What are the other Names for this Condition? (Also known as/Synonyms)

• Ankle Osteoarthritis
• OA of Ankle

What is Osteoarthritis of Ankle? (Definition/Background Information)

• Osteoarthritis (OA) is a painful joint disorder characterized by the progressive degeneration of the articular cartilage that covers the bone surface of joints. It is mostly observed in middle-aged and older adults
• Osteoarthritis of the Ankle affects the ankle joints; there are numerous joints in the ankle, and any of the joints may be affected. The joint that is commonly involved is where the long bones of the leg (the fibula and tibia) meet the talus bone of the ankle
• In this condition, the cartilage that cushions the ankle joints gradually wears down, resulting in pain, stiffness, and weakness of the ankle. This is followed by the formation of bone spurs (abnormal bone growths) at the location
• Osteoarthritis of Ankle can severely affect one’s ability to stand, walk, or run. The condition may be aggravated by a prior foot injury, obesity, or old age. The condition can potentially affect the quality of one’s life
• Early and adequate treatment is necessary to control the progression of Osteoarthritis of Ankle. The treatment associated with the condition includes both nonsurgical and surgical methods. The prognosis of Osteoarthritis of Ankle is good with early treatment in a majority of individuals

Who gets Osteoarthritis of Ankle? (Age and Sex Distribution)

• Osteoarthritis of Ankle may occur in individuals of all ages, races, ethnic groups, and belonging to any gender
• Both males and females are affected, although many cases are observed in middle-aged and elderly women
• No race or ethnic group preference is observed

What are the Risk Factors for Osteoarthritis of Ankle? (Predisposing Factors)

The risk factors for Osteoarthritis of the Ankle may depend on whether the condition is primary (caused by age-related wear and tear of the joint) or secondary (due to an underlying condition or disorder).

The risk factors for primary osteoarthritis may include:

• Advancing age: Osteoarthritis (OA) is rarely diagnosed in individuals under 40 years old. However, since it is a gradually progressing condition, the risk of developing OA usually increases with age
• Women are more susceptible to the condition than men, especially after menopause
• Individuals who sustain a joint injury while participating in rough/high-impact sports, such as           football, tennis, basketball, soccer, wrestling, rugby, hockey, skiing, and snowboarding
• Abnormal pressure on the joints due to excess body weight (obesity)
• Repetitive stress on the joint associated with certain occupations that involve overuse of ankle joints, such as farming or construction-related work, can increase the risk

The risk factors for secondary osteoarthritis may include:

• Prior joint injury or infection 
• Rheumatoid arthritis
• Systemic lupus erythematosus
• Acromegaly
• Hemochromatosis
• Synovial osteochondromatosis (involving the knee or hip)
• Secondary syphilis
• Lyme disease
• Ankylosing spondylitis 
• Psoriatic arthritis
• Avascular necrosis
• Many of the autoinflammatory diseases, such as systemic juvenile idiopathic arthropathy, Behçets disease, and adult-onset Still’s disease
• Gout and pseudogout: Medical conditions caused by high levels of uric acid or calcium crystals in the joint spaces
• Hypermobility syndromes lead to increased range of motion at joints. This excessive mobility leads to increased wear and tear on cartilage and subsequently to early onset secondary osteoarthritis
  • Some conditions are hereditary, such as Ehlers-Danlos syndrome, Marfan syndrome, Stickler syndrome, osteogenesis imperfecta, and others
  • Down’s syndrome, cerebral palsy, and disorders leading to poor muscle tone also lead to increased joint motion
• Wilson’s disease: A copper transport disease with prominent liver and neurologic findings. Wilson’s disease patients also have an increased risk of knee and spine osteoarthritis
• Paget’s disease of bone: A rare, chronic bone disorder characterized by abnormal growth and deformity of the bones
• Hypothyroidism: A medical condition characterized by the body’s inability to produce enough thyroid hormone
• Individuals who have diabetes, a chronic medical condition characterized by excessive levels of sugar in blood
• Genetic disorders that cause improper formation of the joints   

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Osteoarthritis of Ankle? (Etiology)

Currently, the underlying cause of Osteoarthritis of Ankle is unknown. However, certain causative factors associated with the condition include:

• Any injury to the ankle joint while participating in sports such as football, tennis, basketball, soccer, wrestling, rugby, hockey, skiing, and snowboarding
• Repetitive stress on the joint from certain occupations such as construction work, as well as teaching or other activities requiring prolonged standing 
• Obesity, causing abnormal stress on the foot joints
• Some arthritic disorders have a genetic prevalence: Individuals with an immediate family member or relative having a history of osteoarthritis may also develop this disorder
• Progressive damage of the joint cartilage (due to various reasons) is a key factor. The cartilage damage initiated by a cause factor activates an inflammatory response, which leads to further joint destruction

What are the Signs and Symptoms of Osteoarthritis of Ankle?

Osteoarthritis of Ankle is a gradual degenerative disorder that usually worsens over time. The common signs and symptoms of the condition include:

• Noticeable pain and tenderness in the ankle joint or foot; the pain may increase on standing for a long time or after running/jogging
• The pain generally reduces on resting the leg
• Swelling in the foot or ankle
• Sometimes, a popping/crunching sound (called crepitus) may be heard on applying pressure on the affected ankle
• Buckling of the ankle on applying weight on the ankle; this may cause one to lose one’s balance
• Stiffness and reduced mobility of the ankle joint
• Formation of bone spurs or osteophytes around the joint
• The symptoms may either get worse or improve from time to time

How is Osteoarthritis of Ankle Diagnosed?

Diagnostic methods that a physician may use to help diagnose Osteoarthritis of Ankle may include:

• Physical examination: The physician will perform a thorough physical examination to determine if the individual has osteoarthritis. In addition to this, a complete medical history may aid in arriving at a diagnosis
• X-ray of the affected ankle joint: X-rays use radiation in order to produce images of the joint, which can help the physician rule out other possible causes for pain and discomfort
• Various blood tests to rule-out other conditions that may cause similar symptoms
• Joint fluid analysis of affected joint: Occasionally, fluid may accumulate around the ankle joint. Analysis of this fluid will give clues regarding the cause of the joint fluid accumulation, which causes pain and disability. A needle is inserted into the joint space, and the accumulated fluid aspirated with a syringe. It is then sent to a laboratory for analysis to determine:
  • The type of cells present in the fluid
  • Chemical composition of the fluid
  • The presence of crystals (examination of fluid under a microscope)
• If an infection is suspected as the cause of accumulation of the joint fluid, then a joint fluid culture may be performed. The culture of joint fluid will confirm an infection of the ankle joint as the cause of arthritis (termed infectious arthritis)
• Ultrasound imaging of the ankle joint: The use of high-frequency sound waves to generate a thorough image of the affected joint
• CT, MRI scan of the affected joint

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Osteoarthritis of Ankle?

Osteoarthritis of Ankle is a progressive condition that gradually worsens over time. The complications of the condition may include:

• Chronic pain and stiffness within the joint, which may result in reduced mobility
• Walking difficulties, change in gait (change in the way one walks)
• Decreased quality of life

How is Osteoarthritis of Ankle Treated?

The treatment of Osteoarthritis of Ankle includes nonsurgical and surgical methods. A healthcare provider may start with non-surgical treatment methods before adopting surgical procedures and techniques. These include:

• Rest: Any activity that aggravates the joint condition further should be avoided. The physician usually advises to refrain from all such activities until the symptoms get better
• Heat and ice: Applying a damp heated towel or ice to the joint can help reduce pain and swelling
• Splint or brace: A physician may prescribe some type of padded splint or cast to help keep the joint in a stable position, especially while sleeping
• Non-steroidal anti-inflammatory medication: Medications, such as ibuprofen and naproxen, can help decrease the joint pain and swelling
• Topical non-steroidal medications have been shown to improve osteoarthritis at specific locations. Application twice a day is required for a month, then daily, to attain relief 
• Corticosteroid medications, such as prednisone, help provide temporary relief of symptoms and improve the range of motion within the joint.  Corticosteroids can be given systemically or injected directly into a specific affected joint.  It is important to note that corticosteroid injections may only give temporary relief. Repetition of such injections can ultimately lead to further joint injury
• Viscosupplementation: Normal fluid within a joint contains a material called hyaluronic acid. When a joint is affected by osteoarthritis, a reduction of hyaluronic acid levels occurs within the joint. Such a decreased acid level will decrease the ability of the joints to lubricate. Viscosupplementation is a minimally-invasive technique that is commonly used when treating osteoarthritis. During this procedure, small doses of hyaluronic acid are injected into the leg to relieve pain
• Physical therapy: After the symptoms have decreased, it is important to begin some light motion exercises (ankle joint exercises). Physical therapy may help restore strength, as well as provide flexibility to the muscles
• For secondary osteoarthritis, optimal control of the disease or condition (if possible) causing early-onset osteoarthritis is a key treatment goal

Surgical treatment measures include:

• Joint fusion: Joint fusion is a surgical technique that involves the removal of the arthritic part within the joint and fusing two surrounding bones together. The purpose of this procedure is to relieve pain, stabilize the joint, and regain some range of motion in the affected joint
• Total arthroplasty (ankle joint replacement technique): It is a surgical intervention tool in which the joint is completely removed. The arthritic joint that is removed is then replaced by a metal and plastic prosthetic implant. A physician will recommend this surgical procedure if the degenerative disorder affects the entire joint

How can Osteoarthritis of Ankle be Prevented?

A few recommendations to help prevent Osteoarthritis of Ankle include:

• Individuals who maintain a healthy diet, may decrease the chance of developing this condition
• Some evidence exists that adherence to the Mediterranean diet leads to improvement in in osteoarthritis
• Estrogen replacement therapy can decrease the incidence of osteoarthritis after menopause in women
• Using correct posture and tools that decrease stress on joints in the workplace can decrease the incidence of the condition due to occupational causes
• Undertake a proper treatment of gout
• Prompt and adequate treatment of individuals with Paget’s disease
• In individuals with hypothyroidism, prompt treatment of the thyroidal condition may help lower one’s risk
• Proper treatment of diabetes
• Maintaining a healthy body weight can help prevent abnormal pressure on the ankle or foot joints
• Individuals who participate in any high-risk sports, such as football and basketball, should wear appropriate safety gear to help prevent serious injuries to their joints

What is the Prognosis of Osteoarthritis of Ankle? (Outcomes/Resolutions)

The long-term prognosis of Osteoarthritis of the Ankle depends on the severity of this degenerative condition.

• If osteoarthritis is detected early and proper aggressive treatment is provided, then the prognosis is good in a majority of individuals, if no serious complications are noted
• In general, without treatment, a high percentage of individuals who develop this condition may experience a lifetime of gradual degeneration that can be debilitating

Additional and Relevant Useful Information for Osteoarthritis of Ankle:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/orthopedc-disorders/