Ankle arthritis

The ankle is a complex joint made up of three main bones:

• The tibia (the calf bone)
• Fibula (the thin bone next to the tibia, on the lateral side of the leg)
• The talus (foot bone shaped like a pulley)

These bones are connected by ligaments and covered with cartilage, a smooth tissue that allows friction-free movement. The ankle supports the body's weight and enables essential flexion and extension movements of the foot, such as walking and running. There are 28 bones and some 30 joints in the foot, giving it remarkable mobility.

Manifestations of ankle arthrosis can vary from person to person, but the most common symptoms include:

Note that the intensity of symptoms does not always correspond to the degree of wear visible on imaging. Some people may show radiological signs of advanced osteoarthritis with few symptoms, while others may experience significant pain despite minimal changes visible on imaging.

Unlike arthrosis of other joints, ankle arthrosis is rarely primitive (i.e. linked to natural aging). The most frequent causes are:

Although ankle arthrosis is often linked to specific events, certain factors can increase the risk of developing this pathology:

• Age: the risk increases with age, even if ankle osteoarthritis also affects younger people.
• Obesity: excess weight increases pressure on the joint.
• Professional or sporting activities that place heavy demands on the ankle
• Family history of osteoarthritis
• Chronic ankle instability

Management of ankle arthrosis aims to relieve pain, improve joint function and slow disease progression. Treatment options may be conservative or surgical, depending on the severity of the disease and response to initial therapies.

Conservative treatment of ankle arthritis

Non-surgical approaches are generally preferred as first-line treatment. These methods aim to relieve symptoms and slow disease progression without resorting to surgery. Pain and inflammation can be reduced through the use of medications, notably non-steroidal anti-inflammatory drugs. Lifestyle modifications are often recommended, including weight loss if necessary and adapting physical activities to reduce stress on the joints. Physiotherapy helps maintain joint mobility and strengthen surrounding muscles. Wearing orthotics, such as orthopedic inserts or splints, can be beneficial in relieving pressure on the affected joint.
Infiltration is another option. These can take the form of hyaluronic acid injections (visco-supplementation), offering temporary relief from symptoms.

Surgical treatment of ankle arthritis

When conservative treatments are no longer sufficient, surgery may be considered. Surgical options include:

The choice of surgical technique depends on many factors, including the patient's age, activity level, severity of osteoarthritis and the presence of other health problems.

Ankle osteoarthritis is a chronic disease that generally progresses slowly. Left untreated, it can lead to :

• A progressive reduction in mobility
• Increased pain, which may become permanent
• joint deformity
• Impact on quality of life and autonomy

As with any surgical intervention, specific complications may arise, such as

• Non-consolidation after arthrodesis (less than 5% of cases)
• Long-term loosening of the prosthesis
• Development of osteoarthritis in neighbouring joints, particularly after arthrodesis

Although it is impossible to totally prevent ankle arthritis, certain measures can reduce the risk or slow its progression:

• Maintain a healthy weight
• Regular, appropriate physical activity to strengthen the muscles around the ankle.
• Wear appropriate, comfortable footwear
• Treating ankle injuries promptly
• Avoid excessive repetitive movements

Persistent and intensifying pain, morning stiffness, unusual swelling or restricted movement are all reasons to seek medical advice. It's important to take symptoms into account, as early diagnosis means more effective treatment. Prompt consultation can not only relieve symptoms, but also potentially slow the progression of the underlying disease.

Clinical examination and a standard ankle X-ray are sufficient to establish the diagnosis in most cases. X-rays are performed standing up to better diagnose the severity of arthritis and detect any associated joint deformity. Advanced imaging tests, typically a CT scan of the ankle, may be indicated on a case-by-case basis. Finally, blood tests may be prescribed to identify the type of arthritis. For certain types, such as rheumatoid arthritis, these tests are essential for a precise diagnosis.

Specificity of new-generation prostheses

The team at Hôpital de la Tour's foot surgery center uses a new generation of ankle prostheses. A CT scan is carried out, enabling the ankle to be reconstructed in 3D and the implantation of the prosthesis to be simulated. This not only helps to prevent certain complications or surgical difficulties, but also to create custom-made guides that enable extremely precise implant placement. The life expectancy of the prosthesis is greatly increased by this system. 

Can ankle arthritis affect young people?
Yes, ankle arthritis can affect young people, particularly after trauma or in cases of chronic instability of the joint.

Is it possible to play sports with ankle arthritis?
Sports must be adapted to the condition. Low-impact sports such as swimming or cycling are generally recommended, while sports involving jumping or pivoting should be avoided.

Can weight loss improve ankle arthritis?
Yes, weight loss can significantly reduce pressure on the joint, thus relieving the symptoms of ankle osteoarthritis.

Does ankle arthrodesis totally prevent walking?
No, arthrodesis generally allows normal walking, although ankle mobility is reduced. Neighboring joints partially compensate for this loss of mobility.

What's the difference between an arthrodesis and an ankle prosthesis?
Arthrodesis fuses the bones to eliminate pain by immobilizing the joint, while a prosthesis replaces the joint to maintain mobility.

Can arthritis of the ankle be completely cured?
There is no definitive cure for osteoarthritis, but modern treatments can effectively control symptoms and slow the progression of the disease, thus considerably improving patients' quality of life.

Can arthritis of the ankle after a fracture be prevented?
It can be slowed down by following an appropriate rehabilitation program, maintaining a healthy weight and avoiding further trauma.