Dr. Robert Leland on Treating Arthritic Ankles

When arthritis strikes the ankle, it isn’t like the “wear and tear” type that develops from aging hips or knees. The most common trigger for ankle arthritis is an old injury.

“You can get ankle arthritis as a delayed response from a fracture or a major sprain that occurred years ago. We call this post-traumatic arthritis,” fellowship-trained orthopedic foot, ankle and trauma specialist Robert Leland, MD, of BoulderCentre for Orthopedics told a crowd of 125 people during a free health lecture held in Boulder.

Besides injury, there are other risk factors for ankle arthritis. Dr. Leland said these include:

• Rheumatoid arthritis, in which certain cells of the immune system malfunction and attack the joint.
• Chronic instability, or when your ankles “give way.” This instability tends to occur while walking on uneven surfaces, climbing stairs or making side-to-side movements.
• Foot deformities such as high arches or flat feet.
• Avascular necrosis, a condition that develops when blood flow to the joint is interrupted. Common causes of avascular necrosis are the long-term use of high-dose steroid medications and excessive alcohol intake.

“Regardless of the cause, the end result is an ankle joint with damaged or worn out cartilage. This produces bone-on-bone friction, leading to inflammation and pain,” said Dr. Leland.

Treatment for Ankle Arthritis
According to Dr. Leland, treatment of ankle arthritis should always begin with these simple steps:

• Activity modification - limiting activities such as running and jumping, which can put too much strain on the ankles.
• Anti-inflammatory medications - taking these drugs to reduce joint inflammation and pain. However, Dr. Leland suggested to use them carefully as there are possible side effects.
• Shoe modifications - trying cushioned inserts or having a shoe repair shop add a "rocker-bottom" to the sole of your shoe.
• Braces – purchasing a brace at the drugstore to hold your ankle joint in position and prevent excessive motion. If this doesn’t help, a custom-made brace might be the next step.
• Injections – having cortisone or hyaluronic acid injections for temporary pain relief and a reduction in swelling.
• Regenerative medicine – trying platelet rich plasma (PRP) injections or stem cell therapy to reduce discomfort. However, Dr. Leland warned that if you opt for this type of treatment, it’s imperative to have a physician who understands the proper indications and applications involved in the therapy process.

Surgical Treatment for Ankle Arthritis
“If non-surgical treatments don’t help, then your physician may suggest surgery,” Dr. Leland asserted. He explained that surgical options for ankle arthritis include:

• Ankle preservation, which involves either “cleaning out” any bone spurs or fragments and smoothing joint surfaces (debridement) or cutting and reshaping the bone (osteotomy). These procedures can often be performed arthroscopically with small incisions.
• Ankle fusion removes the worn-out ends of two bones in the ankle joint and locks their ends together with screws or a plate so the body can grow a bone bridge across the joint. Once the fusion becomes solid, there’s pain relief but movement of the ankle becomes limited. “This is the most time-tested method of surgical treatment for ankle arthritis, with an 85-to-90 percent success rate,” Dr. Leland stated.
• Ankle replacement (total ankle arthroplasty) removes your damaged joint and replaces it with an artificial one. “The advantage of a replacement is that you can move your ankle after the procedure and enjoy a more normal ankle function,” Dr. Leland explained. “However, this surgery is best suited for patients who are not overweight, don’t have a foot deformity, aren’t smokers or don't have diabetes and will put low demands on the ankle.”

To make an appointment with orthopedic surgeon Robert H. Leland, MD, call (303) 449-2730.

View PowerPoint slides from his lecture on "Easing Foot and Ankle Pain."