Fix It, Fuse It or Replace an Arthritic Ankle?


BALTIMORE, Md. (Ivanhoe Newswire) — For people with ankle arthritis, every step can be a struggle. When medication and bracing don’t bring relief, patients may look for surgical options. Who should consider fusion and which patients are good candidates for total ankle replacement?

Tina Burd, a long-time fitness instructor, teaches spin to serious athletes. But for most of her adult life, Burd has had crippling pain in her left ankle.

“Because there’s no cartilage in the ankle joint, basically, I was bone-on-bone,” explained Burd.

She’s worn braces and boots, done therapy and visited countless orthopedic doctors.

“I’ll be honest, I seriously asked a couple doctors and contemplated amputation,” said Burd.

Lew Schon, MD, is not only an accomplished keyboard player, but an orthopedic specialist at the Institute of Foot and Ankle Surgery, Mercy, using skilled hands to perform delicate foot and ankle surgeries.

When medication and injections fail to relieve pain, patients can either fuse the ankle joint, or replace it. For patients with a history of infection or bone disease, fusing or welding together the two bones that make the joint, might be the best option.

“Get rid of the joint, stop the motion. Stop the pain,” shared Dr. Schon.

But fusing prevents the back and forth flexing motion, so Burd resisted. Five years ago, Dr. Schon replaced the joint.

“The ankle replacement allows us to remove the diseased cartilage and bone, realign the ankle and replace the surfaces with metal and plastic,” said Dr. Schon.

With the replacement Burd can do everything she wants to do, except run. She and her pup choose to walk instead.

Because of the risk of joint replacement parts wearing out, replacement has often been reserved for healthy patients in their sixties or seventies. But with the replacement system in Burd’s ankle, the plastic parts can be changed if they wear down, without the need to remove the entire replacement.

Contributors to this news report include: Cyndy McGrath, Producer; Roque Correa, Editor; and Kirk Manson, Videographer.


REPORT #2786

BACKGROUND: Arthritis is a general term which can involve inflammation and swelling in and around your joints and the nearby soft tissue. With arthritis, your joints wear down over time and slowly begin to lose the smooth “cushioning” cartilage inside them causing your bones to rub and wear against each other. After some time, the joint might not work or move the way it should. Several types of arthritis can cause pain in your feet and ankles. Osteoarthritis is the most common. Doctors also refer to as degenerative joint disease. It usually causes changes over many years. Rheumatoid arthritis is one of the most serious forms. It’s an autoimmune disease in which your immune system attacks the joint. Gout happens when you have a buildup of uric acid from your diet and is most common in your big toe. Psoriatic arthritis can happen in one or more joints, including your ankles and the ends of your toes, and may also cause toe swelling. Finally, post-traumatic arthritis happens after an injury, especially a dislocation or bone fracture.


SYMPTOMS, DIAGNOSIS AND TREATMENT: Symptoms of foot and ankle arthritis can include tenderness when you touch the joint; pain in moving it; trouble moving, walking, or putting weight on it; joint stiffness, warmth, or swelling; and more pain and swelling after you rest, such as sitting or sleeping. Your doctor will ask about your medical history and do tests that could include a physical exam; x-rays; MRI or CT scans. Depending on symptoms and what’s causing the arthritis, treatments could include steroid medications injected into joints; anti-inflammatory drugs to aid with swelling; pain relievers; pads or arch supports in shoes; canes or braces for support; physical therapy; or custom-fitted shoes. Some people need surgery to treat foot and ankle arthritis. Fusion surgery involves fusing bones together with rods, pins, screws, or plates. Joint replacement surgery used in severe cases. This is where they take out damaged bone and cartilage and replace it with metal or plastic.


BREAKTHROUGH TREATMENT: The most common options for patients with big toe joint arthritis is joint fusion or joint replacement. Now, there is a solution, which was approved by the FDA this year, that allows for a quicker recovery with less risk, and leaves the door open for future options. The new Cartiva implant is a synthetic implant that replaces the damaged cartilage surface of the big toe. It’s made of a soft polymer and molded to form a slippery, durable implant. It’s about a 20 to 35-minute outpatient procedure performed under anesthesia, and often combined with a regional foot anesthetic. For many patients, full weight bearing is possible immediately and seated range of motion exercises begin at once. Most patients do not require physical therapy. Based on fusion data, Cartiva patients experienced 93 percent less pain and improved their range of motion by at least 50 percent over standard treatment.


* For More Information, Contact:

Dan Collins, PR

(410) 332-9714


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