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What You Need To Know About Ankle Arthritis and How To Treat It

September 07, 2023

If you’ve been feeling joint pain and stiffness, it might be arthritis. It can happen when any joint in your body gets inflamed, but it’s often seen in the small joints of your feet and ankles.

Ankle arthritis usually is the result of an earlier fracture or dislocation. The older we get, however, the more our cartilage deteriorates — especially in joints that we use most frequently. Almost 20 percent of people older than 65 have degenerative changes in their ankle joints, which also cause arthritis.

Anatomy of the Ankle

The ankle joint is composed of three bones, which are responsible for up and down movement. Additionally, there are 28 bones and more than 30 joints in the foot that allow for a wide range of movement. In many of these joints, the ends of the bones are covered with cartilage that helps the bones glide smoothly over each other during movement. Ankle arthritis occurs when there is a breakdown of cartilage in the ankle joint. The bones rub against each other, causing painful inflammation and, sometimes, sharp bone spurs.

What Causes Ankle Arthritis?

Three major types of arthritis can affect your foot and ankle:

  • Osteoarthritis, also known as degenerative or wear-and-tear arthritis, is a common problem for people as they age. In osteoarthritis, the cartilage in the joint gradually wears away.
  • Post-traumatic arthritis can develop after an injury to the foot or ankle. Dislocations and fractures are the most common injuries that lead to post-traumatic arthritis. Like osteoarthritis, post-traumatic arthritis causes the cartilage between the joints to wear away.
  • Rheumatoid arthritis is an autoimmune disease. This means that the immune cells attack the synovium covering the joint, causing it to swell. Over time, the synovium damages the bone and cartilage, as well as ligaments and tendons, and may cause serious joint deformity and disability.

Symptoms of Ankle Arthritis

Symptoms of ankle arthritis typically come on slowly and worsen over time. Don’t ignore them, though. In some cases, there are treatments to help slow the progression. Be aware of these changes in your ankles:

  • Pain and stiffness that is worse in the morning and after sitting still for a long time
  • Tenderness when someone touches or squeezes the joint
  • Swelling all around or on one side of your ankle
  • Decreased range of motion
  • Difficulty walking due to pain, stiffness and loss of motion

Are You at Risk?

Although there is no single cause of osteoarthritis, these factors have been found to increase your risk for developing the condition:

  • Age: It is most common in older adults.
  • Obesity: Being overweight adds stress to your ankles, and fat cells produce proteins that may make osteoarthritis worse.
  • Injuries: Any ankle injury can lead to osteoarthritis.
  • Repeated stress: High-impact stress on your ankles over a long period of time can increase your risk for osteoarthritis.
  • Genetics: You may have a family history of osteoarthritis.
  • Joint shape: If you have misaligned joints, you are at higher risk.

How To Treat Ankle Arthritis

It is not possible to cure or reverse ankle arthritis, but nonsurgical treatments often can help relieve the pain and improve your mobility. Your provider usually will recommend a combination of these treatments first before suggesting surgery:

  • Physical therapy, which can help increase range of motion and strengthen the muscles in your foot and ankle.
  • Assistive devices, such as a brace to help improve mobility and shoe inserts (orthotics) to help minimize pressure on the foot and decrease pain.
  • Medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, can help reduce swelling and relieve pain. NSAIDs also are available as creams. In addition, cortisone is an effective anti-inflammatory agent that can be injected into an arthritic joint three or four times a year.
  • Lifestyle modifications, such as losing weight and trading high-impact activities for lower-impact alternatives.

If your pain and mobility problems are not relieved with other treatments, you might need surgery. There are two main types of surgery that have been proven to be the most effective for ankle arthritis.

Arthrodesis fuses the bones of the joint completely, making one continuous bone out of two or more bones. This procedure reduces pain by eliminating motion in the arthritic joint. During arthrodesis, the doctor removes the damaged cartilage and then uses pins, plates and screws to fix the joint in a permanent position. Over time, the bones grow together.

In total ankle replacement, your doctor removes the damaged cartilage and bone and then positions new metal or plastic joint surfaces to restore the function of the joint. Although total ankle replacement is not as common as total hip or total knee replacement, advances in implant design have made it a viable option for many people. Ankle replacement relieves the pain of arthritis and offers patients more mobility and movement than fusion.

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