Ankle arthritis

Ankle arthritis is the gradual loss of the smooth cartilage that covers the ends of the bones in the ankle joint. As the cartilage wears away, the ankle becomes painful, stiff, and sometimes swollen. An earlier injury, such as a fracture or dislocation, is a common cause in the ankle, and the arthritis can appear years after the injury.

• Pain deep in the ankle, often worse with walking, standing, or activity
• Stiffness, especially in the morning or after sitting
• Swelling, tenderness, or warmth around the ankle
• Difficulty walking on uneven ground, slopes, or stairs
• Less up-and-down motion of the ankle
• A limp or a change in the way you walk

The main types of ankle arthritis are:

• Post-traumatic arthritis, which follows an injury such as a fracture or dislocation. It can develop even when the injury was treated well.
• Osteoarthritis, the wear-related breakdown of cartilage, which becomes more common with age.
• Inflammatory arthritis, such as rheumatoid arthritis, in which the immune system attacks the joint lining. It tends to strike matching joints on the left and right.

Other factors that raise the risk include extra body weight, a family history of arthritis, and differences in how the joint formed.

A clinician asks about past injuries and symptoms, examines the ankle's motion, alignment, and areas of tenderness, and watches how you walk.

Standing (weight-bearing) X-rays are the main test. They show narrowing of the joint space, bone spurs, and alignment. A CT scan or MRI is sometimes used for more detail or to plan surgery, and blood tests can help when inflammatory arthritis is suspected.

Non-surgical treatment aims to ease pain and keep you active:

• Limiting high-impact exercise and choosing low-impact options, such as cycling or swimming
• Weight loss when appropriate, to reduce the load on the joint
• Physical therapy to maintain strength and motion
• An ankle brace or a custom ankle-foot orthosis
• Shoes with a stiff sole or a rocker-bottom design, which reduce motion at the ankle
• Anti-inflammatory or other pain-relieving medication when appropriate
• A steroid injection into the joint, which may give temporary relief

When pain continues to limit daily life despite these measures, surgery may be discussed:

• Arthroscopic debridement removes bone spurs, inflamed tissue, and loose cartilage through small incisions. It is mainly used in earlier stages.
• Ankle fusion (arthrodesis) joins the bones of the ankle so the painful joint no longer moves. Over time it can place more stress on nearby joints of the foot.
• Total ankle replacement replaces the worn joint surfaces with implants and preserves some ankle motion. The implants can wear or loosen and may need further surgery later.

Fusion and replacement each have advantages and risks, and the right choice depends on factors such as alignment, bone quality, activity level, and overall health. Your surgeon will review these with you.

Recovery after ankle fusion or replacement typically involves a period in a splint, cast, or boot with limited or no weight on the foot, keeping the leg raised early on to control swelling, and then physical therapy. Getting back to daily activities usually takes several months, and some people continue to use a brace or sturdy, supportive footwear for a while afterward.

Not all ankle arthritis can be prevented, but these steps may help:

• Have ankle injuries, such as fractures and severe sprains, evaluated and treated
• Complete rehabilitation after an ankle injury
• Maintain a healthy body weight to lower the load on the joint
• Stay active with low-impact exercise