Damaged ankles can be fused or replaced, but these surgeries have drawbacks
Published: 2010-07-05 06:06:38By: Nancy Rome | Washington Post | March 16, 2010
The best athlete I knew in college has just had both his hips replaced. Another friend recently got two new titanium knees. We're all in our 50s -- once among the fittest in our college classes and now suffering from the kind of worn-out, creaking joints that generally come at a much older age.
Even though I stopped playing lacrosse in 1978, I have spent the past three decades wearing out ankles made unstable by the frequent turns that sport demanded. All the cartilage in my right ankle has eroded, and there's not much remaining in the left. I'm now "bone-on-bone," as the specialists say. A formerly fit 53-year-old, I now have severe osteoarthritis. I can walk only about a dozen city blocks; I take wheelchairs in most airports and museums; and I often have to sit down suddenly in the grocery store or garden when the pain becomes intolerable.
Determined not to give up every sport I love, I've sought treatment and canvassed the ankle gurus in Baltimore, where I live. After a series of appointments with specialists, one cortisone shot, two courses of hyaluronic acid injections (a viscous fluid designed to temporarily replace the body's joint lubricants) and countless X-rays, the prognosis isn't great. They are not offering to give me new ankles in the same way my friends have been getting new hips and knees.
Here's why: Hips and shoulders are simple ball-in-socket joints, which give our limbs rotational movement. The much-injured knee allows only forward and backward motion. But ankles are far more complex: They are a combination of three bones, the tibia and fibula (large and small leg bones) and the talus (the ankle bone). The leg bones are shaped to allow the talus to slide back and forth and in circles, and the talus works inside a socket; this allows your foot to move in many directions, as anyone knows who has been instructed by a physical therapist to use her foot to write the alphabet in the air.
If the ankle is a triumph of evolutionary engineering, it is proving hard to replicate in the lab. Not only is this complex joint sometimes forced to bear nearly five times the body's weight, but it also resides in a thin "soft tissue envelope," which makes healing more difficult if you do have surgery.
Three inadequate options
The doctors discussed three options with me: Fuse the ankle, replace it, or -- and this was the choice they all encouraged me to make -- grin and bear the pain until ankle surgeries and technology catch up to the care available for other worn-out joints. Each of these options comes with a long list of associated problems, especially for someone my age who wants to remain active.
The first option, fusing (or arthrodesis), involves using screws to secure the tibia (and sometimes the fibula, too) to the talus bone (in most cases), which can alleviate much of the pain caused by bone-on-bone friction. Fusing eliminates up-and-down movement but preserves side-to-side movement and allows other bones in the foot to still move after surgery. The problem is that fusing adversely affects your gait and is likely to create arthritis in other parts of the foot. Fusing may also lead to back, hip and knee problems and usually leaves you with a joint not mobile enough to play tennis or golf.
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