In honor of National Pain Awareness Month, we’ve been sharing information about chronic pain caused by arthritis and what conservative and surgical treatment options are available. To wrap up this month’s series, in this post we are taking a deeper dive into chronic pain of the wrists and ankles.
Arthritis of the wrist or ankle can cause pain, inflammation and stiffness. Arthritis damages the smooth outer coverage (cartilage) of the bone, and as it wears away over time, the space between the bones decreases. Think of healthy cartilage as the end of a chicken leg – smooth and shiny. Arthritis causes that smooth, shiny cartilage to become rough and fragmented. During movement, the bones in the joint rub against each other (often called “bone-on-bone”) causing pain, weakness and limited mobility.
Thankfully, there are several conservative treatment options available to alleviate pain from wrist and ankle arthritis, such as braces, over-the-counter pain medications and cortisone injections. But when conservative treatments are no longer providing relief and the pain becomes debilitating, it may be time to have a conversation with your doctor about surgical options for pain relief.
The wrist joint is made up of two long forearm bones, the radius and the ulna, and eight small bones called carpal bones. For severe arthritis of the wrist that cannot be managed with non-surgical treatment, a wrist reconstruction may be a viable option to eliminate wrist pain. A wrist reconstruction procedure involves removing some of the arthritic bone, and possibly fusing some other wrist bones. These procedures can make your wrist stiffer, often losing up to 50% of range of motion. However, this procedure frequently eliminates wrist pain, and in turn provides a stronger wrist.
The ankle joint is made up of three bones: the tibia (shin), fibula (bone next to the shin) and the talus (foot). The talus rotates and glides on the tibia and fibula, which allows the ankle to move up and down. Arthritis occurs when the cartilage in the ankle joint wears away, and that motion along with weight bearing can become painful and more difficult.
Often mild or early arthritis can be treated with anti-inflammatory medication, bracing, supportive shoe wear and activity modification. Occasional steroid injections can also provide temporary relief. In some cases, surgical treatment may also be considered as a solution to treat early or mild stages of arthritis.
During early stages of arthritis in the ankle, an ankle arthroscopy may be beneficial. In an ankle arthroscopy, an arthroscope (small camera) and other surgical tools are inserted through small incisions in the ankle joint. An orthopedic surgeon uses the camera to examine the joint and removes damaged cartilage, bone spurs and inflamed tissue.
For more advanced arthritis where “bone-on-bone” is present, an ankle fusion may be recommended to decrease pain by eliminating motion in the joint. During a fusion, an orthopedic surgeon removes damaged cartilage from around the arthritic joint and inserts screws, pins and plates to join the bones together. As the bones heal, they grow or fuse together, eliminating the pain.
Another treatment option for severe arthritis is an ankle replacement. In an ankle replacement, an orthopedic surgeon removes the arthritic bone and replaces it with artificial implants. After the procedure, the patient should have restored range of motion, and pain should be reduced or eliminated.