title: Nonmedicinal therapy in the management of ankle arthritis.
abstract: OBJECTIVE
  The incidence of ankle osteoarthritis has increased in recent years, in part, secondary to vehicular trauma. This review describes conservative and operative intervention strategies along with current research related to the management of ankle osteoarthritis.
  
  
  RESULTS
  Self-reported physical function in patients with ankle osteoarthritis is equivalent to or worse than that of patients with endstage kidney disease, congestive heart failure, or cervical-spine pain and radiculopathy. Nonoperative-intervention strategies such as assistive devices, orthoses, and viscosupplements are frequently used in this clinical population. However, limited objective data are available examining outcomes following nonoperative intervention. Ankle fusion serves as a standard-surgical treatment for end-stage ankle osteoarthritis. The limitations of ankle fusion include prolonged immobilization, a relatively high risk of nonunion, and adjacent joint arthritis. Increasing evidence supports the safety and efficacy of total-ankle arthroplasty (TAA). Current (third generation) TAA prostheses feature cementless design and ligament preservation with reduced bone resection and improved instrumentation.
  
  
  CONCLUSIONS
  Limited objective evidence exists to guide clinical decision-making related to nonoperative choices such as assistive devices, orthoses, and viscosupplements. Outcomes from prospective clinical trials indicate that newer total ankle-arthroplasty designs provide substantial pain relief in patients with end-stage ankle osteoarthritis.
authors.affiliation: Department of Physical Therapy, New York University, New York, New York, USA.
authors.forename: Smita
authors.initials: S
authors.lastname: Rao
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Ellis
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Deland
authors.forename: Howard
authors.initials: H
authors.lastname: Hillstrom
mesh_terms: D000843:Ankle Joint / Q000503:physiopathology* / Q000601:surgery; D001178:Arthroplasty; D001696:Biomechanical Phenomena / Q000502:physiology; D006801:Humans; D009989:Orthotic Devices; D010003:Osteoarthritis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology