Ankle arthritis
Ankle arthritis is the loss of cartilage in the ankle joint. Cartilage is the smooth surface that lets the bones glide against each other, and as it wears away the joint becomes painful, stiff, and swollen. Unlike arthritis of the hip or knee, ankle arthritis usually traces back to an old injury rather than age alone.
What causes ankle arthritis?
Most ankle arthritis is post-traumatic, meaning it follows an earlier injury — a broken ankle, or repeated bad sprains. The damage can surface many years later, so an injury in your twenties can be the reason your ankle hurts in your fifties. Tell your surgeon about any old ankle or foot injury, even one from childhood, and even one that seemed to heal fine.
Other causes include osteoarthritis, the gradual wear of the joint surface over time; rheumatoid arthritis, where inflammation of the joint lining eventually destroys cartilage; and infection, which can damage a joint directly. Several less common conditions can also lead to it.
What are the symptoms?
The usual three are pain, stiffness, and swelling. Walking on uneven ground or up a hill tends to be worse than walking on a flat floor. Symptoms often come and go in better and worse spells rather than worsening steadily.
Arthritis is generally present before it is felt, and symptoms can appear either gradually or suddenly. Over years, the shape of the ankle can change and the foot can sit at a different angle underneath the leg — a shift most people never notice happening.
How is it diagnosed?
Usually with a weight-bearing X-ray, taken while you stand on the foot. Standing matters: it shows how the ankle lines up under your body weight and how much of the joint space is left. Less space means less cartilage, and a joint described as “bone on bone” has almost none. A CT scan or MRI is sometimes added to look at the joint in more detail or to help choose a treatment.
How is ankle arthritis treated without surgery?
Nonsurgical care comes first, and for many people it is enough for a long time. It usually draws on some combination of:
- Anti-inflammatory medication (NSAIDs), taken by mouth or applied to the ankle as a gel.
- A brace that limits how far the ankle moves, which can reduce pain. Often an off-the-shelf brace first, sometimes a custom one.
- Changing activities — trading running and court sports for cycling or swimming, which load the joint far less.
- Physical therapy to strengthen the muscles that steady the ankle. Most useful early on, alongside the activity changes.
- A steroid injection to quiet inflammation in the joint. Relief typically lasts a few months; some people get none and some get considerably longer. Injections are generally not a long-term answer.
Hyaluronic acid and platelet-rich plasma (PRP) injections are not proven for ankle arthritis and are generally not covered by insurance.
When is surgery considered?
When nonsurgical treatment stops controlling the symptoms. What kind of surgery depends on how much cartilage is gone. In milder arthritis, that can mean cleaning out bone spurs or loose fragments, or repairing a small area of cartilage.
For advanced, bone-on-bone arthritis, the two main operations are total ankle replacement, which removes the worn surfaces and replaces them with metal and plastic so the ankle can still bend, and ankle fusion, which joins the ankle bones with plates or screws so they heal into one bone and the joint no longer moves. Sometimes a bone is also cut and reset to correct the alignment. Both operations are reasonable choices in the right circumstances, and the decision depends on your bone quality, alignment, and what you need your ankle to do.
Can I keep it from getting worse?
Partly. Getting treatment early helps control pain and limit further damage to the joint. Low-impact exercise such as cycling or swimming keeps you fit without loading the ankle, while high-impact activity like running may speed the damage up. Check with your doctor before changing your activity or exercise routine.
What surgery can and cannot do
Worth knowing before any consultation: no operation gives you a normal ankle back. Replacement and fusion are aimed at relieving pain and getting you walking and doing low-impact activity comfortably. The ankle will still feel stiff, and running sports are not part of the expected result.
See what an ankle replacement actually looks like — the three parts, shown in the ankle and on their own.
Source: AOFAS FootCareMD: Ankle Arthritis, a patient guide from the American Orthopaedic Foot & Ankle Society.