Abstract
Arthritis of the ankle is a common condition. The ankle joint is susceptible to the development of arthritis from various conditions that can damage the joint cartilage. Osteoarthritis is the most common form of arthritis that results in ankle pain; rheumatoid arthritis and posttraumatic arthritis are also frequent causes of ankle pain. Less common causes include the collagen vascular diseases, infection, villonodular synovitis, and Lyme disease. Acute infectious arthritis is usually accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized; it is treated with culture and antibiotics rather than injection therapy. Collagen vascular disease generally manifests as polyarthropathy rather than as monarthropathy limited to the ankle joint, although ankle pain secondary to collagen vascular disease responds exceedingly well to the treatment modalities described here.
Most patients complain of pain localized around the ankle and distal lower extremity. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination.
Keywords
ankle pain, arthritis, osteoarthritis, rheumatoid arthritis, joint mouse, synovitis, ultrasound guided injection, diagnostic sonography, Lyme disease
ICD-10 CODE M19.90
Keywords
ankle pain, arthritis, osteoarthritis, rheumatoid arthritis, joint mouse, synovitis, ultrasound guided injection, diagnostic sonography, Lyme disease
ICD-10 CODE M19.90
The Clinical Syndrome
Arthritis of the ankle is a common condition. The ankle joint is susceptible to the development of arthritis from various conditions that can damage the joint cartilage. Osteoarthritis is the most common form of arthritis that results in ankle pain; rheumatoid arthritis and posttraumatic arthritis are also frequent causes of ankle pain. Less common causes include the collagen vascular diseases, infection, villonodular synovitis, and Lyme disease. Acute infectious arthritis is usually accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized; it is treated with culture and antibiotics rather than injection therapy. Collagen vascular disease generally manifests as polyarthropathy rather than as monarthropathy limited to the ankle joint, although ankle pain secondary to collagen vascular disease responds exceedingly well to the treatment modalities described here.
Signs and Symptoms
Most patients complain of pain localized around the ankle and distal lower extremity. Activity makes the pain worse, whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination.
In addition to pain, patients with arthritis of the ankle often experience a gradual decrease in functional ability because of reduced ankle range of motion that makes simple everyday tasks, such as walking and climbing stairs and ladders, quite difficult ( Fig. 121.1 ). With continued disuse, muscle wasting may occur, and a frozen ankle secondary to adhesive capsulitis may develop.
Testing
Plain radiographs are indicated in all patients who present with ankle pain ( Fig. 121.2 ). Magnetic resonance imaging and ultrasound imaging of the ankle are indicated in the case of trauma, if the diagnosis is in question, or if an occult mass or tumor is suspected ( Figs. 121.3 and 121.4 ). Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, comprehensive metabolic profile, erythrocyte sedimentation rate, and antinuclear antibody testing.
