Managing An Arthritic Ankle with Orthotics
Gait impairments caused by the debilitating condition of ankle arthritis can significantly affect an individual’s quality of life.
The articular surface of the ankle joint, composed of the talus, tibia and fibula, is stabilised by medial, lateral and syndesmotic ligaments which facilitate an even distribution of force throughout ankle range of motion.
The ankle joint, when compared to the hip or knee, is considered to be less susceptible to cartilage degeneration because of higher joint surface congruency and the constrained nature of articulation.
Trauma has been clinically established as one of the primary triggers for the onset of a degenerative condition such as arthritis of the ankle joint.
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As stated by James G. DiStefano in his study on the aetiology and epidemiology of ankle arthritis, trauma can cause arthritis either by direct cartilage injury, uneven joint loading, altered loading or a combination of these factors.
Significant cartilage damage is produced by axial load Pilon fractures when compared to rotational ankle fractures because of the higher degree of compression forces on the articular surface of the ankle joint.
Underlying alignment abnormalities in the sagittal and coronal plane can cause alterations in the mechanical loading properties of the ankle joint, for instance, a varus alignment of the ankle increases loading per unit area causing gradual decompensation of the joint.
Arthritic changes can also occur due to disruptions in the ligaments of the ankle which lead to ankle instability and biomechanical alterations, eventually creating a varus ankle deformity. This leads to subsequent medial-sided arthritic changes.
Devising treatment strategies for an arthritic ankle requires individual assessment of the condition since the pathogenesis of arthritis is complex.
The first line of treatment needs to include conservative treatment options such as an orthotic intervention designed to off-load stress from the tarsometatarsal joints, preventing rapid degeneration of joints and providing relief from inflamed joints to the individual.
In addition to decelerating the onset of a progressive deformity such as arthritis, customised orthotics such as MASS4D® can improve stability of the ankle by restoring optimal range of motion at the ankle joint complex and facilitating an even distribution of pressure across the plantar surface of the foot.
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References:
- DiStefano G. J., Pinney S. (2010) Ankle Arthritis: Etiology and Epidemiology. Seminars in Arthroplasty: December 2010, Vol. 21, No. 4, pp. 218-222
- Espinosa N., Klammer G. (2010) Treatment of Ankle Osteoarthritis - Arthodesis versus Total ankle replacement. European Journal of Trauma and Emergency Surgery: December 2010, Vol. 36, No. 6, pp. 525-535
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