“Why is my ankle clicking?” “My ankle makes a popping sound.” We hear this quite a bit from patients in DeLoor Podiatry, pun intended. According to Dr. Jose Loor, the common causes of ankle clicking and popping are tendon snapping over the bones, a chronic ligament injury, and OCD or osteochondritis dissecans. OCD, also meaning osteochondral defect, is severe cartilage damage.
Athletes usually develop OCD in their knees, but ankle cartilage damage is also prevalent, especially as so many people (not only athletes) ignore ankle sprain.
Since cartilage has a minimal ability to repair itself, cartilage damage, when left untreated, can progress to bone or joint degeneration, osteoarthritis.
What is cartilage damage?
Cartilage damage isn’t exclusive to any age group. DeLoor Podiatry has seen it happen to everyone, young and old, athletes or office workers. One bad “twist” in your ankle can lead to OCD.
When the injury is severe enough, or repeated, and when neglected, the cartilage deteriorates and pieces can break off, leading to severely painful “bone-on-bone” contact.
With cartilage damage, you’ll experience pain, swelling and stiffness in the ankle.
The inflammation can be mild to severe. Your ankle may be red, warm to the touch and extremely sore. The range of your ankle’s movement will also be limited. You won’t be able to move your foot easily.
Dr. Loor says, “We’ve had patients who complained of these symptoms and their ankle continued clicking MONTHS after a bad sprain. By then, their pain varied between a persistent mild ache and extreme throbbing.”
The importance of your cartilage
Cartilage is the white connective “bone” found in between joints and in many parts of the body. Your nose and ears are partially and entirely made of cartilage, for instance.
In between the joints, the cartilage functions as a cushioning support. It also holds the bones together. Cartilage is not bone. It’s a tough, flexible tissue, but easy to damage.
It has no blood supply, which explains why cartilage is white. As such, it doesn’t heal easily when damaged or torn. This is where DeLoor Podiatry and other specialist orthopedic surgical clinics help so much. Cartilage is so delicate and needs coaxing from surgeons.
Pieces of cartilage may also break off and cause pain in the joint every time these loose pieces rub against tissue.
Cartilage damage can also lead to:
- Hemarthrosis, bleeding in the joint. In severe cases, a piece of cartilage breaks off and gets stuck between the joints, locking them and causing bleeding. Here, your ankle would look bruised.
- Additional stress on the bones, which, in turn could lead to bones spurs: osteophytes. These bones spurs form at the margins of the joint, leading to even more pain and dysfunction for your ankle. Think of gears rubbing together and not turning at all, screeching because they’re scratching each other.
- Cartilage lesion, a ‘pothole’ in the cartilage. This lesion, like all potholes, can grow bigger until the entire cartilage is worn away.
Dr. Jose Loor often warns his patients that, “When cartilage is completely worn away, your joints lose their cushion and the bones would rub against each other. This is extremely painful.”
Since cartilage has a minimal ability to repair itself, cartilage damage, when left untreated, can progress to bone or joint degeneration, osteoarthritis. Ankle joints are weight-bearing joints, and if the cartilage becomes severely damaged, the patient will lose ability to walk.
Joints need movement to stay healthy. Protracted periods of inactivity and immobility also damages the cartilage.
What causes cartilage damage?
Poor joint alignment
Sometimes this is inborn, and sometimes it’s caused by healing post-injury. It needs to be corrected through surgery and therapy.
Injury and excessive use
A bad fall on a step, a twist in your ankle, an accident where something drops and pins your ankle — all of this can damage your cartilage.
As you may have guessed, football, rugby, tennis and wrestling athletes are most susceptible. Any high impact sport where you have to run and jump, like basketball and badminton.
Lack of movement
Muscle atrophy isn’t the only thing that happens when someone doesn’t move regularly. Joints need movement to stay healthy. Protracted periods of inactivity and immobility also damages the cartilage.
Dr. Loor says, “Our bodies are amazing in adapting and adjusting, but too much weight really does cause a lot of strain on our organs, bones and joints, especially the ankle. It’s a weight-bearing joint. Every time you walk, your ankle supports you. Obese individuals have a higher likelihood of cartilage damage in the ankle, because their body is under much more physical stress.”
Diagnosing cartilage damage
“Cartilage damage can be difficult to differentiate from other issues like ligament damage and subchondral lesions, because the symptoms are similar,” says Dr. Loor.
To confirm cartilage damage, you would get a physical examination from any of the specialists at DeLoor Podiatry, followed by X-rays. If the X-rays are negative despite pain lasting more than 2 months, MRI and CT scans are next.
The MRI and CT scans show us cartilage injury, subchondral injury (see our article on Subchondroplasty for Ankle Arthritis), or a chip fracture, which can be horrendously painful. It also feels like clicking whenever you move your ankle.
When these imaging procedures are still not conclusive, arthroscopy is performed. The arthroscope is a tube instrument with a camera at the tip. It’s inserted into the joint for to assess and repair damage.
Treatments for cartilage damage
There are several conservative treatment options for OCD, similar to other ankle conditions. DeLoor Podiatry prescribes, recommends and fits you with any of these:
Your doctor would prescribe NSAIDs to reduce inflammation and pain.
Therapy for the joints
You would usually be referred to an occupational or physical therapist for strengthening your muscles, restoring your range of motion and increasing your joint position awareness.
Resting the ankles/Alternate mobility
To minimize pain, you should avoid activities that cause it. Use the elevator. Instead of walking, choose biking. Opt for low-impact exercises like elliptical machines, spinning, and swimming.
Braces are custom-molded plastic or leather lace ups that support the joints at back of the foot and your ankle, effectively decreasing the pain there.
You can put an ice compress on your ankle 3-4 times a day, for 20 minutes’ duration. Do this immediately after physical activity.
Foot and ankle surgery
When therapy and medications aren’t enough to help your pain and mobility, it’s time to turn to foot surgery. Only ankle arthroscopy can remove cartilage fragments and fix what needs fixing. Ankle surgery is also the way Dr. Loor can drill tiny holes and entice the growth of new fibrocartilage. For severe damage, cartilage grafting may be the only solution.
Arthroscopy for repairing cartilage damage
Unfortunately, without surgery, OCD would only get worse and worse. You don’t want it to progress to such a severe case that you’d need complete joint replacement.
Arthroscopy can repair the cartilage damage, and, with rest and therapy, you’d soon be back to your previous quality of life and daily activities.
Depending on the extent of your cartilage damage, DeLoor Podiatry does the following procedures through arthroscopy.
- Debridement – Dr. Jose Loor and his team, using small arthroscopic instruments, smooths the damaged cartilage, removing loose edges that rub and irritate other tissues near the joint, the source of pain.
- Marrow stimulation – Here, your surgeon drills tiny holes (micro-fractures) under the damaged cartilage. The exposure of the blood vessels inside the bone would cause a blood clot inside the cartilage. This in turn triggers the production of new cartilage. However, this new cartilage is not on par with the strength and durability of the original. The patient may have to undergo further surgery when this new cartilage wears away.
- Mosaicplasty – Your surgeon would replace damaged cartilage with healthy cartilage taken from another part of your body. This procedure is for those under 50, with isolated cartilage damage, usually caused by accidents or injury. It’s not for patients with osteoarthritis where the damage is bigger and widespread.
What to expect on your arthroscopy
You’ve probably heard jokes about doctors operating on the wrong hip or knee. This is impossible, because the surgeon marks the operative leg before surgery.
You’d be given a general anesthesia and a well-padded tourniquet on your thigh.
Dr. Loor says, “We also sometimes employ a device to stretch your ankle joint. This makes it easier to see what’s what.”
- At least two small incisions are made in the front and/or back of your ankle. These are the entry and exit of the arthroscopic camera and instruments. This is where arthroscopy get its nickname, “keyhole surgery.”
- Sterile fluid is conducted into your joint to expand it, and for a better image delivery.
- The camera and instruments would be alternated between the openings while the surgery is being performed.
- Afterward, the incisions would be sewn closed.
- You’d have a sterile dressing over the sutures and a splint or boot to immobilize your ankle during recovery.
After the surgery:
- You’d take oral pain meds for the pain and swelling for several days.
- Your stitches would be removed 1-2 weeks after surgery.
- That’s also when Dr. Loor would advise you about the range of movement, ankle exercises and physical therapy ideal for you.
- Depending on your condition: you can either walk on your leg again immediately after surgery, or you may have to keep it elevated and not put weight on it for several weeks.
When can you go back to your previous activities?
70% to 90% of patients from Gramercy and Brooklyn, New York who undergo arthroscopy from DeLoor Podiatry gain excellent results.
You can expect to go back to work mere days after the surgery if your work doesn’t put strain on your foot, but most patients need a recovery period of 1 to 2 weeks. It’s best to ask for leave.
You can drive again when you can put weight on your foot and you’re no longer taking narcotic pain medications.
If you’re an athlete or an avid sports enthusiast, expect 4-6 weeks’ recovery before being able to go back to your favorite activity, and that’s not without physical therapy.