When ankle pain is coming from the joint
Ankle arthritis occurs when the cartilage within the ankle joint becomes damaged or progressively lost. This can lead to pain, stiffness, swelling and difficulty walking.
Unlike hip or knee arthritis, ankle arthritis is often related to a previous injury. A significant ankle fracture, repeated severe sprains or other trauma can damage the joint and eventually lead to post-traumatic arthritis. Inflammatory arthritis and other conditions can also affect the ankle.
What does ankle arthritis feel like?
Common symptoms include:
- Pain around the ankle, particularly with walking or prolonged standing
- Stiffness, especially after periods of inactivity
- Swelling around the joint
- Difficulty walking on uneven surfaces
- Reduced ankle movement
- Pain during activities that previously felt comfortable
- A feeling that the ankle has become progressively less flexible
Why does ankle arthritis develop?
Possible causes include:
- Post-traumatic arthritis
Previous ankle fractures, dislocations or significant ligament injuries can damage the joint surface and lead to arthritis over time. - Primary osteoarthritis
The cartilage gradually degenerates without a single major injury being responsible. - Inflammatory arthritis
Conditions such as rheumatoid arthritis can affect the ankle joint. - Previous infection or other joint disorders
Less common conditions can also damage the cartilage and produce arthritis.
How is ankle arthritis diagnosed?
Diagnosis usually begins with a detailed history and clinical examination.
Your assessment may include:
- Location and pattern of pain
- Ankle range of motion
- Alignment of the foot and ankle
- Walking pattern
- Examination of the surrounding joints and tendons
- Previous fracture or surgery history
Does every patient with ankle arthritis need surgery?
No. Treatment depends on the severity of arthritis, symptoms, alignment, activity requirements, age, associated problems and how much the condition is affecting everyday life.
The aim is to control symptoms and maintain function while avoiding unnecessary surgery.
Initial treatment may include
- Activity modification
- Appropriate footwear
- Physiotherapy and mobility exercises
- Calf and ankle strengthening
- Bracing or orthotic support in selected patients
- Weight management where appropriate
- Medication when medically suitable
- Selected injections in appropriate situations
When might surgery be considered?
Surgery may be considered when significant pain and functional limitation persist despite appropriate non-operative treatment.
Depending on the stage and pattern of arthritis, options can include:
- Ankle arthroscopy or removal of symptomatic bone spurs in selected cases
- Realignment procedures in appropriately selected patients
- Ankle fusion
- Total ankle replacement
For advanced arthritis, ankle fusion and total ankle replacement are two important surgical options, but they are not interchangeable procedures.
Ankle fusion eliminates painful ankle-joint movement by allowing the bones to heal together. Total ankle replacement replaces the damaged joint surfaces while aiming to preserve ankle motion. The appropriate procedure depends on the individual patient rather than a single universal rule.
Ankle replacement or ankle fusion?
This is a decision that requires detailed assessment.
Total ankle replacement is an established treatment option for appropriately selected patients with advanced ankle arthritis who have persistent symptoms despite non-operative treatment.
When should you see a specialist?
Consider an assessment if you have:
- Persistent ankle pain after an old injury
- Increasing ankle stiffness
- Recurrent swelling
- Difficulty walking or climbing stairs
- Pain that is progressively limiting your activities
- Persistent pain despite footwear modification and conservative treatment
Frequently Asked Questions
Can an old ankle fracture cause arthritis years later?
Yes. Post-traumatic arthritis is one of the most common forms of ankle arthritis.
Can ankle arthritis be treated without surgery?
Yes. Many patients can be managed initially with activity modification, rehabilitation, footwear, bracing and other non-operative measures.
Is ankle replacement the same as knee replacement?
No. The principles are different, and patient selection and implant-specific considerations are important.
Is ankle fusion still performed?
Yes. Ankle fusion remains an established option for selected patients with advanced painful ankle arthritis.
Can I run with ankle arthritis?
High-impact activity may aggravate symptoms and, depending on the severity of arthritis, may not be advisable. Activity recommendations should be individualised.
Consultation
If ankle pain or stiffness is interfering with your walking or daily activities, a specialist assessment can help determine whether the problem is arthritis and what treatment options are appropriate.
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