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.
Drs. Clanton and Haytmanek 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, 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 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. Clanton and Haytmanek’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. Clanton and Haytmanek, please contact our Vail, Colorado office at The Steadman Clinic (970-476-1100).