Ankle Arthritis

Updated: Nov 13, 2019



Cause: Overuse, previous fracture/sprain, misaligned foot/leg.


Appearance: Pain with movement of the ankle, swelling, decreased motion, grinding of the joint with movement



How to Diagnose: X-ray, clinical exam, MRI/CT, SPECT




Treatment:

- Switching to clay courts

- Bracing (Custom>OTC)

- Maximalist shoes

- Compression

- Topical pain gel

- Anti-inflammatories (if able to take)

- Contrast baths

o Cold/warm contrast for 10 min each, 3 times

- Physical therapy

- Cortisone injection (if able to have)

o 1. Phosphate, never acetate 2. Avoid Marcaine

- In boney impingements the cause needs to be determined, if it is biomechanical in nature, orthotics/bracing help prevent recurrence

- For cartilage loss with joint capsule/ fluid swelling) determining the root cause will help prevent/slow down the progression of the arthritis

- Surgery

o In boney impingements, removal of fragment with arthroscopic technique should be attempted before open procedure unless open procedure is absolutely necessary

o For soft tissue issues, arthroscopic debridement should be attempted prior to open, unless an open procedure is absolutely necessary

o For cartilage loss, cartilage replacement will prolong natural motion and use of the ankle

o For more advanced disease

§ Arthroscopic/open fusion

§ Ankle replacement has not yet been shown to hold up to the rigors of tennis


Long-term prognosis: Typically conservative care in the form of bracing, anti-inflammatories and compression is successful in preventing the progression of symptoms. In our opinion, arthroscopic debridement should be attempted prior to fusion. If MRI/CT shows a focal loss of cartilage, replacement of cartilage should be considered. Fusion of the ankle does NOT mean that the athlete will develop a limp or have to stop tennis. Early physical therapy after surgery helps create successful gait patterns. Maximalist shoes are necessary for prevention of shock on the ankle.


Playing tennis on an arthritic ankle usually causes pain more after activity than during due to the inflammatory nature. Bracing redistributes weight and prevents some of the inflammatory cycle from taking place. The stiffer the brace, the better the load redistribution.


Tennis after an ankle fusion does take some time and readjustment, especially with the serve where ankle bend is used the most, however this is temporary and most athletes return to tennis after ankle fusion within 1-2 years.


Ankle replacement is not a good option for the avid tennis player due to the lack of stability in the implants. Dislocation of the implant, grinding away at the implant/bone interface,cyst formation, and pain are all very real risks.


Who to call: Podiatrist, orthopedic surgeon (skilled in arthroscopy)

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