Treatment Options for Severe Ankle Pain

Anatomy of the Ankle

• Hinge Joint• Made up of 3

bones• Lower end of the

tibia (shinbone), • Fibula (the small

bone of the lower leg)

• Talus, the bone that fits into the socket formed by the tibia and the fibula

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Ankle Joint

• Healthy ankle joint

• Arthritic ankle joint

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Causes of Ankle Pain

• Osteoarthritis (wear and tear)

• Common joint injuries• Fractures and sprains

• Excessive stress causing damage to the cartilage.

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Symptoms of Ankle Pain

• Pain • During activity• At rest or sleeping

• Swelling and Tightness• Squeaking or grinding sound when

ankle is moved.• Stiffness and decreased movement

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Preparing for Examination

• Have the following information ready for your exam:• Chief complaint (Where it is hurting

the most?)• Chronology of illness• What effect does the pain have on

your life?• Family history

Diagnosing Ankle Pain

• Physical Examination• Range of Motion Test

• Medical History Review• X-rays

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How Can My Life Change with Treatment?

• A return to mobility

• Regaining a sense of your former lifestyle.

• A change in pain symptoms

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Non-Surgical Treatment Options for Ankle Pain: Over-the-Counter

Medications• Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)

• Usually first drug used to treat arthritis• Can reduce pain, swelling and redness• Relief can take several months• Examples:

• ibuprofen (Advil®, Motrin®)• naproxen (Aleve®)

• Aspirin• Reduce joint pain and inflammation• Form of NSAIDs.

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Non-Surgical Treatment Options for Ankle Pain: Over-the-Counter

MedicationsAcetaminophen

• Reduces pain• Lowers fever• Does not reduce inflammation of arthritis• Examples:

• Tylenol®• Datril® Extra Strength• Tempra®

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Non-Surgical Treatment Options for Ankle Pain: Prescription Medications

• NSAIDS • Most popular type for osteoarthritis treatment• Includes ibuprofen (Motrin®), naproxen sodium

(Anaprox®), oxaprozin (Daypro®), sulindac (Clinoril®) , etc.

• Analgesics • Provide pain relief, but do not reduce

inflammation• Includes Acetaminophen with codeine (Tylenol®

with Codeine), Oxycodone (OxyContin®, Roxicodone®), Hydrocodone with acetaminophen (Vicodin®, Dolacet®), etc.

Non-Surgical Treatment Options for Ankle Pain: Prescription Medications

• Biological Response Modifiers • Treat rheumatoid arthritis; may postpone injury to the joints• Includes: Infliximab (Remicade®), Etanercept (Enbrel ®)

• Glucocorticoids or Corticosteroids • Treat rheumatoid arthritis; fight inflammation• Includes: cortisone, hydrocortisone (Cortef®,

Hydrocortone®), Prednisolone (Prelone®) • DMARDS

• Treat rheumatoid arthritis; slow joint destruction• Includes: methotrexate, injectable gold, penicillamine

(Depen®), Azathioprine (Imuran®), etc.

Non-Surgical Treatment Options for Ankle Pain

• Physical Therapy• Assistive devices

• Orthosis, walking aids• Activity Modification

• Avoid activities that put excessive stress on the ankle joint.

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Surgical Options for Ankle Pain

• Arthroscopic Debridement• Appx. 11,200 debridements a year.

• Ankle Fusion surgery• 12,000 fusions estimated for 2003.

• Ankle Replacement surgery• Appx. 1,500 replacements a year.

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Arthroscopic Debridement

• Early stage of arthritis and ankle damage.

• Small camera is inserted into the ankle through small incisions.

• Remove debris• Cartilage surfaces smoothed.

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Ankle Fusion Surgery

• End stage of arthritis and ankle pain• Traditional treatment historically• Fuse the bones of the joint to grow

together.• Results in :

• Strong joint• Eliminate pain• Immobile ankle (no range of motion).

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Ankle Fusion Surgery• Incision is made.• Fibula and tibia are

held together until they heal and fuse into one with:• Pins• Plates• Screws

• A bone graft is sometimes needed.

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Ankle Fusion Surgery• Benefits of ankle fusions

• Durable and strong• Usually walk with a near normal gait• Removes pain of arthritis

• Disadvantages of ankle fusion• Immobile joint; forcing remaining joints to move

more.• Load transfer leading to arthritis• Uneven leg lengths, may cause limping

“

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Ankle Replacement surgery

• End Stage of Arthritis and Ankle Pain• Replaces Diseased Bone• Results

• Moveable Ankle Joint• Eliminates Pain

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•When is Ankle Replacement Surgery Right for You?

• Significant pain, even when sleeping.

• Loss of function despite non-surgical treatments.

• Pain is no longer manageable.• Mobility similar to normal ankle is

desired.

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Total Ankle Replacement Components

• Tibial component • made of medical

grade plastic with a metal base plate tray.

• Talar Component• made of metal• replaces the top of

the talus. TalarTalar

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Benefits to Patient from Surgery

• Return to Mobility• Restore their lifestyle• Freedom

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Surgical Procedure

• Incision is made • All arthritic portions of the ankle

joint are removed.• Tibia (shinbone) and fibula are

shaped for the implant.

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Surgical Procedure

• After the top of the talus is cut the talar component is inserted and tested.

• The ankle joint is closed.• Your leg will be wrapped in

a bandage and placed in a splint as it heals.

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X-Rays Before-After Total X-Rays Before-After Total Ankle ReplacementAnkle Replacement

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Preparing for Joint Replacement Surgery

• Ease anxiety by mentally preparing with:• Breathing exercises• Meditation• Talking with family and friends

• Learn more about ankle replacement surgery• Brochures• Handouts• Websites• Videos

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The Night Before Surgery

• Avoid medications, such as “blood thinners” (aspirin, ibuprofen, etc.)

• Do not consume any food or liquid after midnight.

• Make sure you have everything you’ll need at the hospital.

• Ask any questions you may have before surgery.

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After Surgery

• Foot is elevated and immobilized in a splint.

• Basic gentle range-of-motion exercises are started.

• The dressing is normally removed two days after surgery.

• If necessary, physical therapy will be prescribed by your doctor.

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Hospital Discharge

• Hospital stay • Three to five days• Dependent on healing.

• May need some assistance for several weeks after surgery.

• Post-operative care period lasts for approximately six weeks.

• Follow surgeon’s directions precisely.

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A Caregiver’s Role

• Provide support and show patience• Help with needs that the patient can

not do, like:• Meal preparation• Grocery shopping• Laundry• Driving to medical appointments

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Recovery in the First Week

• Use a walker or crutches• No weight on your ankle until

instructed by your doctor.• Range-of-motion exercises at least

two to three times a day.• Special precautions during bathing.

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Recovery in the First Month

• “Post-operative” visit• X-rays • Examination

• 2 Weeks: Sutures Removed

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Recovery After Six Weeks

• 6 weeks (with Doctors Instruction)• Gradually put weight on the leg • Use of a cane or walker.

• Begin Driving • 6 to 8 weeks - automatic shift • 12 weeks – manual shift

• 12 weeks - low-impact activities, such as walking.

• Up to 1 year - may require the use of an ankle support

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Questions?

Thank-you