Tell me about end-stage arthritis in my left ankle.

Q: I have what's called end-stage arthritis in my left ankle. It really affects my walking. Even getting around the house can be a real chore some days. I try not to let this get me down but I have to admit it does put a damper on my life. Do other people feel this way too? Or am I just having a pity party for myself?

A: Severe ankle arthritis is less common than hip or knee arthritis but just as disabling. So say researchers at the VA Medical Center in Seattle Washington. Researchers from the Mechanical Engineering and Orthopaedics and Sports Medicine centers at the University of Washington also assisted in bringing this information to us in a recent study.

They studied 37 patients (men and women) who were expected to have ankle surgery for severe arthritis classified as end-stage arthritis. All patients in the study had failed to achieve pain control or improved function with conservative (nonoperative) care. Surgery to either fuse the ankle or replace it was scheduled.

The purpose of the study was to measure the impact of this type of ankle arthritis on function referred to as impairment of function. They used several different ways to assess function including counting the number of steps taken each day, step length, walking speed, and ankle motion. These measurements were compared to normal, healthy adults of the same age and sex (male or female) who did not have any ankle problems.

The question they asked was: is function affected by end-stage ankle arthritis? If so, how can we measure the amount of disability? At what point do the results of these tests suggest surgery is the best treatment? And finally, which type of surgery is best: fusion or replacement?

Not all of these questions were answered by this study. But the researchers at least got a start on evaluating which tests and measures provide the most information about function and activity limitations. And they began to see how the effects of end-stage ankle arthritis impact health and quality of life for these patients (just like you have experienced).

Analysis of the data showed that everyone had decreased ankle motion and power compared to the unaffected side. Average walking speed, number of steps taken each day, and length of steps were less than those of normal (control) adults. These measures were also correlated with physical function. Just moving around a room took more energy, more steps, and more time compared with normal, healthy adults. Those patients who had better physical function also had less pain and a better mental attitude.

It's likely you will see yourself in some of these results: loss of function, increased pain, and decreased motion do tend to reduce quality of life and affect mental (and physical) health. There may still be some help that could improve your situation.

If you haven't already tried physiotherapy that is usually the first-line of treatment. Surgeons recommend giving this type of conservative care a good three to six months' trial before throwing in the towel. Surgery is an option and some patients are better candidates than others. Your surgeon will be able to evaluate you and guide you through this process.

Reference: Ava D. Segal, MS, et al. Functional Limitations Associated with End-Stage Ankle Arthritis. In The Journal of Bone and Joint Surgery. May 2, 2012. Vol. 94. No. 9. Pp. 777-783.

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