Ankle osteoarthritis

Osteoarthritis of the ankle joint is the name given to arthritis which gives pain in the ankle. This also causes the affected joint to become stiff with reduced range of movement.

The process of osteoarthritis involves wearing or thinning of the smooth cartilage joint surfaces as well as stiffening to the soft tissue surrounding the joint. Swelling, inflammation and pain are potential consequences.

Several factors normally combine to cause symptoms of osteoarthritis:

  • Previous joint damage (from trauma or other conditions such as such as gout and rheumatoid arthritis)
  • Increased bodyweight
  • Age (risk increases with age)
  • Family history (genetics)
  • Poor ankle-foot alignment (termed biomechanics) such as a flat foot posture

General exercise such as walking, cycling and playing sport does not increase the risk of developing or increase the rate of deterioration of ankle osteoarthritis.

Most commonly, pain is felt across the front of the ankle joint. Sometimes the pain may also be felt in the sides or back of the ankle joint area. Some individuals may suffer from referred pain radiating into the top of the foot. Fortunately, the presence of ankle osteoarthritis does not always cause pain so it is quite possible to be pain-free despite reasonably advanced arthritis. In addition, the ankle undergoes a ‘wear and repair’ cycle so pain can improve with appropriate treatment.

Pain and stiffness on walking and ascending or descending stairs is often the main aggravating activity. If ankle osteoarthritis becomes more severe the ankle area may become increasingly swollen and the movements of the ankle may become increasingly stiff.

Ankle osteoarthritis can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination.

The main feature on examination is often a reduced range of movement.

X-rays are not routinely required but may be requested if symptoms are severe enough that ankle replacement surgery is being considered.

Non-surgical management

In the majority of cases, the symptoms of ankle osteoarthritis can be managed effectively by non-invasive measures as described below.

The two most important things you can do to improve your symptoms are:

  • Maintain activity levels within your pain tolerance
  • Lose excess weight

These measures can have significant effects on your symptoms, with no side effects or complications. They have the added benefit of improving your general health.

Exercises. Regular exercises to maintain flexibility and strength to the affected ankle joint.

3 x 15 repetitions 2x per day

5×30 second holds, 2x per day

5×30 second holds, 2x per day

Weight management. Losing weight reduces the load which weighs down on your joints as you move about. Evidence shows that weight loss can result in significantly better mobility; there is also some evidence to suggest that weight loss alone may actually help to reduce pain. However, in combination with exercise, the results can be significant.

For many people, losing weight feels like an uphill struggle. However, there is lots of support and advice available. For example, you can find some excellent ideas, including recipes and advice on making healthy food choices, on the NHS “Change 4 Life” website (this also has a link where you can find out about healthy activities in your area).

You can read more in the NHS recommended guidelines on physical activity.

You can use a BMI calculator to tell you if it might be advisable for you to try to lose some weight.

Using painkillers when needed. Over-the-counter analgesia is available through pharmacies when needed. Paracetamol is most commonly prescribed. Anti-inflammatories, such as Ibuprofen, are also used, but as there is little or no inflammation involved in osteoarthritis these are best avoided without discussing with your GP. Side effects are even more common than with paracetamol so please ensure to take appropriate medical advice There is a good booklet from Arthritis Research UK with information about the various drug options.

Use a walking stick if needed:

Corticosteroid injection therapy. For individuals with ankle OA who continue to suffer disabling symptoms in spite a course of non-surgical management (outlined above) or for patients who are unable to commence a supervised exercise program due to pain levels, a corticosteroid injection can be offered as the next line of treatment. You can read more about local corticosteroid injections here.

Surgical management

Ankle arthrodesis (fusion) and ankle replacement surgery outcomes are far less effective than those for hip replacement or knee replacement surgery. As such, this option is usually only considered for patients who…

  • Have trialed a course of non-surgical management without success
  • Have consistent, disabling pain significantly limiting mobility or affecting sleep pattern
  • Have a satisfactory Body Mass Index (BMI) or have made lifestyle changes to lose excess bodyweight

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Circle Reading Hospital, 100 Drake Way, Reading, RG2 0NE

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Overall rating 16th November 2016