Foot and Ankle Arthritis Specialists
Are you an athlete or older individual who is experiencing joint pain in the feet or ankles? If so, you may have foot and/or ankle arthritis. This is caused by wear and tear to the cartilage around joints in your feet or ankles, and can result in pain, stiffness, or swelling around the joints. Complex foot and ankle specialists, Doctors Thomas Haytmanek and Jonathon Backus, have treated many patients in Vail and Frisco, Colorado, as well as Denver, Boulder, and surrounding Summit County areas who have experienced ankle pain and swelling. Contact The Steadman Clinic’s Sports Foot and Ankle team today!
What is Ankle Arthritis?
Arthritis is a debilitating disability that affects thousands of individuals in the United States. It can occur at any age, but usually affects the older adult population in more severe cases. Arthritis means “joint pain” or “pain within a joint” and it can affect any joint in the human body.
Arthritis is a degenerative condition of the bones and joints that occurs when the natural smooth surface that covers the ends of the bones (known as cartilage) becomes worn, frayed, and damaged. This wear and tear of cartilage eventually results in persistent pain, swelling, and inflammation around the joint. This particular type of arthritis is known as osteoarthritis. It typically worsens with age progressing slowly resulting in pain and stiffness.
Other individuals have what is referred to as post-traumatic arthritis which is arthritis that is caused by a previous injury to the ankle. An example of this would be a broken ankle bone or a severe ankle sprain where ligaments and tissue suffer damage. This can occur in young adults as well as in older individuals.
Rheumatoid arthritis is another form of arthritis that is one of several inflammatory diseases that affect the patient’s own immune system. This type of arthritis attacks and destroys cartilage and is a system-wide disease affecting more than one joint but can often begin in the foot or ankle. Other forms of inflammatory arthritis include ankylosing spondylitis, psoriatic arthritis, and reactive arthritis or Reiter’s syndrome.
Although arthritis does not have a specific cure, there are many joint preservation techniques and arthritis treatment procedures that are available to help minimize the pain and manage the symptoms associated with this disease.
What are the Symptoms of Ankle Arthritis and/or Foot Arthritis?
The symptoms associated with arthritis include a constant ache, dull pain, stiffness of the joints, limited mobility, and swelling. Arthritis of the foot and ankle can present pain in any of the areas of the foot including the ankle, the toes, the midfoot section, or the hindfoot section. Individuals with arthritis of the foot and ankle will have a difficult time walking, especially first thing in the morning and after sitting for long periods of time. These symptoms are almost always worsened with certain activities such as running, jumping, and vigorous movement.
How is Ankle Arthritis and/or Foot Arthritis Diagnosed?
Out team will conduct a thorough physical examination of the foot and ankle and will check for arthritic symptoms and overall mobility. Questioning for any past injury that involved the ankle and an assessment of any prior injuries will be taken into consideration along with any family history of osteoarthritis or inflammatory arthritis. In patients without a prior diagnosis of arthritis, it is sometimes necessary to perform blood tests, x-rays, and/or other imaging methods such as an MRI. In most cases, based on the symptoms present, and the patient history, a specific diagnosis of arthritis in one of these forms can be made.
What are the Treatment Options for Ankle Arthritis and/or Foot Arthritis?
Treatment for arthritis in earlier stages consists of non-narcotic pain relievers, shoe inserts or arch supports, specific arthritis medications, ice, and rest. Managing arthritis using these approaches, mixed with eliminating or decreasing the activities that cause the arthritis to flare up, are effective in minimizing the symptoms over time. If arthritis does not respond to these conservative treatments, particularly in the case of inflammatory arthritis to involve a rheumatologist who is a non-surgical specialist in these forms of arthritis. In other situations, the use of biologics such as platelet rich plasma (PRP) or mesenchymal stem cells may be useful even though these are not typically covered by insurance. Surgery becomes a consideration when conservative measures have failed.
How is Ankle Arthritis Helped with Surgery?
For patients who are not able to find relief even after exhausting all conservative measures, there are surgeries that can be performed to treat the symptoms associated with this condition.
The specialists at The Steadman Clinic’s Sports Foot and Ankle may opt to perform one of the following procedures:
Arthroscopic Debridement Surgery
This is a surgery that is performed arthroscopically using small incisions and instruments to allow a visible look at the inside of the ankle joint. The small camera allows the surgeon to see if any foreign tissue, bone spurs, loose cartilage, or broken pieces are floating or lodged within the joint. Using a shaving instrument, small graspers and burrs, it is possible to clean up the joint and surrounding tissue and remove these fragments, a process known as debridement.
Fusion Surgery
Fusion surgery, known as an arthrodesis, is performed using hardware such as plates, screws and/or staples. These are designed to fuse the bone (or bones) of a joint together making one continuous bone. If bone loss is present, a bone graft may be used to complete this process. This surgery has been the “gold standard”* for the treatment of severe arthritis in the ankle joint for over a century since it very effective in relieving pain and restoring stability to a severely arthritic ankle joint.
*Recent studies have shown that fusion/arthrodesis has been the gold standard for ankle arthritis but ankle replacement is gaining traction and becoming used more often, depending on patient-specific factors.
Ankle Replacement Surgery
Joint replacements for the hip and knee have become so successful that it has been categorized as one of the most important medical breakthroughs of this century. In May 2009, the FDA approved a newly designed, 3-part, cementless ankle replacement that was originally designed in Denmark called the Scandinavian Total Ankle Replacement (STAR). This approval came after a seven-year analysis of the STAR ankle in a study performed at ten institutions in the United States with over 600 patients involved. The prospective controlled trial began in Sept 2000 with enrollment of the Pivotal Study Group and concluded with closure of enrollment of the Continued Access Group in Oct 2006. As one of the investigators in this study, Dr. Clanton (retired) found the STAR ankle to be very effective in treating ankle arthritis in certain of his patients. He brought the procedure of total ankle replacement with him to Vail in 2009 beginning with the STAR ankle. Other ankle joint replacement procedures have since been developed and are included in Dr. Haytmanek and Dr. Backus’s surgical procedures depending on various factors in the patient’s individual, arthritic situation.
The best patients for total ankle arthroplasty are older individuals (usually above age 65) who have arthritis of the ankle that is caused by osteoarthritis, inflammatory arthritis, or post-traumatic arthritis. There are certain conditions that make joint replacement less desirable such as a history of joint infection, severe neuropathy, or severe deformity. For the younger individual with arthritis of the ankle, ankle arthroscopy or ankle fusion may be better alternatives, but patients are carefully evaluated on an individual basis
Those ankle arthritis patients who undergo joint replacement can generally be expected to resume walking, hiking, road biking, skiing, and playing golf once their ankle is fully rehabilitated, but they cannot engage in high impact activities like running and jumping.
What is the Recovery Following Ankle Arthritis Surgery?
It is essential that patients follow the post-operative protocol for recovery as set forth by their surgeon as it remains a crucial part of the healing process. Following arthroscopic ankle surgery, rehabilitation exercises are prescribed which are performed with a therapist, and at home. Following ankle replacement surgery, a similar, yet lengthier physical therapy program is necessary. Recovery from ankle surgery is a joint process that requires participation between the patient, the family, the physical therapist, and the surgeon and should be seen through to the end for optimal results.
For information on arthritis of the foot and ankle, and to learn more about the STAR or other ankle replacement techniques performed by Drs. Haytmanek and Backus, please contact our Vail, Colorado office at The Steadman Clinic (970-476-1100).
