Ankle and Foot Arthritis
The term arthritis indicates cartilage damage that can lead to varying degrees of narrowing of the joint due to the loss of cartilage, which in essence is the shock absorber of the joint. Advanced cases of arthritis are often referred as “bone-on-bone” which implies little or no remaining cartilage. Common causes of arthritis include osteoarthritis (wear and tear or aging), posttraumatic or rheumatological.
Initial treatment of arthritis depends on the patient’s symptoms. Options include activity modification, oral anti-inflammatories, topical cream anti-inflammatories, bracing and inserts. Injections can provide temporary relief. While other medications or substances can be injected, the most common is a cortisone injection. When a patient fails nonoperative treatment, the patient can consider surgical options. The following is a discussion of the most common surgical treatment options for ankle and foot arthritis.
If the ankle arthritis is mild, then an arthroscopic debridement or “clean out” can provide relief. If the arthritis is more severe, then an ankle fusion or replacement could be considered. An ankle fusion is a good option for some of patients. A common misperception is that the entire ankle and foot is fused resulting in a stiff “Frakenstein” ankle/foot. In reality, only the ankle joint is fused and leads to approximately 50% of loss of total motion of the entire foot and ankle. Often times, the ankle joint is already stiff and lacks motion so the perceived further decrease in motion is less. A fusion provides a stable ankle with complete or significant pain relief. There are multiple generations of ankle replacements. The initial generations had poor results, but the most recent generation has good success and outcomes. It is now certainly a viable option for advanced ankle arthritis. Dr. Mroczek will discuss these surgical options and help you decide which is best for you based on your degree of arthritis, level of activity and overall health.
Hindfoot and Midfoot Arthritis
The only option for this type of arthritis is a fusion. Replacements are not available and are generally not even in development. A fusion provides pain relief and correction of any deformity if present.
Big Toe (Hallux MTP) Arthritis
Hallux rigidus refers to a painful and stiff great toe at the metatarsophalangeal joint (MTP). In early stages, the patients will notice a bone spur on the top of the joint which limits the upward motion (dorsiflexion). If the joint has minimal or mild arthritis, then a simple cheilectomy is indicated. The surgery involves removing the bone spur which usually results in less pain and increased motion. If the arthritis is advanced then the best option is a fusion. This provides pain relief and a stable great toe to pushoff and restore a more normal walking pattern. While joint replacements are commercially available, in my opinion, the results are poor and I do not recommend the procedure.