of the bones are covered by articular cartilage.

The movement of these bones over the cartilage is lubricated by synovium which is a thin lining that surrounds the joints. Ligaments help hold these bones in place.

When the articular cartilage is damaged, the smooth movement of the joints is disrupted. This leads to inflammation, pain, and stiffness of the ankle. This disease is called ankle osteoarthritis.

What causes ankle osteoarthritis?

Ankle osteoarthritis is typically a long-term effect of an injury sustained early on in life.

• Injuries: Multiple/severe sprains, fractures, and other injuries cause severe damage to the cartilage of the ankle which cannot be completely healed. Over the years, due to wear and tear, the cartilage is further damaged causing ankle osteoarthritis.
• Primary osteoarthritis: Regular wear and tear of the joints, which is observed by all older adults at different extents.
• Obesity: The heavier one is, the more pressure is exerted on the ankle joints and thus, increases the chances of ankle osteoarthritis.
• Inactivity: The muscles that surround the joints become weak with inactivity. Low-impact exercises like walking and swimming strengthen the muscles surrounding the joints.
• Clubfoot: Abnormal positioning of the foot which is normally present at birth.
• Inflammatory arthritis: Inflammation of the joints that cause pain and stiffness which progressively intensifies with age. This is an autoimmune disease which is caused when the body’s defense system attacks different tissue instead of foreign entities.

Symptoms of ankle osteoarthritis

The symptoms initially are very subtle but gradually because severe. During the early stages, pain occurs only when the ankle undergoes physical exertion, but during the later stages, pain can occur even while resting. Though pain is the most noticeable of symptoms, there are other indicators of ankle osteoarthritis:

• Inflammation of the joints
• Reddening
• Stiffness that restricts movement of the ankle
• Tenderness at the joints
• Squeaking sounds or sensing of crunches while in movement

Long-term effects of ankle osteoarthritis

With proper treatment, surgery and time, the severity of ankle osteoarthritis is reduced and day to day activities can be carried with initial ease. During the last stages of osteoarthritis, the cartilage is damaged unevenly. In order for the balance this irregularity, the bones and joints will shift which will affect the gait of a person. The long-term effects of ankle osteoarthritis are not limited to just the ankle and can eventually cause arthritis in the knee as well as hip joints. The wear and tear of the ankle joints is an inevitable occurrence and with age, everyone faces this pain at different severities.

Vulnerable groups

Those who have sustained injuries to the ankle while younger are the most affected by ankle osteoarthritis. People with careers that require lifting heavy weight for extended periods of time, frequently bending, standing for long hours or continuously exerting physical stress on the ankles are also affected because these activities cause the cartilage to tear more quickly. People who are overweight are also victims of ankle osteoarthritis.

Genetics of ankle osteoarthritis

Ankle osteoarthritis is a disease that affects the older adults. But on rare occasions, due to genetics, one can be diagnosed with the disease in their 20s.

This rarity is because of the presence of a protein collagen which makes up the cartilage. Research conducted by Carroll GJ proves, in those diagnosed with ankle osteoarthritis, the presence of MCP2,3 is frequently observed and a strong link between HFE gene mutation and ankle osteoarthritis is established.

It is also stated that HFE mutations are an indicator of type 2 polyarticular OA phenotype.

Diagnosis

Since ankle osteoarthritis is a long-term side effect of a sustained ankle injury, medical history of the injury is essential to make an efficient diagnosis. The medical history of a family member diagnosed with osteoarthritis is important too. Other tests conducted to make a conclusive diagnosis are listed below.

• X-Rays: Regular X-Rays are taken to monitor any changes or abnormalities in the joint structure.
• Gait analysis: Limping or flinching while walking will indicate pain in the joints which might be because of ankle osteoarthritis.
• Magnetic Resonance Imaging (MRI) or CT (Computed tomography) scan: These tests check the condition of the bones and soft tissues in the joint.
• Blood tests are also conducted to check for the type of arthritis.

Treatment and prevention

Treatment 

• Medications and steroid injections to help ease the pain caused due to the inflammation of joints are prescribed.
• Well-fitting and comfortable footwear are prescribed and designed to help reduce the severity of the symptoms and inhibit the progression of this condition.
• An ankle-foot orthosis or ankle brace are prescribed to help restore shape and reduce the progression of ankle osteoarthritis.
• Physiotherapy is recommended to help relieve the pain and ensure that there is movement in the joints.
• In severe cases, surgery to replace the ankle will be done. Here, the ankle is replaced with a prosthetic ankle to reduce pain and restore movement. Surgery to fuse the ankle bones is done to help restore movement and reduce pain.

Prevention 

• Consume a diet with glucosamine and chondroitin.
• Maintain a healthy body weight.
• Do not do any strenuous activities.
• Do not take any injury lightly and get a checkup done.
• Exercise regularly.
• Do not lead a sedentary lifestyle.

References