Ankle Arthritis FAQs

Arthritis is a term that refers to inflammation of the joints. There are many types of arthritis, but the most common ones are osteoarthritis and rheumatoid arthritis.

1. Osteoarthritis (OA): This is the most prevalent form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time. It commonly affects joints in the hands, knees, hips, and spine, leading to pain, stiffness, and reduced joint flexibility.
2. Rheumatoid Arthritis (RA): RA is an autoimmune disease where the immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. This can lead to inflammation, joint damage, and pain. RA often affects multiple joints and can also have systemic effects on other organs.

Arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life. Treatment options vary depending on the type of arthritis and may include medication, physical therapy, lifestyle changes, or in some cases, surgery.

It’s essential for individuals experiencing joint symptoms to consult with a healthcare professional for an accurate diagnosis and appropriate management plan.

Ankle arthritis involves inflammation and deterioration of the ankle joint cartilage. Ankle arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life.

In vast majority of patients (60-80%) ankle arthritis occurs secondary to injury. This can be a fracture of the ankle or an impact injury without fracture. The initial insult to ankle cartilage results in a slow deterioration of the joint. Over time this progressively results in worsening progressive arthritis. To a lesser extent, ankle arthritis can also be due to a patient’s natural history, infection, gout, or underlying medical conditions such as rheumatoid arthritis / hemophilia.

In many of these cases, an initial fracture/impaction injury results in uneven force dissipation across the ankle joint. This causes the ankle to be overloaded in certain area. After years of walking on this unevenly distributed joint, the cartilage starts to wear thin, and inflammation ensures. 

Ankle arthritis is less common that larger weight bearing joints such as the knee or hip. The incidence of ankle arthritis is approximately 30 per 100,000 people. Global approximation is roughly 1% of the population. 

Often patients will experience pain around ankle joint. This is most commonly with weight bearing, walking, or exercises. Swelling at the joint line is very common. Over time the joint will become stiff, and range of motion will be lost. If this goes on long enough, the alignment of the joint will change, and a progressive deformity will ensue. The natural history of all arthritis is to slowly and chronically progress, with worsening pain exacerbation episodes. 

A surgeon will obtain a thorough history and perform a physical examination. If there is a convincing clinical presentation, we will confirm our suspicion with X-rays and advanced imaging. Additional testing may be required. 

Yes. Most of the time we are able to detect arthritis on X-rays. In the cases of very focal disease, or early arthritis, additional advanced imaging may be required (MRI / CT scans).

Ankle arthritis will show up as narrowing of the joint space at the ankle joint line. There may also be formation of new bony spurs. In severe cases the ankle will start to drift medially or laterally, resulting in deformity.

The treatment of ankle arthritis is divided into non-operative and operative techniques. 

In vast majority of patients, we initially encourage non-operative treatment. The goal of non-operative treatment is to avert or delay surgery. No intervention can “cure” arthritis.  We try to maximize your time with a natural joint. Most of these strategies are aimed at keeping you strong and allowing you to cope with the pain from ankle arthritis. Non-operative interventions include activity modification, shoe modifications, weight loss, bracing, walking aids, physical therapy, and pain medications / anti-inflammatories. You can try turmeric and topical capsaicin as natural remedies. Some patients report improvements in pain. You should maintain optimal levels of Vitamin D and Calcium. This is important for bone and cartilage turnover. Icing and elevation can help with swelling related symptoms.

Once these options are exhausted, we typically turn in injection options. This includes cortisone injections, Hyaluronic Acid injections, Platelet Rich Plasma (PRP) injections, and Mesenchymal Stem Cell (MSC) injections. Cortisone is a strong anti-inflammatory and can provide temporary relief of pain symptoms. Recent literature suggests having too many cortisone injections can hasten joint deterioration. See the article below. Thus, frequent cortisone injections are not ideal. Hyaluronic Acid injections act as lubrication and can help with pain symptoms. These tend to provide temporary pain relief and return of function. PRP are injections where we take blood, spin out the red blood cells, and run the plasma layer through a filtrate. This concentrates growth factors, inflammatory singling molecules, and immune modulators. This can help stabilize cartilage and provided more long-term pain relief. MSC is a more invasive procedure where we harvest stem cells from your pelvic. We then use a special centrifuge to separate the stem cells, and this is then injected into the arthritic joint. These cells secrete the same proteins that are found in your plasma. However, since we are injection cells, the effect of this injection tends to be longer. 

See the article below that summarizes these non-operative arthritis management strategies. 

Once all non-operative options have been exhausted, and you are no longer able to cope with ankle arthritis, surgical options are indicated. Continue reading for further information on how surgery can be helpful for treating ankle arthritis. 

https://journals.lww.com/jbjsjournal/abstract/2021/11170/rapidly_destructive_hip_disease_following.2.aspx

https://journals.sagepub.com/doi/full/10.1177/2473011419852931

Yes. Most ankle arthritis braced work by reducing motion at the ankle joint. This helps prevent excessive motion and helps reduce pain. However, it can worsen ankle stiffness. Use it sparingly. Try to maintain ankle range of motion with stretches / exercises,

Once all non-operative options have been exhausted, and you are no longer able to cope with ankle arthritis, surgical options are indicated. Continue reading for further information on how surgery can be helpful for treating ankle arthritis. 

There are many surgical approaches to treating ankle arthritis. This depends on several factors. This can be patient factors such as underlying medical conditions, level of activity, goals of treatment, and expectations. Joint related factors also come into play. This includes how severe the arthritis is, whether there localized or global disease, severity of arthritis, presence of deformity, and involvement of surrounding soft tissue structures. Furthermore, concomitant foot deformity must also be considered. 

Early ankle arthritis, that is well localized, in young active healthy patients, is amenable to debridement with ankle arthroscopy. This is a minimally invasive procedure where a camera is inserted into the joint, and areas of arthritis are debrided away. This can provide pain relief, more range of motion, and long-term symptom control for patients with early ankle arthritis. See the ankle arthroscopy section for more information regarding these options. Speak to one of our experts if you think you may be a candidate. 

More extensive arthritis is typically treated with two main options: fusion (arthrodesis) or replacement (arthroplasty). Both options have their benefits and pitfalls. It is critical to have a discussion with your surgeon to determine which option is right for you. 

Ankle fusion (arthrodesis) is considered the gold standard for cases of severe ankle arthritis. It has been the go-to procedure for decades. Here we expose the joint, remove any residual cartilage, and oppose the talus bone to the end of the tibia bone. These two bones heal to one another, forming one bony structure. Functionally the joint is eliminated. There is no motion across the joint anymore. However, there is also no pain. 

Ankle replacement (arthroplasty) is a newer procedure that has been advancing quickly over the last 2 decades. Replacement surgery is much more involved than ankle fusion. It provides pain relief similar to fusion surgery. However, it allows us to maintain motion at the ankle joint. This is thought to prevent neighboring foot joints from deteriorating. The recovering and healing form this is more difficult. 

Ask one of our experts if you are a candidate for one of these procedures.

In order to do an ankle fusion, we first make the decision to do it using a traditional open incision, or arthroscopically (though a camera). This depends mainly on how severe the arthritis is. In either case, we expose the joint and removed any residual cartilage. Bony ends of the talus and tibia are exposed. All debris is removed. We then Make perforations that facilitate healing. We then oppose the bony ends of the talus and tibia in a functional position. We use screws or plates to compress and hold this bony apposition. The incisions are closed.

After the procedure the ankle is casted, and you are kept non-weight bearing for a minimum of 6 weeks. After that point, we start the rehab process. 

In order to perform an ankle replacement, we often will utilize advanced imaging and patient specific instruments. This requires a CT scan before the procedure. Custom cutting jigs will be 3D printed. These improve the location of bony cuts and reduce operative time. 

We make an incision in the front of your ankle, avoiding nerves and vessels. We dissect down to the joint, preserving soft tissues. We apply and secure 3D printed custom cutting jigs. These are secured. We then cut the tibia and talus to accommodate metal implants. Once cuts are made, we remove excess bone and debris. We apply trial implants to ensure sizing and tension. Once we have determined the correct size implants, we place metal components in the tibia and talus. We then place a high-density polyethylene component. 

At this stage we stress test the ligament structures. If there is ligament deficiency, we may perform a reconstruction acutely, or stage this to a later time. Similarly, if there is a foot deformity this may be addressed at the time of surgery or staged to a later time. 

All incisions are closed and a cast is applied. This can be present for 2-4 weeks. After this point, rehab is initiated. 

Once the surgery is complete, you are placed into a cast. The cast is required for minimum of 2-4 weeks. We will remove the sutures 2-3 weeks post op. You will have to remain non-weight bearing for minimum of 2-4 weeks. Once the cast is removed, we can start weight bearing and rehab. Often, we will transition you to a rigid removable boot, to start weight bearing. This will be weaned as you progress in physical therapy. 

It will likely take 3-4 months before you feel that you can walk on the ankle comfortably. The fusion will continue to heal and remodel for over a year. Swelling will be present for at least 6 months. In some cases, swelling is present for over 18 month. It goes away eventually as you rehab. 

This is a difficult and complex question. For many decades, there have been similar outcomes in terms of post operative pain, function, and satisfaction when comparing ankle replacement to ankle fusion. Both offer similar pain relief and function. However, ankle replacements preserve motion. Additional, ankle replacements are high risk surgeries. There is higher risk of complications such as infection, fracture, nerve / vessel injury, and requirement for further surgery in the future. 

Historically, ankle fusions were the surgery of choice for vast majority of patients. However, as ankle replacement implants evolve, there is a paradigm shift. We are starting to see better outcomes for replacement patients compared to fusion. Patients are happier, more functional, and have more motion. There is also a lesser risk of neighboring joint degeneration because ankle motion is preserved. This means that there is a lesser risk of the rest of the foot deteriorating because of a fused ankle. Have a look at the below study which demonstrates this. 

https://pubmed.ncbi.nlm.nih.gov/36375147/

For all arthritis, there is no “cure”. No medication or surgery will give you the cartilage you had in your twenties. Nothing can reverse the deterioration of the joint. Non-operative treatments are aimed at decreasing pain and improving function. However, the arthritic process continues to progress. Surgery is aimed at eliminating or replacing the joint. This does not restore cartilage, but instead allows for the joint pain to be eliminated. 

Yes. See the FAQs above for more information. 

Yes. This is a very common symptom of ankle arthritis. You can get swelling in your ankle and in the foot. 

Most ankle sprains do not result in ankle arthritis. However, if the ligaments are severely torn due to injury, or there are recurring injuries, this can lead to ankle arthritis. 

Yes. As the knee joint swells, it can cause pressure on the vessels in the back of the knee. This generates back pressure which causes ankle and foot swelling. 

This is very unlikely. There are most probably two separate issues. 

Typically knee arthritis does not cause ankle pain. Occasionally, in severe knee deformities, ankle pain results due to abnormal loading of the ankle. 

Yes. See the FAQs above for more information. 

Generally, low impact exercise is considered helpful for arthritis related pain. This includes walking, cycling, swimming, etc. High impact exercise can exacerbate pain and cause progression of arthritis. This includes running, jumping, and repetitive impact-based exercises. 

Generally, low impact exercise is considered helpful for arthritis related pain. This includes walking, cycling, swimming, etc. High impact exercise can exacerbate pain and cause progression of arthritis. This includes running, jumping, and repetitive impact-based exercises. 

Yes. However, high impact activities, such as running, are more likely to exacerbate ankle arthritis. 

Pain on range of motion, swelling, and stiffness are the most common signs of ankle arthritis. You gait may be affected, causing a limp. 

Pain at the ankle joint line with range of motion, walking, and weight bearing. The pain tends to be worse with acute activity and progresses slowly over years. Often the pain will come in exacerbations. These will become more frequent and severe. 

No. Most ankle cracking are tendons moving over one another. This does not result in arthritis of the ankles. Thus far, there have not been any convincing evidence that cracking any joint results in arthritis. 

There are several non-operative ways to improve ankle pain. See the treatment FAQs above.

A clinician must perform a history and examination of the ankle. Once this is done, confirmatory studies such as X-rays will be done. Once the work-up has been completed, we can determine the cause of ankle pain. There are several causes for ankle pain. 

Most ankle arthritis is caused by trauma (fractures), and thus are difficult of avoid. However, proper shoe wear, avoidance of high impact activity, avoiding of high-risk activities, and weight reduction, can all help reduce the risk of ankle arthritis. 

Ankle arthritis can cause disabling pain and functional limitations. 

See the treatment FAQ above for more information. 

A semi rigid AFO can help reduce pain in the ankle from arthritis. Rocker bottom shoes can also be helpful. You may also find a removable semi-rigid ankle brace useful for pain and stability. See one of our experts to get a prescription and orthotist recommendation. 

Most commonly, ankle arthritis is post-traumatic. See the above FAQs for more information. 

Yes. Especially if there is swelling. We recommended icing and elevation for 15 min while there is swelling. Try to do this as much as possible to help reduce symptom duration and frequency. 

Some patients find pain relief with massage treatments. We recommend trying it if you are interested. See a reputable licensed provider. 

Yes. The goal of physical therapy is to help obtain and maintain range of motion of the ankle. A physical therapist will give you a home program. It is important to try and these home exercises every day. When you go to see the therapist, they will try to do those activities you cannot do on your own at home. This includes using modalities such as massage, TENS, shockwave, ultrasounds, and manipulations.

Some patients report radiation of ankle arthritis pain into the leg or shin. However, most of the pain is typically prepared at the ankle joint line. 

Yes. See the treatment FAQs above for more information. 

Patients with arthritis of the medial or lateral malleolus will often complain of pain on that corresponding side. 

Yes. However high impact activity such as this is likely to exacerbate arthritis pain. 

Knee arthritis pain tend so radiate distally, but the pain is rarely perceived in the ankle or in the hip. You may feel radiation of pain into the shit. Rare does it radiates to the ankle.

Yes

Yes. 

No. There is no evidence that this is the case. However, read all safety warnings when using any equipment. Improper use can result in injury. 

In vast majority of patients (60-80%) ankle arthritis occurs secondary to injury. This can be a fracture of the ankle or an impact injury without fracture. The initial insult to ankle cartilage results in a slow deterioration of the joint. Over time this progressively results in worsening progressive arthritis. To a lesser extent, ankle arthritis can also be due to a patient’s natural history, infection, gout, or underlying medical conditions such as rheumatoid arthritis / hemophilia.

Ankle arthritis involves inflammation and deterioration of the ankle joint cartilage. Ankle arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life.

Arthritis is a term that refers to inflammation of the joints. There are many types of arthritis, but the most common ones are osteoarthritis and rheumatoid arthritis.

1. Osteoarthritis (OA): This is the most prevalent form of arthritis and occurs when the protective cartilage that cushions the ends of bones wears down over time. It commonly affects joints in the hands, knees, hips, and spine, leading to pain, stiffness, and reduced joint flexibility.
2. Rheumatoid Arthritis (RA): RA is an autoimmune disease where the immune system mistakenly attacks the synovium, the lining of the membranes that surround the joints. This can lead to inflammation, joint damage, and pain. RA often affects multiple joints and can also have systemic effects on other organs.

Arthritis can cause a range of symptoms, including joint pain, swelling, stiffness, and a decreased range of motion. It can be a chronic condition and may impact a person’s quality of life. Treatment options vary depending on the type of arthritis and may include medication, physical therapy, lifestyle changes, or in some cases, surgery.

It’s essential for individuals experiencing joint symptoms to consult with a healthcare professional for an accurate diagnosis and appropriate management plan.