Cartilage is some amazing stuff. And like so much of our health, we take healthy cartilage for granted… until it’s gone.
Cartilage is a smooth, cushioning material which covers the bone-ends of our joints. It’s the cartilage which allows our joints to move in a silky-smooth manner, allowing us to walk, run, jump and play without ever really thinking about it.
But often in my practice, I treat patients who have lost that silky-smooth connectivity of cartilage. It’s often because of arthritis.
My patients commonly present with different types of arthritis: osteoarthritis, rheumatoid arthritis, and post-injury (or post-traumatic) arthritis. Osteoarthritis (OA) is partly due to a heredity, and partly the age-factor, usually occurring as people enter their 60s. Rheumatoid arthritis, an inherited condition, is characterized by severe joint inflammation affecting numerous joints, and often begins at a young age.
And third, the name implies, post-injury arthritis occurs as a result of a single or recurrent injuries to a joint surface. Pro athletes, like NBA and NFL players, are candidates for this condition as the result of repetitive damage on the field. In the ankle, this is usually the result of an ankle fracture. The fix to diminishing cartilage and advancing arthritis? Orthotics can help. Immobilizing the joint –sometimes using a cast or brace—can also be a good initial approach which allows healing to occur. I also recommend non-impact exercises (bicycling, swimming) to strengthen the muscles around the foot and ankle and to maintain motion in the joints, because exercises like running and vigorous hiking may further damage a compromised joint.
Several surgical procedures may be indicated for arthritis when these initial measures do not relieve the pain. In many cases, arthritis causes bone spurs to develop on the edges of the joints. If the spurs are the major cause of the symptoms, then surgical removal of the bone spurs may be all that is necessary to relieve pain and joint stiffness. This is especially true in the big toe joint (the metatarsophalangeal joint) and in the ankle joint. In the big toe, the bone spurs can be removed using a small incision, which often greatly improves the range of motion in the big toe, and relieves pain from pressure on the top of the toe. This procedure can often be used in the big toe even when the arthritis is fairly advanced.
In the ankle joint, bone spurs can be removed arthroscopically. Arthroscopic surgery involves a couple of tiny incisions and the use of a small camera to perform the operation. Removing the bone spurs decreases pain and may improve motion in the ankle. However, this procedure is not as effective if there are generalized arthritic changes present in the joint.
Some patients do not respond to these procedures, calling for more advanced techniques such as ankle joint fusion, joint replacement (using a prosthesis), and what is called OATS – Osteochondral Autograft Transfer. I will have more about these other types of techniques in my next blog….