From auburnpub.com
Unlike arthritis of the hip, knee, shoulder, neck and back, the treatment and management of an arthritic ankle is not as straightforward. For whatever reason the current database of research regarding treatment of an arthritic ankle is not as robust as it is for other joints in the body. The research of nonsurgical injectable treatments is particularly suspect.
Arthritis is degeneration of the joint cartilage in any joint. In the ankle, there can be several processes that stimulate this degenerative process. The most common causes of arthritis in the ankle are recurrent ankle sprains that lead to joint instability, overuse activity involving weight-bearing impact, previous fracture and a variety of genetic arthritic conditions, such as rheumatoid arthritis. Because of the complexity of genetic or familial types of arthritis, this article will deal with acquired degeneration secondary to instability.
If you have ever had an ankle sprain or “rolled” your ankle, you know the feeling of instability in an ankle. When younger people have repeated ankle sprains and fail to get proper treatment and/or undergo rehabilitation, the supporting ligaments become weaker and provide insufficient support, leading to an unstable ankle. The instability leads to a transfer of forces to the cartilage lining the joint surfaces of the bones. Eventually the cartilage wears down, altering the architecture, and this alteration accentuates the instability, accelerating the degeneration.
Unfortunately, when this process occurs in individuals younger than 50, it leaves them with very difficult choices to make regarding treatment. This illustrates why it is so important for someone with ankle injuries to seek out comprehensive treatment and rehabilitation to help prevent long-lasting problems. Having a severely arthritic ankle at 38 years old because you didn’t treat an ankle sprain when you were 18 is a bad trade.
For the last two to three decades, the go-to treatment for an arthritic ankle has been a surgical procedure called ankle arthrodesis, or joint fusion. The problem with joint fusion surgery is that it effectively eliminates any motion of the joint permanently. This will alter the patient’s ability to walk normally and cause increased stress in the knee, hip and lower back, creating additional problems later in life. For these reasons alone, it is prudent to exhaust nonoperative treatments, including measures to prevent the arthritis in the first place.
Fusion surgery for an ankle should be the last choice. This means that all other forms of treatment should have been tried prior to opting for fusion. There are several different types of injections that can be tried. The patient needs to be educated as to what the goal of each injection is, and their expectation needs to align with the mechanism of the injection. For example, cortisone injections reduce inflammation. If the cause of the patient’s pain is inflammatory, a cortisone injection may reduce pain. If the arthritis is severe, the cortisone injection may not provide relief because cortisone doesn’t fix the arthritis. Stem cell injections have shown promise in the arthritic ankle, but once again have not displayed the ability to improve the architecture of the joint. Prolotherapy injections can help with the instability because their job is to stiffen the joint or the ligaments. Alas, they do not change the degree of arthritis either. These three types of injections may provide pain relief but won’t change the arthritis. The best combination of nonoperative care is injections followed by intense physical therapy within one to two weeks of having the injections.
If the arthritis is caught at an earlier stage, an arthroscopic procedure can be performed to clean up or debride any spurring or sharp arthritic edges. This procedure is usually followed with extensive physical therapy. While the surgeon can shave down rough edges, this also stimulates bone growth and spurring may return. Maintaining exercises for stability is very important after this surgery.
Ankle replacement surgery or ankle arthroplasty is relatively new and more challenging than a knee or hip replacement. According to Lawton et al.: “There are pros and cons to ankle replacement. On the one hand, it offers a better range of motion and higher satisfaction among recipients. On the other, ankle fusion is safer and more reliable, with half as many people needing additional surgery compared to arthroplasty."
If you have a severely arthritic ankle especially if you are under the age of 50, there is considerable homework to do. Do not rely on the opinion of one surgeon or provider. Seek at least three opinions from surgeons and rehabilitation professionals familiar with the various treatment options mentioned. Make your decision after gathering this information.
Dr. Dale Buchberger is a licensed chiropractor, physical therapist and certified strength and conditioning specialist diplomate of the American Chiropractic Board of Sports Physicians with 34 years of clinical sports injury experience.
No comments:
Post a Comment