Q) I’m a male aged 61 and have just developed what appears to be osteoarthritis in my right ankle. I was very active as a young man and suffered a lot of ankle injuries and so osteoarthritis is probable. I await an MRI scan to confirm the diagnosis.
I’m physically very active and it’ll be devastating if I have to give up my hobby of mountaineering. Before considering treatment options, could you tell me what treatments are presently being developed? And what are the probable timescales to bring such treatments into production?
I accept I may have to wait a few years for an effective cure, but I consider it’d be better to delay surgery for a year or two in favour of a cure. I’m aware of research into gene therapy and the use of drugs to stimulate cartilage regrowth, but I imagine there are other possible therapies being investigated.
Are there any digests of present research available online?
Simon, via email (Summer 2015)
A) It‘s likely that the injuries you sustained as a younger man have impacted on the pain you’re experiencing in your ankle now. It’s good that you're having an MRI to establish a full diagnosis for your problem. An MRI will identify problems in the bones, joint surface, ligaments and tendons around the ankle joint. This will help to guide your treatment options.
I presume that you’ve damaged the ligaments that support the ankle joint as well as the nerve fibres that provide feedback to your brain about the position of your ankle joint. While you’re waiting for new treatments to become available, the mainstay of treatment is a mix of:
- stretching to maintain full joint range of movement
- resistance exercises to increase the strength and stability of the muscles and tendons around the ankle
- work to improve the sense of balance in the joint (this is called proprioception).
Our exercises for foot pain may be useful for you.
Footwear is incredibly important, particularly if you’re mountaineering. Boots that support your ankle and support the arch of your foot are most suitable – balancing stiffness and support with flexibility.
You might also find that treatments such as steroid joint injections to your ankle joint may help manage symptoms if you’re having a flare-up of pain. Topical creams such as non-steroidal anti-inflammatory drugs (NSAIDs) or capsaicin (chilli extract) may also help to manage pain.
In response to your request for digests of present research I would point you in the direction of what we're funding.
Editor’s note: Our researchers at Keele University are currently running a clinical trial of 100 patients to test the effectiveness of stem cells compared with cartilage cells in treating people with early stage osteoarthritis of the knee by rejuvenating areas of cartilage damage.
If proven to work, this form of treatment could become available for people with early osteoarthritis within the next 10 years. Read more about whether stem cells could be the answer for osteoarthritis.
Ankle fusion or replacement could also be an option further down the line.
This answer was provided by Dr Tom Margham for the Summer 2015 edition of our magazine, Arthritis Today, and was correct at the time of publication.
Send your questions for Dr Tom Margham to firstname.lastname@example.org
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