Arthritis is a broad term for a number of conditions that cause the cartilage (gliding surface) of a joint to break down, much like the tires on your car can wear down. Loss of cartilage in a joint leads to painful motion and swelling.
Arthritis can occur in any joint in the body. In the ankle, arthritis is most commonly due to a prior injury or trauma such as a broken bone or multiple severe ankle sprains. This is called post-traumatic arthritis.
Other types of arthritis include osteoarthritis, which is due to "wear and tear" of the surfaces of the joint over time. Another form of arthritis that can affect the ankle is rheumatoid arthritis, which involves an irritation of the lining of the joint that can cause swelling, pain, and ultimately cartilage loss. Infection can also lead to joint damage and arthritis. There are several other causes of ankle arthritis that are less common.
Patients with ankle arthritis typically experience swelling, stiffness, and pain. Arthritis is usually present before symptoms appear, and symptoms may appear gradually or suddenly. You may also have difficulty standing or walking, especially on uneven ground or on hills.
In more severe cases, there can be a change in the alignment of your foot or the way your foot is positioned underneath you. Often this happens over many years and you may not notice it. Symptoms can be intermittent and go through periods of worsening and improving depending on your activity level and other factors.
Most commonly, ankle arthritis results from a prior injury. It is important that you tell your doctor if you had a prior injury or surgery involving your ankle or foot, even if it was many years ago or in childhood.
Additional causes include osteoarthritis, rheumatoid arthritis, and infection. There are many other medical conditions that can lead to arthritis. Consult with a foot and ankle orthopaedic surgeon to determine the potential cause of your ankle arthritis.
Ankle arthritis is most commonly diagnosed from X-rays of your ankle. These X-rays must be weightbearing (taken when you are standing on your foot). A weightbearing X-ray will show the standing alignment of the ankle and foot, as well as how "narrow" the joint is, which indicates how much cartilage is lost. If you have severe arthritis, the X-ray will show that your joint is "bone on bone," or that most of the cartilage is gone.
Sometimes, your surgeon will request a CT scan (a 3-dimensional X-ray) or MRI (image showing soft tissues, including cartilage) for further evaluation or to help decide what kind of treatment would be best for you.
Once your surgeon confirms you have arthritis, he or she will recommend a treatment regimen. Proper treatment of foot and ankle arthritis addresses both pain and joint deformity.
Non-surgical Treatment
The initial treatment for ankle arthritis is generally non-surgical. Treatments may include any of the following:
The use of medications such as non-steroidal medication (NSAIDs), which calm down inflammation in the ankle. They can be taken by mouth or applied as a gel directly to the ankle.
A brace to support the ankle. Braces limit motion in the ankle, which can help prevent further damage in the joint and decrease pain. Often the first brace prescribed is an over-the-counter brace, such as an ASO (ankle-shoe orthosis). In some cases, your doctor may prescribe a custom brace.
Activity modification, including reducing high-impact activities (such as running and sports like tennis or basketball) and switching to exercises like cycling and swimming that do not put stress on your feet.
Physical therapy to strengthen the muscles that stabilize the ankle. This is particularly helpful in early arthritis when combined with activity modification.
An injection such as a steroid to reduce the inflammation and pain in the joint. Steroid injections typically give 3-4 months of pain relief, with some people getting no relief and others getting more long-lasting relief. For most patients, they are not a good option for long-term pain management. Other types of injections, such as hyaluronic acid or gel injections and platelet-rich plasma (PRP) injections, are not covered by insurance and have no proven effectiveness for ankle arthritis.
Surgical Treatment
If non-surgical treatments do not relieve your symptoms, your foot and ankle orthopaedic surgeon may recommend surgery. Surgical treatments vary depending on the severity of the arthritis. In mild cases, surgery can be used to remove bone spurs or loose pieces of bone in the ankle or repair cartilage if the cartilage loss is small.
In cases where there is more advanced cartilage loss, or "bone-on-bone" arthritis, your surgeon may recommend a total ankle replacement or ankle fusion. In an ankle replacement, the worn areas are removed and replaced with metal and plastic. In an ankle fusion, the ankle bones are bonded together using plates and/or screws and become one bone as they heal. In some cases, your surgeon may perform other procedures to break a bone or bones. This realigns the ankle in addition to treating the arthritis.
Your foot and ankle orthopaedic surgeon has expertise in both ankle replacement and ankle fusion surgery and will work with you to determine the procedure that best fits your lifestyle and treatment goals.
The recovery from an ankle surgery can vary depending upon the surgery performed. Smaller surgeries such as removing a bone spur may take a few months to recover. More involved surgeries such as an ankle replacement or fusion may take up to a year or more for full recovery.
A foot and ankle orthopaedic surgeon can diagnose and treat your ankle arthritis. They will review your medical history and X-rays and can guide your treatment. Other medical providers who can help you include a rheumatologist (medical arthritis doctor), pedorthotist (shoe/bracing specialist), and physical therapist.
The decision to have surgery is an individual one. Surgery should only be considered if non-surgical treatment options are unsuccessful. The type of surgery depends upon the severity of the arthritis.
If you have severe ankle arthritis, it is important to know that no surgery can give you back a "normal" ankle. While ankle replacement and fusion will likely relieve pain and allow you to return to walking and other low-impact activities, your ankle will still feel stiff and you will not be able to return to running sports.
It is important that you take an active role in managing your arthritis. Seek treatment for arthritis as early as possible to help control pain, reduce damage to joints, and avoid surgery.
Maintaining a proper diet and healthy lifestyle is also helpful. Low-impact exercises such as cycling and swimming can improve your physical fitness while also limiting stress on your joints. High-impact activities like running may accelerate damage to your ankle. Talk to your doctor before starting any activity or lifestyle change to make sure it is appropriate for you.
Original article by Sudheer Reddy, MD
Contributors/Reviewers: Elizabeth Cody, MD; David Porter, MD
The American Orthopaedic Foot & Ankle Society (AOFAS) offers information on this site as an educational service. The content of FootCareMD, including text, images, and graphics, is for informational purposes only. The content is not intended to substitute for professional medical advice, diagnoses or treatments. If you need medical advice, use the "Find a Surgeon" search to locate a foot and ankle orthopaedic surgeon in your area.
