Knee / Ankle / Foot

Osteoarthritis Ankle

Definition

Osteoarthritis of the ankle is a degenerative disorder of the ankle 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. Primary idiopathic osteoarthritis of the ankle is almost never seen before the age of forty.

Signs and symptoms

The pattern of symptoms is generally characterised by limitation of movement and pain in the ankle, which increases whenever any weight is put on it. Walking is particularly painful. The ankle may also be swollen at times. If other joints are also involved, this is an indication of a systemic condition, such as arthritis. When other joints are involved, a systemic disease is likely.

Diagnostics

Physical Examination

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

Additional Somatic Diagnostics

  • Standard X-ray ankle.
  • When systemic diseases are suspected, referral to a rheumatologist is indicated.
  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Additional Psycho-cognitive Diagnostics

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