Ankle arthritis is a degenerative condition where the cartilage in the ankle joint wears down over time, leading to pain, swelling, stiffness, and reduced mobility. Unlike arthritis in the knee or hip, ankle arthritis is most commonly caused by previous trauma, such as fractures, severe sprains, or ligament injuries, rather than age-related wear and tear alone. This condition, can develop months or even years after an injury, as the altered mechanics and instability begin to affect the joint surfaces.
There are three main types of arthritis that can affect the ankle joint: osteoarthritis, which involves cartilage breakdown due to mechanical wear; rheumatoid arthritis, an autoimmune condition causing inflammation of the joint lining; and post-traumatic arthritis, which results from prior joint injury. Osteoarthritis of the ankle is less common than in weight bearing joints like the knee or hip but can be just as debilitating.
Symptoms of ankle arthritis typically include persistent pain that worsens with activity and improves with rest, joint swelling, a sensation of grinding or catching, morning stiffness, and reduced range of motion. As the condition progresses, patients may experience difficulty walking on uneven surfaces or up stairs, and may start to limp due to discomfort or instability.
Diagnosis begins with a thorough clinical examination and history, especially to identify previous trauma. Imaging such as X-rays helps assess joint space narrowing, bone spurs, and alignment. In more complex cases, MRI or CT scans may be used to assess cartilage integrity and bone involvement.
Early diagnosis is essential to manage the condition conservatively and delay or avoid the need for surgery.
Ankle Arthritis treatment depends on the severity of symptoms, level of joint degeneration, and the patient’s activity goals. In early to moderate cases, conservative treatments can be very effective in controlling pain and improving function. This includes activity modification, weight management, physical therapy to strengthen the surrounding muscles and improve mobility, and supportive footwear or custom orthotics to reduce joint stress. Over-the-counter or prescribed anti-inflammatory medications may also help manage flare-ups.
A key non-surgical option is injection therapy, which can provide longer-term relief for some patients. This includes corticosteroid injections to reduce inflammation and pain. In some cases, Platelet-Rich Plasma (PRP) or other biologic injections may be considered to reduce symptoms and promote joint health. These options are minimally invasive and can be repeated periodically under ultrasound guidance.
If symptoms progress despite conservative measures, surgical treatment may be considered. For patients with localised cartilage damage, arthroscopic debridement can be used to smooth the joint surfaces and remove loose fragments. In more advanced arthritis, options include ankle fusion (arthrodesis), which eliminates motion in the painful joint but provides reliable pain relief, and total ankle replacement, which preserves movement and is increasingly used in selected patients with end-stage arthritis.
Modern surgical techniques offer excellent outcomes when appropriately selected and performed by experienced specialists. Surgery is only considered after conservative treatments have been exhausted, and the decision is always based on individual needs, lifestyle, and future mobility goals. With the right treatment approach, many patients with ankle arthritis can return to a more active lifestyle, with significantly improved comfort and function.
