Ankle arthritis and total ankle replacement

What is ankle arthritis?

The ends of the ankle bones are covered with a smooth cushion (cartilage). Arthritis means this cushion wears thin. This causes pain and stiffness.

In the ankle, arthritis most often follows an old injury, such as a broken ankle or many sprains (post-traumatic arthritis). It can also come from wear and tear over time, or from a disease that inflames the joints, such as rheumatoid arthritis (inflammatory arthritis).

Signs to watch for

• Deep ankle pain, worse with walking or standing
• Stiffness, especially in the morning or after sitting
• Swelling around the ankle
• Trouble walking on hills, stairs, or uneven ground

Treatment without surgery

Options include:

• An ankle brace to limit painful motion
• Shoes with a curved, "rocker" sole that help the foot roll forward
• Changing activities, such as swimming instead of running
• Physical therapy for strength, balance, and motion
• Medicines for pain and swelling, if safe for you
• An injection into the joint to calm pain for a time

Surgery choices: replacement or fusion

If pain still limits your life, there are two main surgeries.

Ankle replacement (total ankle replacement, or ankle arthroplasty). The worn joint surfaces are replaced with metal and plastic parts, so the ankle keeps some motion. You may be a good candidate if you have:

• Healthy, strong bone
• An ankle that is fairly well lined up
• Good blood flow to the foot and healthy skin around the ankle
• Goals that do not include heavy impact, such as running, jumping, or heavy labor

A replacement may not be a safe choice if you have an active infection or a past deep infection in the ankle, severe nerve damage or Charcot foot, weak or soft bone, a severe deformity, or poor blood flow. Smoking and poorly controlled diabetes can also raise the risks. The parts can wear or loosen over time, and another surgery may be needed later.

Ankle fusion (ankle arthrodesis). The bones are held with screws or plates until they heal as one. Fusion is a very reliable way to relieve arthritis pain. The trade-off is that the ankle no longer bends. Fusion is often the better choice for people with heavy work demands, a severe deformity, or health problems that make a replacement risky.

Recovery

Recovery depends on the surgery, your bone healing, and your health. Most people start in a splint, then move to a walking boot (CAM boot). You often keep weight off the foot for several weeks, using a knee scooter, crutches, or a walker. Then you slowly add weight, move into shoes, and start physical therapy. Full recovery often takes up to a year. Learn more about getting around after surgery.

How Dr. Nafal can help

Dr. Nafal is board qualified by the American Board of Foot and Ankle Surgery in Foot Surgery and in Reconstructive Rearfoot and Ankle Surgery. He performs both total ankle replacement and ankle fusion. He explains every option in plain words, including options that don't involve surgery.

Common questions

Am I too old for an ankle replacement?

Age is only one part of the decision. Your bone health, ankle alignment, blood flow, and activity goals matter a great deal.

Which is better, a replacement or a fusion?

A replacement keeps some motion. A fusion is very reliable and often holds up better under heavy use. Dr. Nafal will walk you through the trade-offs for your ankle.

Do I have to try other treatments first?

For most people, yes. Braces, shoes, therapy, and injections help many people. Surgery is usually considered when these no longer give enough relief.