The ankle forms the angle (the word ankle derives from the Latin word for angle) where the foot meets the leg. It includes three main joints, the ankle joint proper, the talocrural joint, and the subtalar joint. The main bones of the ankle area are the talus (located in the foot) and the fibula and tibia (both in the leg).
The ankle and foot are commonly affected in RA, with 9 out of 10 patients experiencing foot or ankle manifestations at some point in the course of the disease. In RA, inflammation of the ankle makes weight-bearing movement painful. Basic ambulation (walking) becomes difficult or impossible, leading to significant disability.
As is true with RA and joints throughout the body, the sooner diagnosis is made and treatment initiated, the greater the likelihood that joint damage can be minimized or prevented. The availability of disease-modifying anti-rheumatic drugs (DMARDs) and newer biologics that are effective at slowing or preventing structural damage to the joints means that the joints and other structures in the region of the ankle can often be preserved and function maintained.
How does RA affect the ankle?
In RA, joints in the ankle may become inflamed and swollen. This inflammation and swelling can eventually lead to nerve damage, resulting in numbness and tingling in the foot.1
How is RA-related ankle involvement treated?
Treatment of RA symptoms affecting the ankle depends on the severity of symptoms and the nature and extent of damage, as well as the patient’s goals and needs. Options include drug and non-drug treatments, and surgery.2
Drug treatments. The initial approach to treatment should involve medications to control inflammation and pain (including analgesics [NSAIDs], disease-modifying anti-rheumatic drugs [DMARDs], and glucocorticoid injection).2
Injection of glucocorticoids directly into affected joints in the ankle may be useful in controlling acute inflammation. However, glucocorticoids will not prevent progression of the disease and structural damage to joints.2
Non-drug management approaches. Rest and/or restricted activity and application of cold (ice) for 20 to 30 minutes 3 to 4 times per day may be used to provide relief of acute pain. Application of cold may be most useful following physical activity. Do not apply ice directly to your skin.2
Physical therapy and other forms of rehabilitation may be useful in maintaining the strength and flexibility of joints and muscles in the ankle.2
Use of a lace-up brace that provides support to the back of the foot and ankle may be effective in relieving pain in the ankle. A custom-made plastic molded or leather brace may be required in some patients.2
Surgery. If joint symptoms do not respond to medication or other management approaches, surgical interventions may be used. Surgical options include fusion of affected joints and total ankle replacement. Both of these approaches are effective in reducing pain and improving mobility and function. Fusion of joints involves removal of the joint and fusion of two bones into one. Ankle replacement is typically considered for patients who have already had a fusion of joints or where there is severe involvement of the joints in or near the ankle.2