The ankle is the joint where the bones of the leg, the tibia and the fibula, meet the talus, which is the bone above the heel bone. Normally, the surfaces of our joints are covered with cartilage, which is invisible to the x-ray beam, so there is the appearance on x-ray of a space between the bones. There is not actually a space there, but it looks that way since the cartilage can’t be seen. Here are some normal appearing ankle xrays:
Sometimes, the cartilage of the ankle can wear away. This condition can occur due to multiple reasons, but the most common are trauma and inflammatory problems, like rheumatoid arthritis.
In this example to the left and below, the patient had a fracture many years ago, and the cartilage, which is often injured at the time of the trauma, kept slowly wearing away so there was no residual joint space.
This loss of cartilage means that instead of the joint moving smoothly and painlessly, the surface becomes rough, with the bone ends beginning to grind together. The result is a decreased range of motion, and and increase of pain and disability.
In cases of ankle arthritis, the
treatment options include:
Medications (anti-inflammatory medicines, pain medicines)
Mechanical support (Ankle Foot Orthosis, also called AFO)
or surgery, like an ankle fusion, pictured below. In a fusion operation, the arthritic bone surfaces are removed, and the situation is created where the body reacts as if it were a fracture and tries to heal the two bones into one bone. The fusion procedure is like gluing the two bones together with bone.
Another option might be ankle joint replacement, or artificial ankle. For this joint replacement procedure, however, there is a lot of stress concentrated on a small surface area, and the ideal patients would be those with low activity demands. For patients interested in that procedure, a referral can be facilitated.