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The Ankle

The ankle is the joint that connects the lower leg to the foot. It provides the body with stability, directing and distributing weight from the legs to the feet, and mobility, playing a major role in walking, running, jumping, dancing and any other kind of movement that, requires the ability to stand up.

The ankle is actually made up of two joints: the "true" ankle and the subtalar. The "true" ankle joint is comprised of three bones: the tibia (the large shin bone) which forms the inside portion of the ankle, the fibula (the smaller shin bone) which forms the outside portion of the ankle, and the talus, a platform-like bone that fits neatly into a cup-shaped space formed by the ends of the tibia/fibula. The subtalar joint then joins the talus to the calcaneus (heel bone), completing the connection of the leg to the foot. When you walk, run or jump, your body weight is transferred downward from the tibia to the talus and then distributed throughout the foot.

The "true" ankle joint is responsible for the upward/downward motion of the foot, making it possible for you to point your toes and flex your foot. The subtalar joint is responsible for inward/outward movements, so your foot can turn in ("pigeon-toed") or out ("ballet feet"). This two-part ankle joint provides both stability (which helps you stand up and stay standing) and mobility (which helps you walk, run and jump).

Within these joints, the tibia, fibula, talus and calcaneus are capped with cartilage, which is essential for their smooth movement against each other. If the cartilage should become cracked, frayed, pitted, worn through or otherwise damaged, the result may be pain, stiffness and loss of movement, all of which are the symptoms of arthritis of the ankle.

Arthritis and Joint Pain of the Ankle

According to the Arthritis Foundation, arthritis (literally "inflammation of the joint") is not a single disease. Instead, it is a group of over 100 medical conditions that cause harm the joints - those numerous places where two or more bones come together in the body.1 A large number of problems can cause arthritis, ranging from localized infections to body-wide immune system problems, from dietary imbalances to a breakdown of cartilage. Potential symptoms of arthritis, which depend on both the type and severity of the disease, include pain, inflammation, joint instability or weakness, restricted movement within the joint, and even a total loss of joint function.

The most common form of arthritis, osteoarthritis, is characterized by the breakdown of the cartilage, the material that cushions the bone ends inside a joint. The second most common form, rheumatoid arthritis, develops when the body attacks itself, destroying joint tissue, among other things. Less common but still well known is gout, which is caused by the deposition of uric acid crystals within a joint, often in the "bunion joint" of the big toe, and infectious arthritis, which arises when bacteria invade a joint.

Depending on the type and severity of the disease, treatment may be as minimal as an over-the-counter pain reliever plus a specific exercise/rehabilitation program, or as drastic as major surgery. In some people, the cause of arthritis can be pinpointed and eradicated completely, while in others, the symptoms must be "managed" for the rest of their lives.

Click here for Arthritis Type and Symptom Checklist

Types of Arthritis of the Ankle

Arthritis occurs less commonly in the ankle than in the hip or knee, but ankle arthritis is certainly not rare2 and may manifest as osteoarthritis, rheumatoid arthritis or infectious arthritis, among other forms.

Ankle arthritis is typically a chronic condition that doesn't require immediate medical treatment. Sometimes, however, rapid treatment is required. For example, your ankle may become hot and swollen due to infectious arthritis, or it may lock in place if a piece of bone breaks off and "jams" the joint. Both of these situations call for rapid treatment.

1. Osteoarthritis of the Ankle

Also known as "wear and tear" arthritis or degenerative joint disease, osteoarthritis has afflicted humans since they first roamed the earth. Indeed, preserved skeletons from the Ice Age show ample evidence of osteoarthritis.3

How does osteoarthritis occur? For reasons we don't fully understand, the cartilage that cushions the joint and absorbs the shock of movement begins to break down. The once moist, rubbery cartilage dries out, becomes less flexible, and can no longer protect the bone ends from rubbing against each other during movement. This causes pain and prompts changes in the bone ends; they become thicker and may develop cysts and bony growths. Bits of cartilage or bone may break off and float around in the joint fluid, and the lining of the joint, the synovium, may become inflamed. Ironically, the body's attempt to heal the damage via the inflammatory process may cause even greater damage and more symptoms over time.

If you have osteoarthritis of the ankle, you will probably find that the initial symptoms are mild; perhaps a dull ache in your ankle after you've been on your feet for a while, exercised or participated in sports. Over time, the pain may become more severe and frequent, requiring rest, pain medications, ice packs and other home remedies. As the disease process continues, you may suffer from increasing pain, stiffness, inflammation, and difficulty using the ankle joint.

Those are the symptoms you notice. What you cannot see is the ongoing deterioration of the cartilage inside the ankle joint, allowing the bones to shift subtly out of proper alignment. As the ankle joint literally changes shape, you will have more difficulty moving it and suffer from more symptoms.

Although no one can fully explain why osteoarthritis develops, it is clear that injuries can set the stage for the disease. Post-injury arthritis of the ankle may develop years after a fracture, severe sprain or ligament injury. That's why it's important to receive treatment if you injure your ankle: untreated, the ankle may not heal properly, setting the stage for arthritis months or years later.

Click here for more information on Osteoarthritis

2. Rheumatoid Arthritis

Although the word "arthritis" means "inflammation of the joint," rheumatoid arthritis (RA) involves more than the joints. It's a body-wide inflammatory disease brought on by an errant immune system. In rheumatoid arthritis, the body's "internal army" becomes confused, attacking healthy body tissue because it mistakes it for a foreign invader. The immune system's white blood cells ferociously go after the joint lining, causing inflammation and triggering pain. Individual cells of the joint lining multiply and grow in an abnormal manner, infiltrating nearby cartilage and bone and making the situation even worse. Over time, the besieged joint becomes deformed, which makes movement more and more difficult. As the inflammation process continues, both bone and cartilage deteriorate and bumps called nodules may form. In serious cases, the joint can become misaligned, even twisted out of shape, rendering it useless.

Symptoms of rheumatoid arthritis include pain, swelling, warmth, tightness and redness in the afflicted joints. Evidence of joint erosion (the wearing away of bone and the absence of cartilage) might be seen on an x-ray. In rheumatoid arthritis, it's common that "matching" joints are attacked simultaneously: for example, both ankles, both wrists, both elbows, and so on. Other symptoms include fatigue, generalized aching and stiffness, anemia, difficulty sleeping and other problems as the disease attacks other parts of the body.

Although anyone may suffer from the rheumatoid arthritis, it typically strikes women between the ages of 20 and 50. It may last a few months or years and disappear, or it may come and go for decades, waxing and waning but never being cured. There is no single test for rheumatoid arthritis. Instead, the diagnosis is made based on symptoms, x-ray results, an analysis of fluid taken from the ankle, a biopsy, and the results of blood tests such as the rheumatoid factor test and the erythrocyte sedimentation rate.

Click here for more information on Rheumatoid Arthritis

3. Infectious Arthritis

When pathogens (bacteria, viruses or fungi) from nearby tissue or floating through the bloodstream settle within a joint, infectious arthritis can result. This condition can also stem from injury, surgery or an injection with a dirty needle. Whichever method the invader utilizes to get into the joint, within a few hours or days fever may develop, along with pain and swelling in the joint.

The diagnosis of infectious arthritis is generally made by drawing fluid out of the afflicted joint with a needle and examining that fluid in the laboratory to see if it contains some kind of pathogen, as well as white blood cells (immune system "soldiers") which signify that infection is present.

As it is possible for infectious arthritis to destroy a joint within days or even hours, rapid treatment of bacterial and fungal infections with antibiotics or antifungal medications is necessary - even if an infection is only suspected. Viral infections generally resolve without treatment, so pain and fever-reducing medications may be the only ones given.4

A number of pathogens may be to blame for infectious arthritis, including streptococci, staphylococci, gonococci (which cause gonorrhea), borrelia burgdorferi (which cause Lyme disease) and mycobacterium tuberculosis (which cause tuberculosis).5

Although anyone can develop infectious arthritis, those with joints deformed by arthritis are more susceptible to infectious arthritis in those specific areas.

More on Arthritis of the Ankle

Baby Boomers Take Note - The Boomers were the first generation to throw themselves into jogging, aerobics, jazzercise, racquetball and other forms of exercise. The youngest Boomers are now in their mid-40s, while the oldest are in their 60s, which means they've been walking, running, stomping and jumping on their ankles for decades. Even if they haven't injured them, they've certainly subjected their ankles to a lot of repetitive strain, and that may set the stage for osteoarthritis of the ankle.

If the Scale Groans When You Step On It - Because the ankles are weight-bearing joints, the extra weight you carry will make a difference. Every excess pound increases the stress and strain exerted on your ankles when you're standing, and that stress will be multiplied when you're walking or running.6 According to numerous studies, being just 10 pounds overweight adds excess strain on the ankle joints. It goes without saying that the shedding of any unnecessary weight can be a fast-track to relieving many of the symptoms of ankle arthritis.

Don't Ignore Injuries - A fractured ankle bone may throw the ankle joint out of alignment, leading to uneven wear and tear on the cartilage and, eventually, osteoarthritis. Even repeated ankle sprains can set the stage for osteoarthritis over time if the ligaments that help maintain joint alignment and stability do not heal properly. Injured joints are also more susceptible to infectious arthritis than sound joints.

Treatments and Supplements for Arthritis and
Joint Pain of the Ankle**

The type of treatment you receive for ankle arthritis will depend on the type of arthritis you have and its severity. In some cases, such as infectious arthritis, the problem may be handled quickly and permanently with medications. In other cases, such as osteoarthritis, the goal may be to reduce and manage symptoms with the use of supplements, rest, physical therapy and careful exercise. Switching from activities that put strain on the ankles to those that do not (e.g. substituting swimming or bicycling for jogging or aerobics class) can also help you manage symptoms while staying active.

• Rest
• Weight loss
• Exercise
• Proper footwear
• Dietary Strategies
• Physical and other therapies
• Surgery

Rest and joint pain of the Ankle

While rest won't cure the underlying problem, and staying off your feet for too long can cause its own problems, simply getting off your feet for a while can help relieve arthritis pain in the short term. While you're resting your ankle, you may also try the following:

• Apply ice to the ankle every hour for up to 15 minutes the first day. (Apply it at least 4 times per day after the first day).
  
• Keep your feet elevated as much as possible to relieve swelling.
  
• Gently compress the ankle by wearing an ace bandage or elastic sleeve to reduce swelling and stabilize the joint.

Weight loss, Obesity and Arthritis of the Ankle**

The ankle joint bears almost the entire weight of the body. That means there may be 100, 120, 150, 200 or more pounds of pressure bearing down on your ankles when you're simply standing still. When you walk, the force of that weight is multiplied, and when you run or leap, it's compounded even more. Therefore, every excess pound you carry will create a great deal of unnecessary pressure on your ankles when you move - and, conversely, shedding the extra weight will literally "take a load" off your ankles. If you have any form of chronic arthritis, slimming down to your idea weight will help reduce your symptoms. While it won't cure the underlying arthritis, it will relieve at least some of the pain and make the symptoms more tolerable.

For more information on weight management and arthritis see Arthritis and Weight Loss

Exercise and Caring for the Ankle**

When your ankles are painful, swollen or inflamed, the thought of exercising is not very enticing. In fact, you may hesitate even to walk, fearing that you'll make matters worse. However, in most cases carefully selected exercises are a necessary part of treatment, for they help to:

1. Maintain circulation - Cartilage is not serviced by blood vessels that bring it nutrients and carry away waste products. Instead, it depends on the in-and-out flow of nutrient-rich joint fluid caused by movement. When the joint is still, the flow of fluid slows or stops, and the cartilage is not adequately "fed" and moisturized.
2. Maintain or increase joint flexibility - Flexing and extending the areas connected to a joint will help keep the joint mobile and flexible and keep it from "freezing up."
3. Strengthen the muscles, tendons and ligaments that support the joint - If the joint's supporting structures become weak, they will be less effective at maintaining proper joint alignment and stability and absorbing the shock of movement.

Your physician or physical therapist may recommend stretching or yoga to improve flexibility, and weight training to strengthen to the muscles that service the ankle, leg and foot.

You might also consult a physical therapist or kinesiologist to make sure that you're walking properly and not putting undue stress on your ankles.

Click here for more information on Exercise and Arthritis.

Proper Footware for Ankle Support

High heels and flip-flops may be fashionable, but they don't provide the support an injured ankle needs and may even place unnecessary strain on the joint by holding your feet in an unnatural position. Depending on the extent and type of your arthritis, your doctor may suggest that you wear supportive, well-cushioned, "foot friendly" shoes. In more severe cases, braces and splints may be prescribed to limit the ankle joint's motion and offload some of its stress.

Supplementation with JoMo, a 100% Natural Maximum Strength Joint Relief and Cartilage Support Supplement

In studies conducted at medical centers in the United States and abroad, two natural substances found in the cartilage - glucosamine and chondroitin - have been shown to help relieve the symptoms of osteoarthritis. Back in the 1960s, researchers discovered that the cartilage in osteoarthritic joints contained less chondroitin than the cartilage in healthy joints, and suggested that supplying the missing chondroitin in supplement form could be helpful. A number of studies have since suggested that chondroitin can actually slow the deterioration of cartilage. Glucosamine, which the body uses to help keep the cartilage resilient and healthy, has also relieved symptoms of osteoarthritis in numerous studies. Learn More

JoMo was developed by one of the leading Orthopedic Surgeons for an NBA basketball team to help relieve the pain and suffering of joint and cartilage related conditions.

JoMo's active 100% natural ingredients include:

JoMo is shellfish free, contains non-GMO glucosamine, is 100% natural with no added sugar or artificial flavors.

Click here for more information on JoMo's Ingredients

Arthritis Dietary Strategies**

There are no foods that can cure arthritis of the ankle. However, certain dietary strategies can be helpful in managing symptoms.

• Weight Loss. Sliming down to your ideal body weight will eliminate excess "pound pressure" on your ankles and help reduce symptoms.
  
• Reduce intake of inflammation-generating foods. Inflammation is a problem in numerous forms of arthritis, so it may be wise to cut back on foods associated with the inflammatory process. These foods include meat, poultry, many fast foods, corn oil, safflower oil and other foods containing linoleic acid (which is converted within the body to arachidonic acid, a key player in the inflammation process.) Click here for details on foods that increase inflammation
  
• Increase inflammation-reducing foods. Foods containing omega 3 fatty oils, such as salmon, green soybeans and butternuts, can potentially help dampen the inflammatory processes in the body. They won't eliminate inflammation, but decreasing it even a bit may be helpful. More on foods that decrease inflammation
  
• Increase nutrients that support strong bones to lessen risk of fracture. Bone fractures can set the stage for certain forms of ankle arthritis, so it's important to consume ample amounts of nutrients that support strong bones. These include calcium (found in milk, dried figs and cheese), vitamin D (vitamin D-fortified dairy products, cod liver oil) and vitamin K (found in broccoli, Romaine lettuce, spinach and other green leafy vegetables).
  
• Eat a balanced diet. Consume a healthy mix of lean protein, complex carbohydrates, and fats high in omega 3 fatty oils, to maintain healthy joints and joint supporting structures.
• Decrease intake of "Nightshade Vegetables"

Click here for more information on Diet and Arthritis

Physical and Other Therapies for the Ankle**

A number of therapies that involve physically manipulating the body or otherwise altering or influencing it are used to reduce the symptoms of arthritis and improve the body's ability to heal. These include:

• Acupuncture - Traditional Chinese Medicine has long maintained that good health depends on a balanced flow of energy throughout the body. Through acupuncture, doctors of this ancient healing system remove blockages that may hinder the flow of energy, allowing the body to heal itself.
  
• Infrared Sauna and Steam - Infrared radiation is believed to penetrate deep into the tissues - deeper than the heat of a regular sauna - and improve circulation. Special heaters are used to create this heat.
  
• Magnetic Therapy - Magnetic fields are generated in order to correct the body's electromagnetic balance: this is thought to increase circulation and help the body heal itself.
  
• Osteopathy - Acting on the belief that the human body is capable of a great deal of self-repair, an osteopath will physically manipulate the musculoskeletal system in order to improve the movement of the body fluids necessary for healing.
  
• Physical Therapy - Utilizing the findings and recommendations of your physician, a physical therapist can teach you exercises to rehabilitate your ankle, and can apply heat and use other techniques to improve ankle function and range of motion.
  
• Reiki - This Japanese therapy is designed to revitalize your body's energy system so it can repair itself. This is accomplished through the "laying of the hands" near the surface of your skin.
  
• Transcutaneous Electrical Stimulation (TENS) - TENS is a non-invasive method of introducing a mild electrical current into the distressed part of the body in order to lessen the perception of the pain. TENS may also be used to facilitate the transfer of medicine from a patch through the skin and into the body.
  
• Ultrasound - High-energy sound waves, too high for humans to hear, are directed into the distressed part of the body in order to increase circulation and facilitate repair.

Click here for more information on Alternative Therapies

Ankle Surgery

Surgery is usually the last option, utilized only after all other options have been exhausted. The surgeries designed to relieve arthritis-related ankle pain include:

• Arthroscopy - In certain cases of moderate joint damage, arthroscopic surgery - "pinhole" surgery performed through small cuts in the skin - may be helpful for cleaning up small bone spurs.
  
• Joint Fusion - When arthritic damage causes too much pain or has significantly hampered or even destroyed the function of the joint, your doctor may suggest surgical fusion to literally "lock" the joint into place. The worn out portion of the joint is removed and the remaining bones are fused together.
  
• Ankle Replacement - This form of joint replacement is generally reserved for older and less active people, who will place less stress on the replacement joint than their younger or more active counterparts. For the surgery, the ends of the tibia (shin bone) and talus (platform-like ankle bone) are removed; the edges of these bones are leveled and a plastic-and-metal artificial joint is inserted.

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