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 Medications
Acetaminophen
•
•
•
•
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.
Talar
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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 Ankle
Replacement
Before
After
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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