Arthritis in the leg and ankle

Arthritis is a common condition that affects the joints and can have various causes such as degenerative, inflammatory and post-traumatic. Although the causes may be different, they have as a common result the degeneration and reduction of the thickness of the articular cartilage, exposed bone articular surfaces and bone erosion. Clinically, patients may experience swelling, stiffness and pain that limits their activities. In more advanced forms, bone erosion inside the joints can also create deformities.

The anatomical area of the foot and ankle includes about 33 joints in which arthritis can develop. The ankle joint (ankle – tibia – fibula) can develop arthritis as a result of a fracture. Injury from the fracture and any mismatch (i.e. matching) of the broken pieces of bone (the so-called subcutaneous limbs) can cause post-traumatic arthritis. Correspondingly, the sub-astragal joint can develop arthritis after fractures of the ankle or heel, or as a final stage in other deformative diseases of the hind leg. The joints in the middle leg can also develop arthritis after losing the height of the arch of the foot. One of the most common joints that develop arthritis in the front leg is the first metatarsiophalangeal joint, that is, a joint at the base of the big toe. This is partly due to the great forces exerted on this joint on a daily basis. It is estimated that about 50% of the forces pass through the joint of the big toe during loading and walking, while all the other fingers share the other 50%. This means that the joint at the base of the big toe is subject to more wear and tear, which ultimately leads to arthritis.

When symptoms of arthritis appear, gradual treatment is recommended. Usually, simple X-rays are performed to determine the degree of arthritis, while in some cases imaging is also done with CT scan. An MRI scan may also be requested by your surgeon to ascertain the degree of wear and tear of the articular cartilage, and to rule out other pathological conditions in the area. If the main clinical and imaging features of the condition match an autoimmune disease, a comprehensive rheumatological assessment will be requested to substantiate the correct diagnosis (such as rheumatoid or other inflammatory arthritis). In these cases, the condition can be treated mainly with medication without the need for surgery.

Arthritis is initially treated with conservative means. These initially include modifying daily life by reducing high-energy activities such as running and replacing them with others such as walking, cycling and swimming. Simple analgesics and anti-inflammatory ointments may provide symptomatic relief. Using supportive footwear with a suitable sole or with ankle support in case of arthritis in the ankle can also reduce symptoms. Orthopedic insoles or other orthotic aids can be very helpful, especially in arthritis that affects specific areas, such as that of the big toe (the so-called “stiff big toe” – hallux rigidus). In some cases, using a cane or losing weight will significantly reduce symptoms. Your surgeon may also recommend a topical injection with an anesthetic and steroid or some other substance (such as hyaluronic acid or concentrated platelets – Protein Rich Plasma / PRP). This can help both symptomatic relief and diagnostics, in cases where pain is difficult to pinpoint accurately.

Surgical treatment is applied to patients who have not been relieved with conservative means. The type of surgery depends on the location of the arthritis. In the ankle joint, in cases where the pain is mainly due to impact/friction, treatment may include simple arthroscopy to clean the areas that collide and cause pain. More advanced arthritis can be treated with arthrodesis (i.e. joining the bones of the joint) or with ankle arthroplasty (equivalent to knee and hip arthroplasty). The potential risks and the recovery time of the two operations differ significantly and for this reason patients need detailed and long information from the surgeon about the appropriate treatment option for them, taking into account important parameters such as the patient’s daily needs, age and other medical conditions. Arthrodesis in the larger joints of the foot (ankle/—-, sub-astragalus) can generally be performed either arthroscopically, or as an open operation. Smaller joints are generally treated with open articulation.

After the operation, patients will need not to load their leg for a period of time to be determined by the surgeon, depending on the type of articulation and each case. As a rule, a type of plaster splint is first applied, which is replaced by a kind of postoperative boot, and then by ordinary commercial sneakers. Rehabilitation will be monitored by your surgeon at regular intervals postoperatively for months after surgery. Based on the clinical re-evaluation and X-rays, appropriate instructions will be given to ensure a good postoperative result.