Introduction

Arthritis is a medical condition that affects the joints, causing painful inflammation and stiffness. Although arthritis is often associated with the most common joints such as the knees and hands, it can also affect less commonly affected joints, such as the ankle. Ankle arthritis can cause significant pain and limit mobility, impacting the quality of life of those affected.

Ankle arthritis can be caused by a variety of factors, including natural age-related wear and tear on the joints, previous injuries, joint infections, or autoimmune diseases. People with ankle arthritis often experience symptoms such as pain, swelling, stiffness, and decreased mobility. These symptoms can vary in intensity, but they have a significant impact on daily life.

Pain is one of the most predominant symptoms of ankle arthritis. It can be felt during movement of the ankle, but also at rest, especially at night. This pain can range from mild to severe and can sometimes be accompanied by a feeling of warmth around the affected joint. Ankle swelling is also common, resulting from inflammation of the tissues around the joint. This can make the ankle swollen, red, and warm to the touch.

Joint stiffness is another common problem among people with ankle arthritis. This stiffness can make it difficult to perform simple movements, such as bending or rotating the ankle. Daily activities such as walking, climbing stairs or even getting up become challenges for those suffering from this condition.

Reduced ankle mobility can have a significant impact on daily life. People with ankle arthritis may have difficulty completing simple tasks, which can lead to a loss of independence. Work and social activities may also be compromised due to pain and limited mobility.

Diagnosing ankle arthritis often involves extensive medical examinations, such as x-rays, blood tests, and clinical exams. Once the diagnosis is confirmed, treatment generally aims to relieve pain, reduce inflammation, and improve joint function. Treatment options may include anti-inflammatory medications, physical therapies, orthotics, and in some cases, surgeries to repair or replace the damaged joint.

Besides medical treatments, managing ankle arthritis may also include lifestyle changes. Maintaining a healthy weight, exercising regularly to strengthen the muscles around the ankle, and adopting strategies to reduce stress on the joint are important parts of the management plan.

Thus, ankle arthritis can have a significant impact on daily life due to pain, swelling, stiffness and decreased mobility. Early diagnosis and appropriate management are essential to alleviate symptoms and improve the quality of life of those affected by this debilitating condition.

Causes

Ankle arthritis is a debilitating condition that can cause severe pain, stiffness and reduced mobility. This joint condition can be the result of several factors, including normal age-related wear and tear, previous injuries, infections, or autoimmune disorders.

First of all, normal wear and tear on the joints, known as osteoarthritis, is one of the most common causes of ankle arthritis. Over time, the protective cartilage that covers the joint surfaces wears away, leading to direct friction between the bones. This can cause inflammation and chronic joint pain.

Next, previous injuries, such as severe ankle sprains or poorly healed fractures, can increase the risk of developing arthritis in the ankle. The structural damage caused by these injuries can alter the way the joint functions, which can eventually lead to post-traumatic arthritis.

Additionally, joint infections, although less common, can also cause arthritis in the ankle. Bacteria or viruses can invade the joint and trigger an inflammatory response, leading to damage to the cartilage and surrounding tissues.

Finally, autoimmune disorders such as rheumatoid arthritis can affect the ankle joints. Under these conditions, the immune system mistakenly attacks healthy tissue, leading to chronic joint inflammation and eventually cartilage destruction.

Overall, ankle arthritis can have a variety of causes, but it often results in pain and mobility limitation that can significantly affect a person’s quality of life. It is essential to consult a healthcare professional for an accurate diagnosis and a suitable treatment plan to effectively manage this condition and improve overall well-being.

  1. Osteoarthritis: Osteoarthritis is a common cause of ankle arthritis, especially in older people. It results from the progressive wear of the cartilage which covers the bony ends of the joint. This breakdown of cartilage can lead to inflammation and pain in the ankle.
  2. Previous injuries: Trauma such as severe sprains, fractures or dislocations of the ankle can increase the risk of developing arthritis. Joint damage can trigger an inflammatory response and accelerate cartilage degeneration.
  3. Infections: Joint infections, although less common, can cause ankle arthritis. Bacteria, viruses, or other pathogens can invade the joint, triggering an inflammatory response. In such cases, antibiotic or antiviral treatment may be necessary.
  4. Autoimmune diseases: Autoimmune diseases such as rheumatoid arthritis can affect the ankle joints. In these conditions, the immune system mistakenly attacks healthy tissue, causing chronic inflammation and joint damage.
  5. Gout: Gout is a form of arthritis caused by the buildup of uric acid crystals in the joints, including the ankle. This can lead to sudden, painful inflammation.
  6. Juvenile Idiopathic Arthritis: This form of arthritis affects children and adolescents, and it can also affect the ankle. The exact mechanisms are not always clear, but it is often an autoimmune reaction.
  7. Genetic factors: Some individuals may be genetically predisposed to developing joint problems, including ankle arthritis. A family history of arthritis may increase the risk.
  8. Inflammatory Diseases: Conditions such as ankylosing spondylitis, lupus, and other inflammatory diseases can affect joints, including the ankle, by causing systemic inflammation.

Symptoms

Symptoms of ankle arthritis vary depending on the underlying cause and severity of the condition. However, there are several common symptoms that may indicate the presence of arthritis in the ankle.

First of all, pain is one of the most characteristic symptoms of ankle arthritis. This pain may be described as dull, stabbing, or throbbing, and it may be present in varying degrees of intensity. The pain tends to get worse with activity and may also be more pronounced in the morning or after a period of rest.

Next, joint stiffness is a common symptom of ankle arthritis. Sufferers may experience stiffness and difficulty moving the ankle, particularly after a prolonged period of immobility. This stiffness can limit the ankle’s range of motion and make daily activities more difficult.

Additionally, swelling and tenderness around the ankle joint are also common symptoms of arthritis. The swelling can be mild to severe and may be associated with a feeling of warmth or redness in the affected area. This swelling can make it difficult to wear shoes or have direct contact with the affected area.

Additionally, some patients with ankle arthritis may also experience cracking or crackling sounds when they move the joint. These sounds may indicate cartilage wear or structural changes in the joint, which may be associated with arthritis.

Finally, in advanced cases of ankle arthritis, joint deformity may develop. This may include changes in the shape of the joint or adjacent bones, which may be visible to the naked eye.

The symptoms of ankle arthritis can vary in intensity from person to person, but they generally share common characteristics. Here are the symptoms most commonly associated with this condition:

  1. Pain: Pain is one of the most characteristic symptoms of ankle arthritis. Pain may be present during movement of the ankle, but also at rest. It can range from mild to severe and can become more intense with physical activity.
  2. Swelling: Inflammation of the tissues around the ankle joint can lead to swelling. The ankle may appear swollen, red, and warm to the touch due to the buildup of synovial fluid and infiltration of inflammatory cells.
  3. Stiffness: People with ankle arthritis may experience joint stiffness, especially after a period of inactivity such as sleeping or prolonged sitting. This stiffness can make ankle movements difficult and uncomfortable.
  4. Loss of mobility: Arthritis of the ankle can lead to decreased joint mobility. Movements such as flexion, extension and rotation of the ankle may become limited, affecting the ability to walk normally.
  5. Crackles: Some individuals may experience crackling or cracking sensations when they move their ankle. This may be due to increased friction between damaged joint surfaces.
  6. Fatigue: Chronic pain and the constant struggle with discomfort can lead to general fatigue. People with ankle arthritis may experience excessive fatigue even after moderate exertion.
  7. Gait Modification: Due to pain and stiffness, people with ankle arthritis may modify their gait to relieve discomfort. This can cause changes in the way they walk, which can affect other joints or muscles.
  8. Systemic symptoms: In some cases, the inflammation associated with ankle arthritis can lead to systemic symptoms such as fever, weight loss, and a general feeling of malaise.

Pathophysiology


The pathophysiology of ankle arthritis involves a series of complex processes that lead to inflammation and destruction of joint tissues. Understanding these mechanisms is crucial for the development of effective treatments against this debilitating condition.

First of all, in the case of ankle osteoarthritis, the pathophysiology is largely based on the progressive degeneration of the articular cartilage. Cartilage, which normally acts as a shock-absorbing cushion between bones, wears away over time due to factors such as age, obesity, previous injuries or genetics. This wear of the cartilage exposes the underlying bony surfaces, leading to direct friction during joint movements. In response to this chronic irritation, the body triggers an inflammatory response, characterized by the release of pro-inflammatory cytokines and destructive enzymes, such as metalloproteinases, which contribute to the destruction of remaining cartilage.

Next, autoimmune forms of ankle arthritis, such as rheumatoid arthritis, involve dysregulation of the immune system. Under these conditions, the immune system mistakenly attacks healthy tissue in the ankle joint, triggering a persistent inflammatory response. Synoviocytes, cells present in the synovial membrane which lines the inside of the joint, become hyperactive and proliferate in an uncontrolled manner, forming an inflammatory pannus. This pannus tissue gradually invades the joint, causing destruction of the adjacent cartilage, ligaments and bones.

Furthermore, joint infections, although less common, can also lead to ankle arthritis. In these cases, pathogens such as bacteria or viruses enter the joint, triggering an acute inflammatory reaction. This immune response can directly damage cartilage and surrounding tissues, and if not treated promptly, can lead to severe joint destruction.

The pathophysiology of ankle arthritis involves complex mechanisms that lead to inflammation and degradation of articular cartilage. Different forms of arthritis may have specific disease pathways, but some general characteristics often apply. Here is an overview of the pathophysiology of ankle arthritis:

  1. Inflammation: Inflammation is a normal immune response of the body to stimuli such as injury or infection. However, in arthritis this process becomes dysregulated. Immune cells, particularly macrophages and lymphocytes, invade the ankle joint, releasing inflammatory mediators such as cytokines and prostaglandins.
  2. Attack on the cartilage: Chronic inflammation causes constant attack on the cartilage that covers the joint surfaces. The synovial cells, which line the inside of the joint, can undergo pathological changes and contribute to the destruction of cartilage.
  3. Synovial Proliferation: In many cases of arthritis, there is excessive proliferation of synovial tissue. This causes the synovial membrane to thicken, which then secretes more synovial fluid. The buildup of synovial fluid contributes to ankle swelling.
  4. Pannus Formation: Pannus is an abnormal layer of inflammatory tissue that develops from the synovial membrane. It invades the cartilage, causing progressive destruction. This pannus formation is a common feature of rheumatoid arthritis.
  5. Production of degradative enzymes: Inflammatory cells in the joint release enzymes such as metalloproteinases, which contribute to the breakdown of cartilage. These enzymes degrade the structural proteins of the cartilage, thus weakening its resistance.
  6. Osteophyte Formation: In response to cartilage breakdown, the body can form osteophytes, also called bony growths. These growths can develop at the edges of joints, further limiting mobility.
  7. Autoimmune response: In certain types of arthritis, such as rheumatoid arthritis, the immune system mistakenly attacks healthy tissue in the joint. Autoantibodies, such as rheumatoid factors, contribute to this autoimmune reaction.
  8. Changes in synovial fluid: The synovial fluid, which lubricates the joint, undergoes changes in its chemical composition. These changes can contribute to inflammation and cartilage deterioration.

Diagnosis and treatment

Diagnosing ankle arthritis requires a thorough evaluation by a healthcare professional. This may include a physical examination, laboratory tests, x-rays and other imaging tests. Once the diagnosis is confirmed, the choice of treatment depends on the specific type of arthritis, the severity of symptoms and the individual needs of the patient. Here is an overview of common diagnosis and treatment approaches:

Diagnostic

  1. Physical examination: The doctor will examine the ankle to assess pain, swelling, mobility and other clinical signs. He or she may also look for signs of stiffness, warmth, or redness around the joint.
  2. Laboratory tests: Blood tests may be done to detect inflammatory markers such as erythrocyte sedimentation rate, C-reactive protein, or autoantibodies in the case of autoimmune diseases.
  3. Imaging: X-rays, ultrasounds and MRI can be used to visualize joint structures, assess the condition of the cartilage and detect possible abnormalities.
  4. Synovial fluid aspiration: A joint puncture may be performed to collect and analyze the synovial fluid, helping to determine the presence of infections, crystals or other pathological markers.

Treatment

Treatment for ankle arthritis generally aims to relieve pain, reduce inflammation, improve joint function, and prevent progression of the disease. Treatment approaches may include:

  1. Drugs :
    • Nonsteroidal anti-inflammatory drugs (NSAIDs): Relieve pain and reduce inflammation.
    • Antirheumatic drugs (DMARDs): Used in autoimmune forms to modulate the immune response.
    • Corticosteroids: May be injected into the joint to reduce inflammation.
    • Analgesics: For pain relief.
  2. Physical therapy: Specific exercises can strengthen the muscles around the ankle, improve mobility and relieve pressure on the joint.
  3. Orthotics and assistive devices: Devices such as splints or orthotics can help relieve pressure on the ankle and improve stability.
  4. Lifestyle changes: Maintain a healthy weight, eat a balanced diet, and avoid activities that may worsen symptoms.
  5. Surgical treatment: In some severe cases, surgery may be considered to repair or replace the damaged joint.
  6. Pain management: Pain management techniques, including osteopathy, relaxation and, in some cases, specific medications.

Differential diagnosis

The differential diagnosis of ankle arthritis involves the exclusion of other medical conditions with similar symptoms. Some disorders may present with joint pain, swelling or stiffness, and it is important to differentiate them from arthritis for an accurate diagnosis. Here are some of the conditions that might be included in the differential diagnosis:

  1. Ankle sprain: A sprain can cause pain, swelling and stiffness similar to arthritis. It often results from a traumatic injury to the ankle ligaments.
  2. Tendinitis: Inflammation of the tendons around the ankle can cause symptoms similar to arthritis. Tendonitis is often associated with excessive physical activity or overuse.
  3. Bursitis: Inflammation of a bursa, a small pocket of fluid that facilitates the movement of tendons, can lead to arthritis-like symptoms.
  4. Gout: An attack of gout, caused by the buildup of uric acid crystals in the joint, can cause sudden pain and swelling.
  5. Joint infection: Bacterial or viral infections can affect the ankle joint and cause inflammation.
  6. Bone tumors: Benign or malignant bone tumors can cause symptoms similar to arthritis.
  7. Tarsal tunnel syndrome: Compression of the posterior tibial nerve can cause pain, tingling, and numbness around the ankle.
  8. Systemic Diseases: Some systemic diseases such as lupus, scleroderma, or Lyme disease can cause joint symptoms similar to arthritis.
  9. Post-traumatic osteoarthritis: Premature wear of cartilage from previous injuries can cause symptoms similar to osteoarthritis.
  10. Pseudogout: A condition similar to gout, but caused by the deposition of calcium pyrophosphate crystals in the joint.

Stretching and exercise

Stretches and exercises can play a crucial role in managing the symptoms of ankle arthritis. However, it is essential to consult a healthcare professional before beginning an exercise program, especially if you have a joint disease. Here are some stretches and exercises that might be beneficial under the supervision of a qualified professional:

Stretching

  1. Calf stretch:
    • Stand upright, facing a wall.
    • Bend the front leg, keeping the back leg straight.
    • Place hands on the wall and push hips forward to stretch the calf of the back leg.
  2. Achilles Tendon Stretch:
    • Standing, place the affected foot behind you with the heel on the floor.
    • Slightly bend the knee of the back leg while keeping the front leg straight.
    • You should feel a stretch in the Achilles tendon.
  3. Seated Ankle Stretch:
    • Sit in a chair with your feet flat on the floor.
    • Raise the affected foot and draw circles in both directions with the ankle, then flex and extend the toes.

Strengthening exercises

  1. Tiptoe elevation:
    • Stand with the weight evenly distributed on both feet.
    • Slowly lift your heels off the floor by pushing upwards onto the balls of your feet, then gently lower yourself back down.
  2. Ankle rotation exercises:
    • Sitting or standing, rotate your ankle, first in one direction, then in the other.
  3. Resistance exercises:
    • Use a resistance band to perform ankle flexion and extension exercises under professional supervision.
  4. Balance exercises:
    • Stand on one leg at a time to improve balance and strengthen the ankle stabilizing muscles.

Low-impact aerobic exercises

  1. Swimming: Movements in the water provide resistance while being gentle on the joints.
  2. Cycling: A low-impact activity that can help maintain ankle mobility.
  3. Walking: A simple but effective activity to improve circulation and maintain mobility.

It is crucial to start slowly and adjust exercise intensity based on individual tolerance. A healthcare professional or an osteopath can develop an exercise program tailored to your specific needs. Listen to your body, avoid painful movements, and be consistent in your routine to maximize the benefits of stretches and exercises in managing ankle arthritis.

Ankle Arthritis Prevention

Preventing ankle arthritis may involve various measures to reduce potential risk factors and promote joint health. Although some risk factors cannot be changed, adopting a healthy lifestyle can help prevent or reduce the risk of developing ankle arthritis. Here are some prevention tips:

  1. Maintain a healthy weight: Excess weight puts extra pressure on joints, including those in the ankle. Maintaining a healthy body weight can reduce the risk of developing arthritis and lessen the severity of symptoms.
  2. Eat a balanced diet: A diet rich in nutrients, particularly vitamins and minerals, can contribute to joint health. Omega-3 fatty acids, found in some fish, may have beneficial anti-inflammatory properties.
  3. Regular exercise: A regular exercise program can strengthen the muscles around the ankle, improve mobility and promote joint health. Low-impact aerobic exercises, such as walking or swimming, are often recommended.
  4. Avoiding Injuries: Preventing ankle injuries can reduce the risk of developing post-traumatic arthritis. Use appropriate footwear, be aware of your surroundings to avoid falls, and practice physical activities safely.
  5. Stress management: Stress can influence general health, including that of the joints. Stress management techniques, such as meditation or yoga, can help prevent arthritis.
  6. Protection against infections: Some forms of arthritis can be triggered by infections. Maintaining good hygiene practices and treating infections promptly can help prevent these complications.
  7. Avoid smoking: Smoking has been linked to an increased risk of developing certain forms of arthritis. Avoiding smoking can help maintain joint health.
  8. Monitoring family history: If arthritis runs in the family, it may be helpful to discuss this history with a healthcare professional. Specific preventive measures can be considered depending on genetic risks.

Radiographic Signs

Radiographic signs of ankle arthritis play a vital role in the diagnosis and management of this joint condition. X-rays provide valuable information about the condition of the bone structures, cartilage and soft tissues of the ankle joint, allowing healthcare professionals to determine the severity of the disease and plan appropriate treatment.

First of all, one of the most common radiographic signs of ankle arthritis is loss of joint space. In a healthy joint, the space between the bony surfaces is occupied by cartilage. However, in cases of arthritis, this distance may be reduced due to wear of the cartilage or the presence of bone deposits (osteophytes) around the joint. A decrease in joint space may indicate cartilage deterioration and disease progression.

Next, radiographic signs of ankle arthritis may include osteophytes or bony growths. These growths form in response to cartilage wear and tear and the body’s attempt to stabilize the damaged joint. Although osteophytes can provide some stability to the joint, they can also cause limited mobility and increased pain.

Additionally, x-rays may reveal signs of osteoarthritis, such as changes in bone density and erosions of joint surfaces. These changes are the result of chronic inflammation and cartilage destruction, which can affect the structure and function of the ankle joint.

Additionally, x-rays may also show signs of inflammatory arthritis, such as fluid leaking into the joint or signs of synovitis. These manifestations are more common in conditions like rheumatoid arthritis, where inflammation of the synovial membrane can be detected radiographically.

Finally, x-rays can be used to evaluate other complications associated with ankle arthritis, such as fractures or joint deformities. This additional information helps healthcare professionals formulate a comprehensive treatment plan that considers all facets of the disease.

The radiographic signs of ankle arthritis may vary depending on the specific type of arthritis and the stage of the disease. X-rays are often used to evaluate structural changes in the joint and confirm the diagnosis. Here are some common radiographic signs associated with ankle arthritis:

  1. Loss of joint space: A characteristic sign of arthritis is a decrease in the space between the joint surfaces. This can be seen on x-rays as a narrowing of the space between the ankle bones.
  2. Osteophytes: Osteophytes, also called parrot beaks, are bony growths that form at the edges of joints. They are often present in osteoarthritis and may be visible on ankle x-rays.
  3. Bone erosions: Chronic inflammation in arthritis can lead to erosions or loss of substance in the bone. These damaged areas can be detected on x-rays.
  4. Synovitis: Inflammation of the synovial membrane may be visible on x-rays, showing thickening of the synovial membrane around the joint.
  5. Bone sclerosis: In some cases, a response to arthritis can lead to sclerosis, which is a thickening or hardening of the bone. This may appear as a dense area on x-rays.
  6. Subchondral Cysts: Subchondral cysts can form in the area beneath the articular cartilage in response to cartilage deterioration. These cysts may be visible on x-rays.
  7. Joint deformity: Untreated arthritis can lead to joint deformities, changing the normal shape of the ankle bones. These deformations can be seen on x-rays.
  8. Calcifications: In some forms of arthritis, including gout, crystal deposits can form in the joints, creating areas of calcification that can be detected on x-rays.
Arthrite sous-talienne. Case courtesy of Patsy Robertson, Radiopaedia.org. From the case rID: 28151

Conclusion

In conclusion, ankle arthritis is a medical condition that can lead to painful inflammation, stiffness, and impaired joint function. The causes of this condition can be varied, from normal age-related wear and tear on joints to autoimmune diseases. Symptoms, such as pain, swelling and loss of mobility, can have a significant impact on quality of life.

Diagnosing ankle arthritis involves clinical assessments, laboratory tests, and imaging tests, such as x-rays. Once diagnosed, management of this condition may include medical approaches, such as the use of anti-inflammatory medications and physical therapies, as well as lifestyle changes aimed at relieving symptoms and improving function. articular.

The pathophysiology of ankle arthritis highlights complex mechanisms, including chronic inflammation, cartilage breakdown, and autoimmune response in some cases. Understanding these disease processes is essential to guide treatment strategies.

Preventing ankle arthritis involves adopting healthy behaviors, such as maintaining proper body weight, exercising regularly, and managing stress. Additionally, targeted stretches and exercises can play an important role in relieving symptoms and preserving joint mobility.

Radiographic signs, such as loss of joint space, osteophytes, and other structural changes, are important diagnostic tools for assessing the condition of the ankle joints.

In short, the management of ankle arthritis requires a multidisciplinary approach, involving health professionals such as rheumatologists, orthopedists and posteopath. Early diagnosis, appropriate treatment and ongoing management can help improve the quality of life of those affected by this condition.

References

  1. oldberg AJ, MacGregor A, Dawson J, Singh D, Cullen N, Sharp RJ, Cooke PH. The demand incidence of symptomatic ankle osteoarthritis presenting to foot and ankle surgeons in the United Kingdom. Foot 201222163–166. ( 10.1016/j.foot.2012.02.005) [PubMed] [CrossRef] [Google Scholar]
  2. Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clinical Orthopaedics and Related Research 20094671800–1806. ( 10.1007/s11999-008-0543-6) [PMC free article] [PubMed] [CrossRef] [Google Scholar]
  3. Thomas RH, Daniels TR. Ankle arthritis. Journal of Bone and Joint Surgery: American Volume 200385923–936. ( 10.2106/00004623-200305000-00026) [PubMed] [CrossRef] [Google Scholar]
  4. Glazebrook M, Daniels T, Younger A, Foote CJ, Penner M, Wing K, Lau J, Leighton R, Dunbar M. Comparison of health-related quality of life between patients with end-stage ankle and hip arthrosis. Journal of Bone and Joint Surgery: American Volume 200890499–505. ( 10.2106/JBJS.F.01299) [PubMed] [CrossRef] [Google Scholar]
  5. Stufkens SA, Knupp M, Horisberger M, Lampert C, Hintermann B. Cartilage lesions and the development of osteoarthritis after internal fixation of ankle fractures: a prospective study. Journal of Bone and Joint Surgery: American Volume 201092279–286. ( 10.2106/JBJS.H.01635) [PubMed] [CrossRef] [Google Scholar]
  6. Horisberger M, Valderrabano V, Hintermann B. Posttraumatic ankle osteoarthritis after ankle-related fractures. Journal of Orthopaedic Trauma 20092360–67. ( 10.1097/BOT.0b013e31818915d9) [PubMed] [CrossRef] [Google Scholar]
  7. Saltzman CL, Salamon ML, Blanchard GM, Huff T, Hayes A, Buckwalter JA, Amendola A. Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. Iowa Orthopaedic Journal 20052544–46. [PMC free article] [PubMed] [Google Scholar]
  8. Herrera-Perez M, Gonzalez-Martin D, Vallejo-Marquez M, Godoy-Santos AL, Valderrabano V, Tejero S. Aetiology of ankle osteoarthritis. Journal of Clinical Medicine  202110 4489. (10.3390/jcm10194489) [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar
  9. Harrington KD.Degenerative arthritis of the ankle secondary to long-standing lateral ligament instability. Journal of Bone and Joint Surgery: American Volume 197961354–361. ( 10.2106/00004623-197961030-00006) [PubMed] [CrossRef] [Google Scholar]
  10. Weigelt L, Laux CJ, Urbanschitz L, Espinosa N, Klammer G, Götschi T, Wirth SH. Long-term prognosis after successful nonoperative treatment of osteochondral lesions of the talus: an observational 14-year follow-up study. Orthopaedic Journal of Sports Medicine 202082325967120924183. ( 10.1177/2325967120924183) [PMC free article] [PubMed] [CrossRef] [Google Scholar]
  11. Lindsjo J.Operative treatment of ankle fractures. Acta Orthopaedica Scandinavica, Supplement 19811891–131. ( 10.3109/ort.1981.52.suppl-189.01) [PubMed] [CrossRef] [Google Scholar]
  12. Kraeutler MJ, Kaenkumchorn T, Pascual-Garrido C, Wimmer MA, Chubiskaya S. Peculiarities in ankle cartilage. Cartilage  2017812–18. ( 10.1177/1947603516642572 ) [ PMC free article ] [ PubMed ] [ Cross Ref ] [ Google Scholar
  13. Kuettner KE, Cole AA. Cartilage degeneration in different human joints. Osteoarthritis and Cartilage 20051393–103. ( 10.1016/j.joca.2004.11.006) [PubMed] [CrossRef] [Google Scholar]
  14. Treppo S, Koepp H, Quan EC, Cole AA, Kuettner KE, Grodzinsky AJ. Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. Journal of Orthopaedic Research 200018739–748. ( 10.1002/jor.1100180510) [PubMed] [CrossRef] [Google Scholar]
  15. Adams SB, Setton LA, Bell RD, Easley ME, Huebner JL, Stabler T, Kraus VB, Leimer EM, Olson SA, Nettles DL. Inflammatory cytokines and matrix metalloproteinases in the synovial fluid after intra-articular ankle fracture. Foot and Ankle International 2015361264–1271. ( 10.1177/1071100715611176) [PubMed] [CrossRef] [Google Scholar]
  16. Schmal H, Salzmann GM, Langenmair ER, Henkelmann R, Südkamp NP, Niemeyer P. Biochemical characterization of early osteoarthritis in the ankle. Scientific World Journal 20142014 434802. ( 10.1155/2014/434802) [PMC free article] [PubMed] [CrossRef] [Google Scholar]
  17. Tochigi Y, Rudert MJ, McKinley TO, Pedersen DR, Brown TD. Correlation of dynamic cartilage contact stress aberrations with severity of instability in ankle incongruity. Journal of Orthopaedic Research 2008261186–1193. ( 10.1002/jor.20589) [PMC free article] [PubMed] [CrossRef] [Google Scholar]
  18. Schreiner MM, Mlynarik V, Zbýň Š, Szomolanyi P, Apprich S, Windhager R, Trattnig S. New technology in imaging cartilage of the ankle. Cartilage 2017831–41. ( 10.1177/1947603516632848) [PMC free article] [PubMed] [CrossRef] [Google Scholar]
  19. Paul J, Barg A, Kretzchmar M, Pagenstert G, Studler U, Hügle T, Wegner NJ, Valderrabano V, Geurts J. Increased osseous (99m)Tc-DPD uptake in end-stage ankle osteoarthritis: correlation between SPECT-CT imaging and histologic findings. Foot and Ankle International 2015361438–1447. ( 10.1177/1071100715596745) [PubMed] [CrossRef] [Google Scholar]

RELATED ARTICLESMORE FROM AUTHOR