Ankle Arthritis

What Is Ankle Arthritis?

To understand ankle arthritis, it's helpful to know a bit about the anatomy of the ankle joint. The ankle is a hinge joint that connects the lower leg bones (tibia and fibula) to the talus, a bone in the foot. The joint is lined with a smooth, slippery tissue called cartilage, which helps the bones glide smoothly against each other and absorbs shock during movement.

In ankle arthritis, this cartilage breaks down and wears away, causing the bones to rub directly against each other. This can cause inflammation, pain, stiffness, and bone spurs (small, bony projections that develop along the edges of the joint). Over time, the joint may become more damaged and painful, making it difficult to walk or put weight on the affected foot.

There are several types of ankle arthritis, including:

• Osteoarthritis: This is the most common form of ankle arthritis, often from wear and tear on the joint over time. It typically affects older adults but can also occur in younger people with a history of ankle injury or overuse.
• Rheumatoid arthritis: This is an autoimmune disease that causes the body's immune system to attack the joints, causing inflammation and damage. It can affect multiple joints throughout the body, including the ankles.
• Post-traumatic arthritis: This type of arthritis develops after an injury to the ankle, such as a fracture or severe sprain. The injury can damage the cartilage and change the mechanics of the joint, increasing the risk of arthritis.

Ankle arthritis is relatively uncommon, affecting about 1% of the general population. 8,9 However, it can have a substantial impact on your mobility and quality of life, so it is important to understand.

Causes of Ankle Arthritis

Ankle arthritis can develop for a variety of reasons, but the most common cause is a previous injury to the joint. Up to 70% of ankle arthritis cases are likely related to past trauma, such as a fracture or severe sprain. 10

When the ankle is injured, the cartilage that lines the joint can be damaged directly or indirectly. A fracture, for example, can cause a piece of cartilage to break off and float freely in the joint space, causing inflammation and further damage over time. A severe sprain can stretch or tear the ligaments that support the ankle. This makes the joint less stable and more prone to wear and tear.

Even a single ankle sprain with persistent pain can lead to arthritis down the road. That's because the injury can cause subtle changes in the way the joint moves and bears weight. Extra stress might be placed on certain areas of cartilage. Over time, this uneven wear can cause the cartilage to break down and arthritis to set in.

Other risk factors for ankle arthritis include:

• Age: Like other types of arthritis, ankle arthritis becomes more common with age as the cartilage naturally begins to wear down and lose its cushioning ability.
• Obesity: Carrying extra weight puts more stress on the ankle joint, which can speed up the breakdown of cartilage.
• Genetics: Some people may be born with slight defects in the shape or alignment of their ankle joint, which can make them more susceptible to developing arthritis over time.
• Occupations or activities that place repetitive stress on the ankles: Jobs that require a lot of standing, walking, or heavy lifting, as well as sports that involve jumping or quick changes in direction (like basketball or tennis), can increase the wear and tear on the ankle joint and the risk of arthritis.

Certain inflammatory conditions like rheumatoid arthritis can also affect the ankle joint. In rheumatoid arthritis, the body's immune system mistakenly attacks the lining of the joints, causing chronic inflammation and damage to the cartilage and bone. While it is less common than osteoarthritis, rheumatoid arthritis can cause ankle pain and disability.

Understanding the causes and risk factors for ankle arthritis is an important step in preventing the condition and managing it effectively. By protecting the ankles from injury, maintaining a healthy weight, and seeking prompt treatment for any ankle pain or instability, you can help reduce your risk of developing this condition.

Symptoms and Diagnosis of Ankle Arthritis

Ankle arthritis can cause a range of symptoms that can make it difficult to walk, stand, or participate in daily activities. The most common symptoms include:

• Pain: This is often the first and most noticeable symptom of ankle arthritis. The pain may be dull and achy or sharp and stabbing, and it typically gets worse with activity and improves with rest. In the early stages of arthritis, the pain may come and go, but as the condition progresses, it can become more constant and severe.
• Stiffness: Arthritis can make the ankle joint feel stiff and difficult to move, especially first thing in the morning or after sitting for a long period. This stiffness may improve with gentle movement and activity, but it can also make it harder to walk or bear weight on the affected foot.
• Swelling: Inflammation in the ankle joint can make the area swell and feel tender to the touch. This swelling may be more noticeable after activity or at the end of the day.
• Reduced range of motion: The joint may become less flexible and harder to move through its full range of motion. This can make it difficult to point or flex the foot, walk on uneven surfaces, or climb stairs.
• Grinding or popping sensations: In some cases, people with ankle arthritis may feel or hear a grinding, clicking, or popping sensation when they move the joint. This can be a sign that the cartilage has worn away and the bones are rubbing directly against each other.

Diagnosing Ankle Arthritis

If you have any of these symptoms, it's important to see a healthcare provider for an accurate diagnosis.

1. Medical history: The provider will start by taking a detailed medical history and asking about your symptoms, including when they started, how severe they are, and what makes them better or worse.
2. Physical exam: They will perform a physical exam, checking the ankle for signs of swelling, tenderness, and reduced range of motion.
3. Imaging test: To get a closer look at the inside of the joint, your provider may order imaging tests such as X-rays or an MRI.
4. X-rays can show changes in the bones of the ankle joint, such as the narrowing of the joint space or bone spurs.
5. An MRI can show more detailed images of the soft tissues in the joint, including the cartilage, ligaments, and tendons.
6. Blood tests: Your provider may also recommend blood tests to check for signs of inflammation or to rule out other conditions that can cause similar symptoms, such as gout or rheumatoid arthritis.

Once a diagnosis of ankle arthritis is made, your provider will work with you to develop a personalized treatment plan based on the severity of your symptoms, your age and activity level, and any other health conditions you may have. Treatment options can range from simple lifestyle changes and over-the-counter medications to more invasive procedures like surgery.

Treatment Options for Ankle Arthritis

When it comes to treating ankle arthritis, there is no one-size-fits-all approach. The best treatment plan will depend on a variety of factors, including the severity of your symptoms, the underlying cause of your arthritis, and your overall health and lifestyle goals. In general, treatment options can be divided into two main categories: non-surgical and surgical.

Non-Surgical Treatments

For many people with mild to moderate ankle arthritis, non-surgical treatments can help reduce pain and improve function. These may include:

• Lifestyle changes: Switching to low-impact activities (such as swimming or cycling instead of running), losing weight to reduce stress on the joint, and using assistive devices like a cane or brace can help symptoms and prevent further damage to the ankle. 1,2
• Physical therapy: Working with a physical therapist can help strengthen the muscles around the ankle, improve flexibility and range of motion, and learn proper gait and balance techniques to reduce stress on the joint. 1,2
• Medications: Over-the-counter pain relievers like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation in the ankle joint. In some cases, stronger prescription medications may be needed. 1,4
• Injections: Corticosteroid injections can provide short-term relief by reducing inflammation in the joint. Viscosupplementation injections, which use a gel-like substance to lubricate and cushion the joint, may also be helpful for some people. 1,4
• Orthotic devices: Custom-made shoe inserts or ankle braces can help support the joint, reduce pain, and improve alignment and stability. 2

Surgical Treatments

If non-surgical treatments are not effective, or if the joint damage is severe, surgery may be necessary. The two main surgical options for ankle arthritis are:

• Ankle fusion (arthrodesis): This procedure involves removing the damaged cartilage and fusing the bones of the ankle joint together with metal plates and screws. This can significantly reduce pain, but also limit flexibility and range of motion. 11,12
• Total ankle replacement (arthroplasty): In this procedure, the damaged parts of the ankle joint are removed and replaced with artificial parts made of metal and plastic. This can help keep some degree of motion in the joint while still reducing pain and improving function. 11,12

The choice between these two procedures will depend on several factors, including your age, activity level, and the severity of your arthritis. In general, younger and more active people may be better candidates for ankle replacement, while older or less active patients may benefit more from fusion. 3,5

In addition to these main surgical options, there are also several other procedures that may be helpful in certain cases. For example, arthroscopic debridement involves making small incisions and using a camera to remove loose cartilage or bone spurs from the joint, which can provide temporary relief in mild to moderate cases. 11 Distraction arthroplasty is another option that involves using an external fixator to slowly separate the bones of the ankle joint, which can help encourage cartilage regeneration and reduce pain. 6,7

Regardless of the specific treatment approach, the goal of managing ankle arthritis is to reduce pain, improve function, and help you maintain your quality of life. This often is a multidisciplinary approach that includes both non-surgical and surgical options, as well as lifestyle changes.

If you are experiencing symptoms of ankle arthritis, it's important to talk to your healthcare provider about your treatment options and work together to develop a personalized plan that meets your personal needs and goals. With the right approach, many people with ankle arthritis are able to successfully manage their symptoms and maintain an active, fulfilling life.

Preventing and Managing Ankle Arthritis

While there is no guaranteed way to prevent ankle arthritis, there are several steps you can take to reduce your risk and manage the condition if you do develop it. Here are some key strategies for preventing and managing ankle arthritis:

Preventing Ankle Arthritis

• Maintain a healthy weight: Excess weight puts extra stress on the ankle joint, which can speed up the wear and tear on the cartilage over time. Maintaining a healthy weight through diet and exercise can help reduce your risk of developing ankle arthritis. 33,34
• Wear proper footwear: Shoes that provide good support and cushioning can help absorb shock and reduce stress on the ankle joint. Avoid high heels or shoes with poor arch support, which can put extra strain on the joint. 13,14
• Use proper form during activities: When participating in sports or other physical activities, be sure to use proper form and technique to avoid unnecessary stress on the ankle joint. If you're not sure how to do this, you can work with a coach or physical therapist. 13,14
• Stretch and strengthen the muscles around the ankle: Regular stretching and strengthening exercises can help improve flexibility and stability in the ankle joint, which can reduce your risk of injury and arthritis over time. 13,14
• Treat injuries promptly: If you do experience an ankle injury, such as a sprain or fracture, seek prompt medical attention and follow your provider’s recommendations for treatment and rehabilitation. Proper care can help prevent long-term damage to the joint. 28,29

Managing Ankle Arthritis

If you have already developed ankle arthritis, there are several strategies you can use to manage your symptoms and maintain your quality of life:

• Stay active: While it may seem counterintuitive, regular physical activity can actually help reduce pain and stiffness in the ankle joint. Low-impact activities like swimming, cycling, and elliptical training can provide a good workout without putting too much stress on the joint. 16,32
• Use assistive devices: Assistive devices like a cane, walker, or ankle brace can help reduce stress on the ankle joint and improve stability. 16,32
• Use heat or cold therapy: Applying heat or cold to the affected ankle can help reduce pain and stiffness. Heat therapy can increase blood flow and relax muscles, while cold therapy can numb pain and reduce inflammation. 15,21
• Maintain a healthy weight: Excess body weight puts additional stress on the ankle joint, which can worsen symptoms of arthritis. Losing weight, if needed, can help reduce pain and improve mobility. 33,34

Conclusion

Ankle arthritis is a complex and often debilitating condition that can significantly impact your quality of life. By understanding the causes, symptoms, and available treatment options, as well as taking steps to prevent and manage the condition, people with ankle arthritis can work with their healthcare providers to develop personalized plans for maintaining mobility and reducing pain.

Citations:

<1>Barrett, S. (2012). Nonsurgical Treatments for Ankle Arthritis. Practical Pain Management, 12(4).</1>

<2>Jordan, K. M., Arden, N. K., Doherty, M., Bannwarth, B., Bijlsma, J. W., Dieppe, P., & Dougados, M. (2003). EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Annals of the Rheumatic Diseases.</2>

<3>Laufer, S. (2004). Osteoarthritis therapy--are there still unmet needs?. Rheumatology, 43(suppl_1), i9-i15.</3>

<4>Morelli, V., Naquin, C., & Weaver, V. (2003). Alternative therapies for traditional disease states: osteoarthritis. American family physician, 67(2), 339-344.</4>

<5>Richards, J. T., O'Hara, N. N., Healy, K., Zingas, N., McKibben, N., Benzel, C., ... & Sciadini, M. F. (2022). Fix or Replace? Patient Preferences for the Treatment of Geriatric Lower Extremity Fractures: A Discrete Choice Experiment. The Journal of Bone and Joint Surgery, 104(13), 1117-1124.</5>

<6>Bernstein, M., Reidler, J., Fragomen, A., & Rozbruch, S. R. (2017). Ankle distraction arthroplasty: indications, technique, and outcome. Journal of the American Academy of Orthopaedic Surgeons, 25(2), 89-99.</6>

<7>Xu, C., Zhao, L., Li, J., Huangfu, X., & Xie, G. (2017). Ankle joint distraction arthroplasty for severe ankle arthritis: a systematic review. BMC Musculoskeletal Disorders, 18(1), 1-9.</7>

<8>Casciato, D. J., Hyer, C. F., Berlet, G. C., & Roukis, T. S. (2023). Ankle Osteoarthritis: Epidemiology, Etiology, and Treatment. The Journal of Foot and Ankle Surgery, 62(3), 492-497.</8>

<9>Valderrabano, V., Horisberger, M., Russell, I., Dougall, H., & Hintermann, B. (2009). Etiology of ankle osteoarthritis. Clinical Orthopaedics and Related Research, 467(7), 1800-1806.</9>

<10>Saltzman, C. L., Salamon, M. L., Blanchard, G. M., Huff, T., Hayes, A., Buckwalter, J. A., & Amendola, A. (2005). Epidemiology of ankle arthritis: report of a consecutive series of 639 patients from a tertiary orthopaedic center. The Iowa Orthopaedic Journal, 25, 44.</10>

<11>Haddad, S. L., Coetzee, J. C., Estok, R., Fahrbach, K., Banel, D., & Nalysnyk, L. (2007). Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis: a systematic review of the literature. JBJS, 89(9), 1899-1905.</11>

<12>Saltzman, C. L., Kadoko, R. G., & Suh, J. S. (2010). Treatment of isolated ankle osteoarthritis with arthrodesis or the total ankle replacement: a comparison of early outcomes. Clinics in Orthopedic Surgery, 2(1), 1-7.</12>

<13>Arthroscopy Joint Replacement Preparing for Surgery Nonsurgical Treatments Diagnostic Tests Ortho-pinion Blog ... Bone Health Fitness & Exercise Sports Injury Prevention Home & Recreational Safety Ortho-pinion Blog Diet & Nutrition ... Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body and is common in the small joints of the foot and ankle.</13>

<14>There are more than 100 forms of arthritis, many of which affect the foot and ankle. All types can make it difficult to walk and perform activities you enjoy. Although there is no cure for arthritis, there are many treatment options available to slow the progress of the disease and relieve symptoms.</14>

<15>With proper treatment, many people with arthritis are able to manage their pain, remain active, and lead fulfilling lives. During standing, walking, and running, the foot and ankle provide support, shock absorption, balance, and several other functions that are essential for motion.</15>

<16>Initial treatment of arthritis of the foot and ankle is usually nonsurgical. Your doctor may recommend a range of treatment options. Lifestyle modifications. Some changes in your daily life can help relieve the pain of arthritis and slow the progression of the disease. These changes include:</16>

<17>If non-surgical treatments have not been effective and your ankle pain interferes with daily activities, talk to you doctor about options for surgery. "Our goal is to preserve your ankle joint for as long as possible," said Dr. Schweitzer, "and there are intermediary procedures that might help." For instance, if you have mild arthritis and the cause of your symptoms is joint instability, surgery to tighten ligaments supporting the ankle may be recommended.</17>

<18>The degree of your arthritis and potential impact on daily function indicates which treatment is right for you. For example, some people can stay active with low-impact exercises. However, if everyday activities like walking cause unbearable pain, surgery like an ankle replacement may be recommended to improve your function and mobility.</18>

<19>Ankle replacement replaces your arthritic joint with an artificial one and preserves motion. It may be a better choice for people who want to stay active. ... For many of Dr. Schweitzer's patients, something as simple as walking or going up and down stairs can be incredibly painful and challenging. "When patients get an ankle fusion or an ankle replacement, the most common feedback I get is, 'I wish I had done this sooner.' It really helps them get back to doing the things that they want to do, so that they can essentially forget about their ankle and move on with their lives," he said.</19>

<20>Symptoms of foot and ankle arthritis often involve the following: Tenderness or pain. Reduced ability to move or walk. Stiffness in the joint. Swelling in the joint. ... A preliminary medical history in which the provider asks questions about when and where the pain began, as well as aggravating or alleviating factors. A test called a gait analysis, in which the healthcare provider measures your stride and the way you walk. ... Foot and ankle arthritis can be treated in many ways.</20>

<21>Our doctors often recommend nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and relieve pain in foot and ankle joints affected by arthritis. NSAIDs are taken by mouth, and many, including ibuprofen and naproxen, are available over the counter. If these medications aren't working to ease your arthritis-related pain, your doctor may recommend a prescription medication. Whether your doctor recommends prescription or nonprescription NSAIDs, he or she can advise you on the right dosage for you, including how long to continue treatment.</21>

<22>Whether your doctor recommends prescription or nonprescription NSAIDs, he or she can advise you on the right dosage for you, including how long to continue treatment. NSAIDs may cause side effects including nausea, diarrhea, and headache, and prolonged use should be monitored by a doctor. Some people find that wearing an orthotic insert, which fits into the shoe, or a foot or ankle brace helps to ease arthritis symptoms.</22>

<23>Barylak, M., Arena, S., Hamlin, S., & Queen, R. (2023). End-stage ankle arthritis alters dynamic stability during gait as measured by margin of stability between limbs and compared to healthy controls. Gait & Posture, 97, 1-6. https://doi.org/10.1016/j.gaitpost.2023.03.009</23>

<24>Chirongoma, T., Cabrera, A., Bouterse, A., Chung, D., Patton, D., & Essilfie, A. (2023). Predicting Prolonged Length of Hospital Stay and Identifying Risk Factors Following Total Ankle Arthroplasty: A Supervised Machine Learning Methodology. Foot & Ankle Orthopaedics, 8(2), 24730114221145. https://doi.org/10.1177/24730114221145</24>

<25>Tejero S, Prada-Chamorro E, González-Martín D, García-Guirao A, Galhoum A, Valderrabano V, Herrera-Pérez M. Conservative treatment of ankle osteoarthritis.</25>

<26>Outcomes of total ankle replacement, arthroscopic ankle arthrodesis, and open ankle arthrodesis for isolated non-deformed end-stage ankle arthritis. Journal of Bone and Joint Surgery: American Volume 20191011523–1529. ( 10.2106/JBJS.18.01012) [PubMed] [CrossRef] [Google Scholar]</26>

<27>Shih CL, Chen SJ, Huang PJ. Clinical outcomes of total ankle arthroplasty versus ankle arthrodesis for the treatment of end-stage ankle arthritis in the last decade: a systematic review and meta-analysis.</27>

<28>Kiely PDW, Lloyd ME. Ankle arthritis – an important signpost in rheumatologic practice. Rheumatology. 2021;60(1):23-33. doi:10.1093/rheumatology/keaa531</28>

<29>Yucesoy B, Charles LE, Baker B, Burchfiel CM. Occupational and genetic risk factors for osteoarthritis: a review. Work. 2015;50(2):261-273. doi:10.3233/WOR-131739</29>

<30>Bossert, M., Boublil, D., Parisaux, J.-M., Bozgan, A.-M., Richelme, E., & Conrozier, T. (2021). Imaging Guidance Improves the Results of Viscosupplementation with HANOX-M-XL in Patients with Ankle Osteoarthritis: Results of a Clinical Survey in 50 Patients Treated in Daily Practice. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 14, 1-7. https://doi.org/10.1177/11795441211027789</30>

<31>Paterson, K. L., & Gates, L. (2019). Clinical Assessment and Management of Foot and Ankle Osteoarthritis: A Review of Current Evidence and Focus on Pharmacological Treatment. Drugs & Aging, 36(4), 303-311. https://doi.org/10.1007/s40266-019-00643-4</31>

<32>Cleveland Clinic. (n.d.). Foot and Ankle Arthritis. Retrieved from https://my.clevelandclinic.org/health/diseases/13900-foot-and-ankle-arthritis</32>

<33>Arthritis Foundation. How fat can worsen arthritis.</33>

<34>Choo YJ, Chang MC. Commonly used types and recent development of ankle-foot orthosis: a narrative review.</34>