Arthrosis of the ankle joint

Ankle joint arthrosis is a wear and tear disease that affects the joint connecting the foot and lower leg. Typical symptoms are initially pain when taking the first steps after a period of rest, and later increasing pain after prolonged weight-bearing on the foot. How treatment can look, whether ankle arthrosis can be treated conservatively or whether foot surgery is necessary, can only be decided after a thorough examination by a foot specialist.

Dr Tonio Gottlieb is a foot surgeon and proven expert in foot diseases. Whether you need an initial examination or a second opinion, he will be happy to provide you with a reliable diagnosis and a well-founded therapy proposal that takes into account the entire foot and the associated body statics. Make a personal appointment right away!

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The upper ankle joint enables the foot to be raised and lowered, the rear lower ankle joint (subtalar) and the front lower ankle joint (chopart) enable the outer and inner edges of the foot to be raised.

The term arthrosis is derived from the ancient Greek arthron - joint -, the suffix -ose refers to a disease state. In medicine, arthrosis stands for a degenerative joint disease, i.e. a disease caused by wear and tear or ageing, the so-called joint wear.

Osteoarthritis in the ankle joint usually results from wear and tear of the joint cartilage. The joint space, i.e. the cavity between the cartilage surfaces of the joint, becomes narrower and the joint gradually loses its "shock absorption". This leads to pain and eventually to a restriction of movement.

Unlike osteoarthritis of the hip and knee, osteoarthritis of the ankle affects younger adults more often. A look at the causes of this joint disease shows why this is so.

Arthrosis of the ankle joint can have various causes. In most cases, it occurs as a result of joint injuries. Other causes include incorrect loading of the joint as a result of foot malposition, permanent overloading, but also lack of exercise, as well as inflammation and metabolic disorders. The development and course of this degenerative joint disease is probably also influenced by genetic factors.

When looking at ankle arthritis in detail, there are often several aspects that influence each other:

• Biomechanical factors: Damage to the cartilage layer due to overloading and disruption of the collagen fibre network; later, the repeated "repair" of minute damage to the underlying joint bones can reduce their elasticity and thus lead to increased stress on the cartilage.
• Biochemical factors: Disturbance of collagen formation in the cartilage cells; later, arthrosis-related changes in the joint membrane can adversely alter the composition of the "joint lubricant" (synovial fluid) so that it "lubricates" and nourishes the joint less well.

Osteoarthritis (Arthrosis) and Rheumatoid arthritis: what is the difference between a primary and a secondary arthrosis of the ankle joint?

In order to initiate a cause-oriented therapy, a precise diagnosis of ankle joint arthrosis is necessary.

Arthrosis (Osteoarthritis) is a joint degeneration without (primary arthrosis) or with (secondary) recognisable trigger.

• Primary arthrosis develops exclusively through age-related wear and tear. Genetic factors probably also play a role here, which determine the quality of the cartilage layer in the joint in particular. The symptoms usually develop gradually and only get worse slowly although the joint is fundamentally exposed to heavy stress due to its position. Nearly everybody develops a primary arthrosis; even one does not suffer from it.

• Secondary arthrosis occurs as a result of an injury or disease of the joint, which can also date back several years. The ankle joint is relatively often affected by sprains or "twisting" of the foot due to its construction and high load. This can result in both ligament injuries and bone fractures. Secondary ankle joint arthrosis as a result of such injuries, also known as post-traumatic ankle joint arthrosis, is correspondingly common.

Arthrosis of the ankle joint as a result of a torn ligament

The bones of the ankle joint are stabilised by strong, little stretchable ligaments (ligaments) made of connective tissue fibres. A stretched or torn ligament can affect the stability of the ankle joint and promote a misalignment of the bones involved.

This misalignment leads to increased friction in the joint, and in some cases the body also reacts with inflammation or with the formation of bone outgrowths. All these factors attack the cartilage tissue and thus hinder the smooth gliding of the joint.

Joint instability, injuries and accidents as causes of arthritis in the ankle joint

Joint injuries are the most common cause of arthritis of the ankle joint: you slip, trip or fall, e.g. during a leisurely walk or even during sport (20% of all sports injuries affect the ankle joints).

A typical accident mechanism is supination trauma, colloquially also called "twisting an ankle": The foot slips away when stepping and twists over the outer edge, so that the retaining apparatus of the ankle joint is abruptly overstretched. Twisting in the other direction, over the inner edge of the foot, is called pronation trauma. The following ankle injuries can occur:

• Strained ligaments and sprain (distortion): Ligaments and joint capsule are abruptly overstretched, some of the connective tissue fibres tear, but the overall structure remains intact. The injury to small blood vessels often leads to bruising (haematoma, colloquially "bruises").
• Torn ligaments (ligament rupture): Here, the connective tissue fibres tear completely; the external ligament rupture of the upper ankle joint is particularly typical. The ligament structures between the calf and shin (so-called syndesmosis) can also be injured and thus lead to complete instability of the ankle joint fork in the upper ankle joint.
• Cartilage injury or shearing of cartilage and bone fragments: These can occur as osteochondrosis dissecans in various stages (dissolution of bone tissue in a demarcated area of the joint surface, resulting in degenerative changes in the cartilage) and turns out in a so-called lose body. The damaged cartilage-bone substance detaches and leaves a defect site, which remains as a freely movable fragment in the joint.
• Bone fracture (fracture): In the case of ankle fracture, colloquially known as ankle fracture, depending on the course of the accident, there is a fracture of the outer and/or inner ankle, i.e. the joint process of the calf and/or tibia, often in conjunction with a torn ligament.

These injuries can lead to a malposition of the ankle joint, which promotes wear and tear of the cartilage and can also promote inflammation or the development of bone outgrowths. This is how a classic, secondary ankle joint arthrosis develops.

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Malpositions as triggers of ankle joint arthrosis

Deformities in the ankle joint can not only result from injuries, but can also be present from birth. Typical examples are congenital foot deformities such as high arches, flat feet or clubfoot.

Here, too, the joint cartilage can be loaded on one side or incorrectly for years, which accelerates wear at the affected area.

Arthrosis in the ankle joint as a result of overloading

The entire weight of the body rests on the ankle joint. Excessive weight can also overload the joint and promote the development of ankle joint arthrosis. Likewise, very intensive sport can also lead to ankle joint arthrosis if the joint cartilage is worn down more than normal.

Arthrosis in the ankle joint due to lack of exercise

Regular, age-appropriate exercise keeps you fit - this also applies to the ankle joints. Movement of the joint stimulates the regeneration process of the cartilage. Lack of movement can lead to the body not replicating enough cartilage cells, the cartilage layer in the joint shrinks and thus arthrosis develops.

Rheumatoid arthritis as inflammation or metabolic disorders can cause arthritis of the ankle joint

Internal diseases such as rheumatism or gout as well as certain neurological diseases can also affect the articular cartilage through inflammatory processes in the body. The most common joint destructive disease is Rheumatoid arthritis.

Do you suffer from ankle complaints and are afflicted with one of the aforementioned clinical pictures? It is best to make an appointment for an examination with the Berlin foot specialist Dr. Tonio Gottlieb. His extensive experience in the field of arthrosis in the ankle joint can also help you to become pain-free again with a well-founded diagnosis and a treatment recommendation geared to your individual problem.

Dr Tonio Gottlieb advises:

"Do not hesitate in case of pain or problems with the ankle joint and consult a specialist who specialises in foot surgery and foot diseases. Then treatment can be successful right from the start."

Osteoarthritis usually passes through several stages, which the doctor can easily assess with modern diagnostic methods. He primarily examines the condition of the joint cartilage: The Kelgren scale can be used to assess the course of the disease:

• Healthy cartilage: The cartilage surface is smooth, shiny and slippery, the cartilage substance is white, elastic and fulfils its function as a "shock absorber". (Grade 0)
• Cartilage softening: The surface of the articular cartilage is still smooth, but loses its shine and appears matt grey-yellow. The cartilage substance softens and becomes more susceptible to injury. This "silent arthrosis" does not yet cause any noticeable symptoms. (Grade 1)
• Superficial cartilage damage: The structure of the connective tissue in the cartilage changes, the surface becomes rougher and more uneven, cartilage abrasion increases. In addition, deeper defects of the cartilage substance can already occur. The joint hurts occasionally. (Grade 2)
• Deeper cartilage cracks and damage: As arthrosis progresses, the surface of the joint cartilage shows clear cracks and the first pieces of cartilage detach. This results in a "bone burr" where the joint surfaces are no longer covered with the protective cartilage layer - the bone is exposed and often covered with scar tissue. This "manifest arthrosis" manifests itself as permanent pain and restricted movement. (Grade 3)
• Bone damage: In particularly severe ankle joint arthrosis, an ulcer develops which destroys the now unprotected bone surface and exposes the bone marrow. Cavities (pseudocysts), some of which are filled with fluid, develop in the main stress zones of the joint, and bone growths (marginal exostoses) form at the edges. (Grade 4)

How quickly ankle joint arthrosis progresses varies from individual to individual. Basically, however, the structural changes develop slowly and gradually. Often the body actively tries to counteract - it reacts to the instability and incorrect loading of the joint by forming bony outgrowths (osteophytes) to stabilise the joint. However, this leads to increasing ossification and decreasing mobility of the joint. Osteoarthritis can also cause inflammation, which causes swelling and pain.

After a detailed examination, the foot surgeon Dr. Tonio Gottlieb can tell you exactly what stage of ankle arthritis you are in. Listen to your body and make an appointment at the specialist's practice! Dr. Gottlieb is not only an experienced foot surgeon and operator, but also actively researches the topic of ankle surgery and treats his patients according to current scientific findings.

Arthrosis in the ankle joint develops slowly and can be expressed by various changing symptoms. It is very important to have the affected ankle examined by a foot specialist after sports injuries or everyday accidents, such as twisting your ankle. This way you can avoid long-term damage.

What does arthrosis in the ankle joint feel like?

The first vague signs of ankle arthritis can be deep-seated pain. Later, those affected feel pain from exertion, for example after longer walks or sporting activities. The so-called start-up pain is also typical, which occurs when taking the first steps in the morning or after resting for a long time. The range of motion diminishes.

In advanced ankle joint arthrosis, the joint usually also visibly deforms and stiffens, which often result in chronic pain in the resting position.

Other typical symptoms of ankle arthritis are:

• stabbing pain and
• pain reaching into the foot and lower leg,
• furthermore Entrapment symptoms,
• crunching noises (crepatitio) as well as
• swelling of the ankle joint.

With arthrosis of the ankle joint, non-specific pain can also occur in the adjacent joints. This is due to the restricting range of the affected joint.

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For ankle arthritis in the early stages, conservative, non-surgical treatment can often provide effective relief.

However, if the ankle joint has already undergone degenerative changes so that conservative therapy does not achieve relief and you continue to have severe pain, you should consider surgery. So that you can make a well-informed decision - especially if you are not yet completely sure - it is often worthwhile to obtain a competent second opinion.

Which surgical procedure is best for you depends on the exact diagnosis. Basically, the following ankle surgeries are possible:

• Ankle arthroscopy (joint endoscopy, also joint lavage): In this minimally invasive procedure, the surgeon uses a special endoscope (arthroscope) to remove loose and protruding pieces of cartilage and bone that exert an inflammatory stimulus on the joint.
• Ankle joint axis correction (osteotomy): This operation corrects malpositions by surgically realigning bones that deviate from the healthy joint axis and thus place the wrong load on the joint.The aim of the correction is to equilibrate the load distribution on the ankle joint and with this prevent the progression of arthrosis.
• Ankle arthrodesis (joint fusion): This standard treatment for ankle arthritis involves fusing the upper ankle joint. The foot surgeon removes all cartilage remnants and stiffens the upper ankle joint by screwing the ankle bone to the tibia so that the bones subsequently fuse together. After the healing phase, the foot is fully weight-bearing again and usually allows a pain-free gait. However, the ankle fusion leads to increased stress on the tarsal joints and thus increases the risk of concomitant arthritis. Therefore, regular follow-up care by a foot specialist is recommended in order to counteract possible problems at an early stage.
  
• Ankle joint prosthesis: As with the hip and knee, it is also possible to replace the natural joint of the ankle joint with an endoprosthesis. The prosthesis consists of several parts and a sliding body. It is inserted surgically, grows together with the bone tissue during the healing phase and then allows a very natural movement. In the case of osteoporosis or extreme leg or foot deformities, implantation of an endoprosthesis may be sometimes challenging or impossible.

Dr Tonio Gottlieb is a specialist for all kinds of ankle surgery. With him, you are in competent hands with arthritis in the ankle joint. He will make a clear treatment recommendation after the diagnosis. Make an appointment with his practice and get an impression of his expertise for yourself.

Surgery for arthrosis in the ankle joint: how long is one unable to work?

Depending on the surgical method and your personal healing process, it can take eight to twelve weeks before you can put full weight on your ankle again.

How long you are unable to work therefore also depends on your profession. You can resume a sedentary job after two to three weeks, for physically demanding work it is best to consult your doctor.

Conservative treatment is particularly suitable for the early stages of ankle joint arthrosis. Mostly it is impossible to reverse damage that has already occurred to the bone and cartilage. The goal is to slow down the progression of the disease and preserve the ankle joint as long as possible.

These conservative therapies can help you strengthen or, if possible, maintain your ankle:

• Orthopaedic shoes to improve the rolling motion when walking
• Physiotherapy for pain relief
• Joint-friendly diet, i.e. foods with cartilage-strengthening and anti-inflammatory ingredients
• Bandages to relieve the joint

In order to prevent the progression of arthrosis as far as possible, you should refrain from sports with strong impact loads, for example jogging, tennis or squash. Are you suffering from early-stage ankle arthrosis? Foot specialist Dr. Gottlieb is the perfect contact person for you, both for conservative and surgical therapy. The internationally recognised foot surgeon examines and advises you in detail on a treatment that is optimally tailored to your needs.

Dr Tonio Gottlieb advises:

"The ankle joint is particularly important for the coordination of gait and stance. The earlier ankle arthritis is detected and treated, the better the chances of preserving the mobility of the ankle joint."

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You can prevent arthrosis in the ankle joint through regular exercise that is easy on the joints: cycling and swimming are good, but you should avoid sports with frequent stop-and-go as well as jump movements (especially ball sports).

For the sake of your joints, you should aim for or maintain a healthy normal weight; numerous studies also prove the positive additional effects of a diet low in fat and meat.

If necessary, your doctor will also recommend physiotherapy exercises and orthopaedic shoes or insoles to relieve the feet.