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Home Health Education Foot & Ankle
Osteoarthritis of the Ankle Print E-mail
The ankle joint is a commonly injured joint in the body. While ankle fractures and ankle sprains heal pretty well, they can lead to problems much later in life. This is due to the wear and tear that occurs for years after the injury. This condition is called osteoarthritis, or post-traumatic arthritis. The term trauma means injury, and the term post-traumatic arthritis is used to describe the condition of the arthritis after injury.

Degeneration is a term that describes a condition where something wears out over time. The term degenerative arthritis is used by doctors to describe a condition where a joint wears out, usually slowly over a period of many years. The term arthritis means inflammation of a joint, so the term degenerative arthritis means inflammation of a joint due to wear and tear. You may also hear the term degenerative arthrosis used. Some doctors believe that degenerative arthritis isn't a true arthritis and confuses people. The term arthrosis is used to describe the condition of a worn out joint. The term arthritis is used to describe the true inflammatory conditions such as gout, infection and rheumatoid arthritis.

Osteoarthritis is usually considered a type of degenerative arthritis, or wear and tear arthritis. Doctors usually consider osteoarthritis pretty much the same whether it appears years after an injury to the joint or whether it simply appears without any history of injury. Over the past several years, there has been increasing evidence that osteoarthritis is genetic, meaning that it runs in families. Research suggests that osteoarthritis that occurs without any injury may be related to differences in the chemical makeup of the articular cartilage with which people are born.

Injury to a joint, such as a bad sprain or fracture, can cause actual damage to the articular cartilage. The cartilage can be damaged by bruising when too much pressure is exerted on the cartilage surface of a joint. This damages the cartilage, although if you look at the surface it may not appear to be any different. The injury to the material doesn't show up until months later. Sometimes the cartilage surface is damaged even more severely and pieces of the cartilage are ripped from the bone.

These pieces do not heal back and usually must be removed from the joint surgically. If not, they may float around in the joint causing the joint to catch and be painful. These fragments of cartilage may also do more damage to the joint surface. The areas where these pieces of cartilage are ripped from do not normally grow back. Unlike bone, the holes in the surface are not simply replaced by the cartilage tissue around the hole. Instead the defects are filled with scar tissue. The scar tissue that forms is not nearly as good a material for covering joint surfaces as the cartilage it replaces. It just can't support weight bearing like true articular cartilage.

An injury to a joint, even if it does not injure the articular cartilage directly, can alter how the joint works. This is true for a fracture where the bone fragments heal slightly different from the way they were before the break occurred. It is also true that when ligaments are damaged it leads to instability in the joint. When an injury results in a change in the way the joint moves, the injury may increase the forces on the articular cartilage. This is very similar to any mechanical device or machinery. If the mechanism is out of balance, it wears out faster.

Over many years this imbalance in the joint mechanics can lead to damage to the articular surface. Since articular cartilage cannot heal itself very well, the damage adds up. Finally, the joint is no longer able to compensate for the increasing damage and it begins to hurt. The damage is occurring well before the pain begins.

Degenerative arthritis may come from differences in how each of us is put together based on our genes; a condition best described as osteoarthritis. Or degenerative arthritis may come years after an injury has occurred that leads to slow damage to the joint surfaces; a condition probably best described as post- traumatic arthritis. Either way the joint is worn out - and it hurts.


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