Joint pain and stiffness are common arthritis symptoms for millions of people as they age. Ankle arthritis is unique, however, because the cartilage in the ankle is thicker and more durable than that of the hips or knees. This makes it more resistant to age-related arthritis.

Ankle arthritis and how it occurs

The ankle is a complex structure, with seven, multiple bones and joints that connect the foot to the lower leg. Ankle arthritis develops from wear and tear on the cartilage of the ankle joint over time, eventually leading to stiffness, pain or swelling in and around the ankle. 

“Ankle arthritis can happen for several reasons, but the majority occur when you’ve had an ankle injury followed by the ankle cartilage wearing out over time,” says orthopaedic surgeon Alexander Sawatzke, MD. “Some people do develop primary ankle arthritis as happens in the hips or knees with age, but this is less common than with the damage that can occur after a post-traumatic injury that we see more often in younger people.” 

Risk factors include:

• History of traumatic ankle injury, such as multiple fractures and repeated severe sprains.
• Chronic ankle instability, especially in people who frequently roll their ankles.
• Inflammatory arthritis, such as rheumatoid arthritis.
• Ankle deformities.

Diagnosis and treatment

A definitive diagnosis can be challenging, and there is no one-size-fits-all solution. Seeing an orthopaedic foot and ankle expert is often the best way to receive an accurate diagnosis and treatment. Expertise is essential, as ankle arthritis can be complex. An expert team capable of managing the ankle and any associated foot deformities is crucial.

“If you’ve had a previous ankle injury and the pain is becoming a problem in your daily life, it’s a good time to reach out to your doctor or an orthopaedic surgeon who has foot and ankle expertise,” advises Dr. Sawatzke. “Each case is very individualized based on your age and situation.”

 The primary goal of treatment is to:

• Reduce pain.
• Preserve and maintain function in daily activities.
• Correct progressive deformity if present.
• Delay joint-sacrificing surgery in younger patients when possible.

During an exam, your doctor will likely:

• Review your health history and discuss symptoms.
• Perform a physical exam to understand the injury.
• Take weight-bearing X-rays to look for cartilage loss and bone-on-bone contact.

Treatment typically begins with the least invasive option before considering surgery. 

“Non-surgical treatment won’t fix the arthritis, but it can help manage the symptoms,” adds Dr. Sawatzke. “We aim to reduce your pain, maintain your ankle function and delay surgery if we can.”

Non-surgical options (especially in younger patients):

• Ankle bracing provides support and pain relief.
• Corticosteroid injections offer temporary pain relief.
• Physical therapy helps strengthen muscles and improve stability.

Surgical options may be considered for end-stage arthritis with severe pain and near-absent joint space after exhausting non-surgical treatment. Your doctor will discuss the risks and benefits of each, and how they relate to your particular circumstance.

Surgical options:

• Ankle fusion: Fuses the ankle bones and eliminates joint motion. Highly effective for pain relief and is durable.
• Total ankle replacement: Replaces the joint with implants, preserving motion and a more natural gait.

A multidisciplinary approach to ankle care 

Nebraska Medicine foot and ankle specialists are experts in diagnosing and treating a wide range of foot and ankle conditions, including ankle arthritis. Providing state-of-the-art options and individualized treatment, the orthopaedic team is equipped to manage complex cases, including revision surgery and associated foot deformities.