By Jeffrey C. Christensen, DPM Special to HBJ
EVERETT — People with severe ankle arthritis have lost the nearly frictionless cartilage surface that provides smooth gliding and rotation that allows the foot to rotate freely and painlessly.
While some forms of ankle arthritis can take years to develop, the major cause of ankle arthritis is a traumatic incident, usually a previous fracture, sports injury, repetitive ankle sprains or industrial injury. These injuries can lead to traumatic ankle arthritis, which often affects the working class in the twilight of their work career. Debilitating and painful ankle arthritis will no doubt reduce worker productivity.
According to a New York Times article that cited Dr. John G. Kennedy of the Hospital for Special Surgery, “Fifty percent of all joint injuries occur in the ankle.” A recent Canadian study showed that ankle arthritis is just as crippling and severe as hip arthritis. Many of these people are on their way to end-stage traumatic arthritis. Therefore, it is imperative for people to seek treatment as soon as possible from a foot and ankle specialist so that they can assess the damage and recommend the appropriate treatment.
Once the arthritis is allowed to occur and the cartilage is lost, any movement or weight bearing will produce crippling pain, causing one to limp and turn their foot outward. As the symptoms of ankle arthritis progress, early treatments include medication and bracing. Occasionally, minor surgical procedures are performed to repair ligaments or remove bone spurs from the joint. When the condition advances and conservative treatments fail, the only options left are more definitive surgical procedures that involve either fusion of the joint (were the joint is locked in position) or replacement with an artificial joint made of metal and plastic parts.
Fusing the ankle at one time was the only surgical option to treat end-stage ankle arthritis. While ankle fusion relieves joint pain, it sacrifices ankle function by eliminating motion. Despite the loss of function, the procedure was widely accepted because of its ability to significantly reduce pain. Unfortunately, ankle fusion places stress on adjacent joints in the foot and can allow the arthritis to spread to the other joints. Fusions can create a significant barrier for a worker to return to gainful employment due to the functional loss and difficulty with rehabilitation.
Total ankle replacements were first performed in the 1970s. These implants were cemented in place and made of inferior materials that functioned poorly in the ankle. The stress at the ankle was underestimated and most implants failed within a few years. In the past 40 years, led by knee and hip implants, there has been a revolutionary change in materials used in joint replacement. As a result, ankle replacement has become a viable alternative to ankle fusion, with the main advantage being the maintenance of ankle function coupled with significant pain relief and the avoidance of adjacent joint arthritis.
Individuals with painful ankle arthritis are good candidates for ankle replacement if their lives do not involve high-impact activities. These people are typically still in the workforce, unlike patients who receive hip or knee replacements and are generally retired. The best candidates for ankle replacement are usually more than 40 years old, have normal sensation, fully functioning muscles, no recent deep infections or widespread areas of dead bone, intact or repairable ligaments and no severe leg deformity. Similar to any other type of total joint replacement, the disadvantage is that the plastic material will need to be replaced in 10 or more years when it wears out, requiring future surgery.
An office visit with a podiatrist is necessary to determine if one is a viable candidate for implantation. During the initial visit, the patient is educated as to how the devices function compared to alternative treatments. The best type of implant for your situation will be discussed and the decision will be based on your current ankle condition along with other factors.
In most instances, an overnight stay in the hospital is necessary. Recovery usually requires six weeks without bearing weight, at which time transitioning into regular shoes takes place. Physical therapy may be necessary. Since there are few surgeons who perform total ankle replacement, you should look for an experienced surgeon who regularly performs the procedure to help ensure the best possible outcome.
Employers who want to keep their employees productive should work with their employees and encourage visits to their foot and ankle specialist should an injury occur, whether on or off the job, because early treatment can often avoid the progression of arthritis.
Ankle injuries are serious and require a comprehensive treatment plan to permit full return to work and reduce risk of progression to end stage arthritis.
Dr. Jeffrey Christensen has been in practice in Everett for more than 27 years and has a dedicated practice for the treatment of the ankle.