Q: I have arthritis in one ankle, which stems from a bad break I suffered in my wild and woolly 20s. Now that I’m in my 40s, I’m really feeling the effects. Is there any way to tell if it’s getting worse over time, and when I should think about surgery? I’d like to delay surgery as long as possible.
A: Ankle arthritis, though less common than arthritis in the hip or knee, can be just as disabling. It is possible to track the progression of ankle arthritis by taking baseline measurements and monitoring changes over time. The impact of ankle arthritis on daily function can be referred to as impairment of function.
There are several ways to assess this function, including measuring the number of steps you take each day, your step length, walking speed, and the range of motion in your ankle. These measurements can be compared to those of healthy adults of the same age and gender who don’t have any ankle issues. Alternatively, they can be compared to your unaffected ankle if it’s still in good condition. However, using your healthy ankle as a control may not be ideal since arthritis on one side can cause compensatory changes in the other side, even if it’s not injured.
Deciding between ankle fusion (arthrodesis) and ankle replacement (arthroplasty) can be challenging. Ankle fusion eliminates pain by stopping motion in the ankle joint, but this can lead to changes in your walking pattern, which might cause problems later on. Ankle replacement, on the other hand, preserves ankle motion and can reduce stress on surrounding joints, but long-term studies on ankle replacements haven’t shown consistently outstanding results yet.
The key questions are: Is your ankle function worsening over time due to arthritis? If so, how can you measure this decline? At what point should surgery be considered the best option? And finally, which surgical option—fusion or replacement—is best for you?
While not all these questions have clear answers yet, researchers have started evaluating which tests and measures provide the most useful information about function and limitations due to ankle arthritis. They’re beginning to understand how end-stage ankle arthritis impacts health and quality of life, which might help guide future treatment decisions.
Measurements like average walking speed, daily step count, and step length can provide insight into your ankle function and overall physical condition. These tests could potentially help identify when treatment should start and what type of treatment would be most effective.
Unfortunately, there isn’t yet enough detailed information to definitively guide your decision. Your surgeon is the best person to help you navigate these choices. They can advise you on how long to continue with conservative treatments (non-surgical care) and when it might be time to consider surgery. They’ll also help determine which type of surgery—fusion or replacement—would be most appropriate for your specific case.
Reference: Ava D. Segal, MS, et al. Functional Limitations Associated with End-Stage Ankle Arthritis. In The Journal of Bone and Joint Surgery. May 2, 2012. Vol. 94. No. 9. Pp. 777-783.