Ankle pain, stiffness, or swelling can quietly chip away at your daily routine; from morning walks to workouts to simply standing comfortably. In a recent OrthoCarolina webinar, foot and ankle surgeon Dr. Fletcher walked through what ankle arthritis is, why it develops, and how it’s treated today.
Below, we break down the key takeaways into a clear, educational guide to help you better understand ankle arthritis and your options for care.
What Is Ankle Arthritis?
Arthritis refers to inflammation within a joint. In the ankle, that inflammation can lead to pain, swelling, stiffness, and changes in how the joint moves. Over time, inflammation can damage the cartilage that cushions the joint, causing bones to rub against each other and triggering bone spurs, deformity, or loss of motion.
While many people associate arthritis with aging, ankle arthritis is different from arthritis in the hip or knee. The ankle is a smaller joint with thinner cartilage and bears significant force. With each step, several times your body weight travels through the ankle, and even more during running or jumping. This unique combination makes the ankle especially vulnerable after injury.
Why Ankle Arthritis Develops
Unlike hip and knee arthritis, ankle arthritis is most often caused by prior injury. In fact, the majority of cases develop after ankle trauma, such as fractures, repeated sprains, or long-standing ankle instability. Even injuries that occurred years earlier can lead to gradual joint damage.
Other contributing factors include inflammatory or autoimmune conditions, excess body weight, genetics, and natural wear over time. Because of these causes, ankle arthritis often affects younger patients than arthritis in other joints, sometimes appearing in the 30s or 40s.
Common Symptoms to Watch For
Ankle arthritis symptoms often progress gradually. Many people experience intermittent discomfort at first before symptoms become more persistent. Common signs include:
- Ongoing ankle pain, especially with activity
- Swelling that worsens throughout the day
- Stiffness or reduced range of motion
- Catching, clicking, or locking sensations
- Difficulty walking on uneven surfaces
- Recurrent ankle sprains or feelings of instability
Pain that begins to interfere with daily activities or sleep is often a sign that it’s time to seek evaluation.
How Ankle Arthritis Is Diagnosed
Diagnosis begins with a detailed discussion of your symptoms and injury history, followed by a physical exam to assess motion, tenderness, swelling, and stability. X-rays are typically the first imaging step and help identify joint space narrowing, bone spurs, or deformity.
In some cases, advanced imaging such as MRI or CT scans may be used to better evaluate cartilage damage, alignment, or subtle joint changes that are not visible on standard X-rays. Early arthritis may not always appear clearly on imaging, but symptoms can still be very real.
Non-Surgical Treatment Options
Treatment usually starts conservatively, especially in early or moderate arthritis. Many patients find meaningful relief through a combination of approaches, including:
- Activity modification and rest during flare-ups
- Ice to reduce joint inflammation
- Compression socks or braces to control swelling
- Anti-inflammatory medications when appropriate
- Custom or over-the-counter orthotics to improve alignment
- Physical therapy to maintain motion and strengthen supporting muscles
Injections may also be considered. Corticosteroid injections can reduce inflammation inside the ankle joint and are often effective for symptom relief, particularly in earlier stages. These are typically spaced several months apart. While gel injections are common in the knee, they are not routinely used in the ankle.
When Surgery Becomes an Option
If conservative treatments no longer provide adequate relief, surgical options may be considered. The best approach depends on the severity of arthritis, alignment, activity level, age, and overall health.
Minimally invasive procedures such as ankle arthroscopy may be used in select cases to remove scar tissue, bone spurs, or loose cartilage fragments. Ligament reconstruction can also help patients with chronic ankle instability and prevent further joint damage.
For advanced or end-stage arthritis, two primary surgical options are typically discussed:
Ankle Fusion
Fusion permanently joins the bones of the ankle joint to eliminate painful motion. While ankle movement is lost, surrounding joints often compensate well. Fusion is durable and may be recommended for younger patients or those who are not candidates for joint replacement.
Ankle Replacement
Ankle replacement removes damaged joint surfaces and replaces them with metal and plastic components that preserve motion. Advances in implant design, surgical technique, and patient-specific planning have made ankle replacement a highly successful option for the right candidates, particularly older adults. Today’s ankle replacements demonstrate strong long-term outcomes and can restore both comfort and function.
Life After Treatment
Recovery timelines vary depending on the treatment selected. Non-surgical care often allows patients to remain active with modifications, while surgical recovery is more structured. Ankle replacement patients typically progress through a period of protection, gradual weight-bearing, physical therapy, and continued improvement over the course of several months.
Regardless of the treatment path, the goal is the same: relieve pain, restore function, and help patients return to the activities they enjoy safely.
Get Expert Care for Ankle Arthritis
Ankle arthritis is not one-size-fits-all, and treatment should be tailored to your symptoms, lifestyle, and goals. The foot and ankle specialists at OrthoCarolina offer comprehensive evaluation and advanced treatment options to help you move comfortably again.
Schedule an appointment with OrthoCarolina today to take the next step toward relief and recovery.
Frequently Asked Questions
Can repeated ankle sprains really cause arthritis?
Yes. Recurrent ankle sprains can damage cartilage inside the joint over time, leading to instability, scar tissue, bone spurs, and eventually arthritis.
Is exercise safe if I have ankle arthritis?
Low-impact activities such as walking, cycling, yoga, and swimming are generally encouraged. High-impact activities may worsen symptoms and should be discussed with your provider.
Are ankle replacements successful long term?
Modern ankle replacements have strong outcomes, with most patients maintaining good function and pain relief many years after surgery when properly selected and followed.
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