Unlike other forms of arthritis, rheumatoid arthritis is a systemic autoimmune disease that is not caused by common wear and tear on the joint. This condition usually affects joints symmetrically (for example, both knees, both wrists, both ankles). Rheumatoid arthritis causes degeneration of the articular or joint cartilage. It can also affect the tissue that surrounds and lubricates the joint (synovium). If the joint surfaces and cartilage are not lubricated they can start to rub, causing wear.
Rheumatoid arthritis can affect other parts of the body including organs like the heart and lungs, and can even cause fatigue. The cause of Rheumatoid arthritis is not fully known. It is considered an autoimmune disease where the cells of the body attack themselves. Although it is a chronic condition, individuals can have periods of little to no symptoms mixed with acute or symptomatic periods. There can be a genetic component to this disease.
- Pain is present over the ankle joint often affecting both right and left.
- Swelling and inflammation of the joint.
- The joint will feel hot or warm to the touch.
- Stiffness and loss of motion of the ankle when flexing or moving the joint.
- Weakness, which may be manifested as difficulty walking or climbing stairs.
- Fatigue or tiring easily when performing normal daily activities.
The ideal treatment involves a combination of medication, rest, joint range of motion and strengthening exercises, joint protection strategies such as bracing and splinting and patient education. Restoring range of motion and strength is paramount to maintaining function. Protecting the joint through education about movement as well as bracing and splinting when necessary can help reduce further joint damage. Treatment is customized depending on the individual’s age, level of function, acute versus chronic flare up, pain level and general health.
Physical Therapists are professionals, educated and trained to administer interventions. As defined by The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and the patient or client’s goals.
Your physical therapist will perform a thorough evaluation to assess and determine the following:
- Joint: a series of measurements will be performed to determine which joint is involved and the extent to which the inflammation is acute
- Strength: resisted testing is performed to determine if there is associated weakness or strength imbalances
- Flexibility: range of motion measurements will be taken to determine if there is reduced joint movement
- Technique and ADL: the therapist will review what activities you have difficulty with and will help you make modifications in technique to reduce stress on the involved joint.
- Gait, Balance, and Alignment: the therapist will assess your gait and balance on even and uneven surfaces. An assistive device such as a cane or walker may be indicated to improve safety, gait and reduce stress on the affected joint.
Physical therapy for ankle arthritis must remain conservative at the onset to avoid aggravating the condition. Emphasis will be placed on rest, reducing the inflammation, protecting the joint and increasing the blood circulation for healing. Once the initial inflammation has reduced a program of stretching and strengthening will be initiated to restore flexibility and improve strength to reduce stress on ankle joint. Taping, bracing or strapping to rest and protect the joint while promoting healing may be indicated.
Common Physical Therapy interventions in the treatment of Ankle Arthritis include:
- Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, stretching and joint mobilization by a physical therapist to improve alignment, mobility, and range of motion of the ankle. The use of mobilization techniques also helps to modulate pain.
- Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen muscles of the ankle and lower extremity to support, stabilize and decrease the stresses placed on joint cartilage and the ankle joint.
- Neuromuscular Re-education (NMR) to restore stability, retrain the lower extremity and improve movement techniques and mechanics (for example, running or jumping) of the involved lower extremity to reduce stress on the joint surfaces in daily activities. Taping, strapping or bracing may be indicated for joint protection and promote healing. Gait and balance training may be indicated in those that have issues with walking.
- Modalities including the use of ultrasound, electrical stimulation, ice, cold, laser and others to decrease pain and inflammation of the involved joint.
Early aggressive medical care is recommended for individuals with Rheumatoid Arthritis. Interventions may include the following:
- The use of DMARD (disease modifying anti-rheumatic drugs).
- The use of NSAIDs (nonsteroidal anti-inflammatory drugs)
- When indicated steroids in low doses will be prescribed to reduce joint inflammation.
- Physical and Occupational Therapy to develop a stretching and strengthening program.
- Bracing and splinting to protect and rest the involved joints
- Surgery may be indicated in severe cases. An arthroscopic procedure to remove an inflamed synovial lining is one surgical option. In the case of severe joint and cartilage degeneration, an ankle replacement is the preferred procedure.