Deciding whether to have surgery for painful ankles

It may be worth doing when you have had to give up activities because of your pain,
It may be worth doing when you have had to give up activities because of your pain,

A: The decision to have an operation for arthritis is related to how much a person's quality of life is affected by the condition. When you have had to give up activities because of your pain, that's when it's worth doing something about.

In order to justify going through an operation and recovery, there has to be a significant amount of improvement in the patient.

So someone who's bothered a little bit by their arthritis is probably not going to be that happy after a big operation. They might say 'Well, I'm only a little bit better'.

But someone who says 'I've had to give up walking, I've had to give up playing bowls, I've had to give up exercising and now I can do those things after my joint replacement' - they've gained a lot, even though it's been quite inconvenient to have the surgery. They're so much better than they were, it was worth doing.

Up until recently, surgical treatment for arthritis in the foot has meant fusing the joint together.

The outcome of that is you often go from what is a stiff and painful joint to a stiff and painless joint. So you lose what movement you have, but you also lose the pain.

However newer treatments are able to preserve the joint and its movement so that we hopefully get a joint that moves but doesn't hurt.

The first one is ankle replacement. By using a CAT scan we create a 3D printed version of the ankle which allows us to analyse exactly where the custom-made instrumentation will fit onto the existing limb.

The big toe is also susceptible to arthritis. That joint is about the size of a 10 cent piece, and you put all of your body weight through that one little joint as you're pushing off on it.

If you do a lot of walking or running or if you do things in the gym like squats or lunges, or you wear high heels, it can obviously be quite painful.

A new thing that we use in the foot and ankle is a thing called Cartiva, a small implant made from the same material as contact lenses. It's currently used in big toes as well as the smaller toes, and I'm sure they will look at using it in other joints.

What is arthritis?

Arthritis is a disease of the joints. There are two types of arthritis: the most common is osteoarthritis (OA) which is due to the wear and tear of the joint surface, and inflammatory arthritis (IA), where the body has a reaction against itself which damages the joints.

IA can occur in younger people as opposed to OA which affects more older people.

The signs of arthritis are pain, swelling and stiffness. All of us are experiencing these symptoms to some degree. Sometimes people who have had damage to the cartilage in their joints can develop OA, or are likely to develop it in the future. Some people have a genetic predisposition, and for others it just happens.

Treatment for arthritis consists of simple things like pain relief using anti-inflammatories, wearing comfortable and supportive shoes.

Inevitably, the arthritis will progress or get worse, however we can't predict to when this will happen, or to what degree.

The best predictor of what will happen is what has happened, meaning if your arthritis has come on quickly then it is likely to progress quickly too.

Newer treatments are able to preserve the joint and its movement so that we hopefully get a joint that moves but doesn't hurt.