Definition

Ankle arthritis is degeneration of the cartilage within the tibiotalar joint that can result from a wide range of causes, most commonly post-traumatic degenerative joint disease. An acute injury or trauma sustained a number of years before presentation or less severe, repetitive, minor injuries sustained during a longer period can lead to a slow but progressive destruction of the articular cartilage, resulting in degenerative joint disease [1]. Other common types are primary osteoarthritis, inflammatory arthritis (including rheumatoid, psoriatic, and gouty), and septic arthritis. Osteoarthritis is usually less inflammatory than rheumatoid arthritis but can also involve many joints simultaneously.

Symptoms

As with arthritis of any joint, the presenting symptoms are pain (which may be variable at different times of the day and exacerbated by activity), swelling, stiffness, and progressive deformity [1]. The ankle may be stiff on initial weight bearing; this improves after walking a while but then worsens with too much ambulatory activity. The pain is often relieved with rest. Pieces of the cartilage can break off, forming a loose body, and the joint can “lock” or “catch,” sticking in one position and causing acute, excruciating pain until the loose body moves from between the two irregular joint surfaces. Another symptom is that of “giving way” or instability of the joint, which may be a result of surrounding muscle weakness or ligamentous laxity. With progression of the arthritis, night pain can become a major complaint.

Physical Examination

Swelling, pain, and possibly increased temperature on palpation may be present. The pain is usually maximal along the anterior talocrural joint line and typically chronic and progressive. If the patient’s other ankle is normal, it is important to compare the two. Deformity and reduced range of motion in plantar flexion and dorsiflexion (normal: up to 20 degrees of dorsiflexion and 45 degrees of plantar flexion) may be seen. The patient may exhibit an antalgic gait or a limp. Acute arthritis is manifested very differently. Onset is rapid with associated warmth, erythema, swelling, and severe pain with passive range of motion and may be accompanied by constitutional symptoms such as fever and rigors.

It is appropriate to examine the other joints in the lower limb, particularly the knee. The findings on neurovascular examination are typically normal. Decreased sensation in the lower limb raises the possibility of a Charcot joint causing a destructive arthropathy (see Chapter 128).

Functional Limitations