Knee / Ankle / Foot

Gonarthritis

Definition

Gonarthritis of the ankle is a degenerative disorder of the knee joint related to overload, or to age or systemic diseases, and can be accompanied by inflammation.

Aetiology

The cause of osteoarthritis in the ankle is degenerative changes in the joint due to age, infection, trauma, or systemic diseases such as rheumatoid arthritis. There is a clear relation with genetic factors, age, gender, obesity, previous trauma and work load. The highest prevalence is seen after the age of 65 years and increases till 44% after the age of 85 years..

Signs and symptoms

The pattern of symptoms is generally characterised by pain during activities. In particular, climbing stairs can provoke knee pain. In addition, period with swelling of the knee can occur. When other joints are involved, a systemic disease is likely.

Diagnostics

Physical Examination

Apart from palpation, on physical examination, passive and active extension and flexion of the knee is important for establishing knee motion restriction.

Additional Somatic Diagnostics

  • Standard X-ray ankle.
  • When systemic diseases are suspected, referral to a rheumatologist is indicated.

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis.  Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment consisting of various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Acetaminophen
  • Cyclo-oxygenase-2 (COX-2 blockers)
  • NSAID
  • Topical NSAID

Other Treatments

Interventional Pain Treatment