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Ankle Arthritis: Symptoms, Treatment & Surgery
Ankle arthritis is a condition in which the cartilage within the ankle joint becomes damaged or progressively worn, resulting in pain, stiffness and reduced function. Unlike arthritis affecting some other joints, ankle arthritis is frequently associated with previous injury, including ankle fractures and significant ligament injuries.
Treatment depends on the cause and severity of the arthritis, the patient's symptoms, activity levels, alignment and the condition of the rest of the foot and ankle. Options range from non-operative treatment and injections through to ankle replacement or ankle fusion for patients with advanced symptomatic arthritis.
Mr Shelain Patel is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital (RNOH), specialising in the assessment and treatment of ankle arthritis, ankle replacement and complex foot and ankle conditions in London.
What is ankle arthritis?
The ankle is formed by the junction of the tibia, fibula and talus. These bones are covered by a smooth layer of cartilage that allows the joint to move with minimal friction.
Ankle arthritis develops when this cartilage becomes damaged or progressively lost. As the cartilage deteriorates, the joint can become painful and stiff. In more advanced arthritis, changes can develop in the underlying bone and the shape and alignment of the joint may change.
Ankle arthritis can range from relatively mild disease causing occasional symptoms to advanced arthritis in which pain and stiffness significantly affect walking and everyday activities.
Importantly, the appearance of arthritis on an X-ray does not always correspond directly to the severity of a patient's symptoms. Treatment should therefore be based on both the imaging findings and the patient's clinical symptoms and functional limitations.
What causes ankle arthritis?
Ankle arthritis has several possible causes:
Post-traumatic arthritis
Previous injury is one of the most important causes of ankle arthritis. This can follow:
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Ankle fractures
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Pilon fractures
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Recurrent ankle injuries
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Significant ligament injuries
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Previous dislocation
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Previous ankle surgery
Arthritis can develop many years after the original injury.
Osteoarthritis
Some patients develop ankle arthritis without a clearly identifiable major injury. This is sometimes described as primary osteoarthritis.
Inflammatory arthritis
Conditions such as rheumatoid arthritis and other inflammatory diseases can affect the ankle joint.
Previous infection
Infection affecting the ankle can damage the cartilage and subsequently result in arthritis.
Ankle instability
Long-standing instability can alter the mechanics of the ankle and contribute to progressive joint damage.
What are the symptoms of ankle arthritis?
The symptoms of ankle arthritis vary according to the severity of the condition. Common symptoms include:
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Pain around the ankle
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Pain when walking
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Stiffness
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Swelling
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Reduced walking distance
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Difficulty walking on uneven ground
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Pain when going up or down stairs
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Reduced ankle movement
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Difficulty participating in sport
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A feeling of grinding or catching
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Increasing difficulty with everyday activities
Some people experience pain mainly during activity, while others develop symptoms at rest or at night as the arthritis becomes more advanced.
When should I see a foot and ankle specialist?
You may benefit from specialist assessment if:
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Ankle pain is persistent
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Symptoms are affecting your walking or exercise
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You have a history of significant ankle injury
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You have been diagnosed with ankle arthritis
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Non-operative treatment is no longer controlling symptoms
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You have progressive stiffness
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Your ankle appears increasingly deformed
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You have been advised that you may need ankle surgery
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You would like a second opinion about ankle replacement or fusion
A specialist assessment does not necessarily mean that surgery is required.
The purpose is to establish the diagnosis, understand the severity of the problem and discuss the full range of treatment options.
How is ankle arthritis diagnosed?
Diagnosis begins with a detailed clinical assessment.
This includes understanding:
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The nature and duration of the pain
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Previous injuries
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Previous surgery
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Activity levels
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Walking limitations
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Previous treatment
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Other foot and ankle problems
X-rays
Weight-bearing X-rays are particularly useful.
They can demonstrate:
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Loss of joint space
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Osteophytes
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Changes in the underlying bone
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Alignment
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Deformity
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Previous fracture-related changes
CT scans
A CT scan may be useful where detailed information about the bones, alignment or deformity is required.
MRI scans
MRI is not required for every patient with ankle arthritis. It may be useful where there is uncertainty about associated soft-tissue, bone or cartilage pathology.
Can ankle arthritis be treated without surgery?
Yes. The treatment of ankle arthritis should not automatically lead to surgery. Depending on the severity of symptoms, non-operative treatment may include:
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Activity modification
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Physiotherapy
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Appropriate footwear
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Orthotics
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Weight management where appropriate
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Medication
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Injections in selected circumstances
The objective is to reduce pain and maintain function while allowing the patient to remain as active as possible.
Injections for ankle arthritis
Injections may be considered in selected patients. A corticosteroid injection can sometimes provide temporary symptom relief and may also have a diagnostic role. The potential benefits and limitations of injections should be discussed individually.
An injection does not reverse the underlying cartilage damage.
When is surgery considered?
Surgery may be considered when ankle arthritis is causing significant symptoms and appropriate non-operative treatment is no longer providing satisfactory relief. The appropriate operation depends on the individual patient.
Potential surgical treatments include:
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Ankle arthroscopy in selected circumstances
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Corrective osteotomy
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Ankle replacement
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Ankle fusion
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Additional reconstructive procedures
The decision depends on factors including:
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Severity of arthritis
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Age
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Activity
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Alignment
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Bone quality
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Previous surgery
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Ligament stability
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Adjacent-joint arthritis
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Expectations
Ankle replacement for arthritis
Total ankle replacement is designed to replace the damaged joint surfaces while preserving useful movement at the ankle. It may be considered for carefully selected patients with advanced symptomatic ankle arthritis. Assessment considers:
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The degree of arthritis
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Alignment
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Bone quality
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Deformity
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Ligament stability
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Previous surgery
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Activity levels
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Overall health
Some patients may also require additional procedures to correct deformity or instability.
Ankle fusion for arthritis
Ankle fusion, or arthrodesis, removes movement from the arthritic ankle joint by joining the tibia and talus.
The principal aim is to eliminate painful movement.
Fusion remains an established treatment for severe ankle arthritis and can be particularly appropriate in circumstances where ankle replacement is unsuitable.
Ankle replacement or ankle fusion?
The choice between replacement and fusion is individual. Ankle replacement is designed to preserve movement. Ankle fusion eliminates movement at the ankle. Factors considered include:
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Age
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Activity
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Alignment
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Bone quality
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Deformity
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Previous surgery
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Ligament stability
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Adjacent-joint arthritis
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Expectations
There is no single operation that is appropriate for every patient.
Post-traumatic ankle arthritis
Post-traumatic arthritis is particularly important because ankle arthritis frequently develops following previous injury. It may occur following:
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Ankle fracture
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Pilon fracture
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Syndesmotic injury
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Severe ligament injury
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Previous ankle dislocation
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Previous surgery
The resulting arthritis can be accompanied by deformity, altered alignment or instability. These factors are important when considering treatment.
Complex ankle arthritis
Some patients have more complicated disease involving:
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Significant deformity
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Previous fracture
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Previous surgery
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Bone loss
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Ligament instability
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Tendon dysfunction
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Arthritis in neighbouring joints
Treatment may require a combination of procedures rather than treatment of the ankle joint alone. This is where detailed assessment of the whole foot and ankle becomes particularly important.
Living with ankle arthritis
The impact of ankle arthritis is not determined solely by an X-ray. Patients may find that arthritis affects:
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Walking
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Work
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Exercise
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Sport
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Travel
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Stairs
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Uneven ground
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Sleep
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General quality of life
Treatment should therefore be tailored to the activities that matter to the individual patient.
Why choose a specialist foot and ankle surgeon?
Ankle arthritis can involve much more than cartilage loss within the ankle joint. Assessment may need to consider:
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The ankle
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Hindfoot
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Midfoot
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Tendons
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Ligaments
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Alignment
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Previous surgery
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Adjacent joints
A specialist foot and ankle surgeon can assess these factors together when considering treatment.
Mr Shelain Patel is a Consultant Orthopaedic Foot & Ankle Surgeon at the Royal National Orthopaedic Hospital and has a specialist practice encompassing ankle arthritis, ankle replacement, complex reconstruction, Achilles disorders, sports injuries and other foot and ankle conditions.
Frequently asked questions
Is ankle arthritis curable?
There is currently no treatment that reliably restores the original cartilage of an arthritic ankle. Treatment is directed at controlling symptoms, maintaining function and, where appropriate, treating advanced disease surgically.
Can ankle arthritis get worse?
It can. The rate of progression varies considerably between individuals.
Can I exercise with ankle arthritis?
Many people can remain active with appropriate modification. Lower-impact activities may be better tolerated than repetitive high-impact activities.
Is walking good for ankle arthritis?
Walking may be appropriate for many people, although the amount and type of activity should be guided by symptoms.
Do I need surgery?
Not necessarily. Surgery is generally considered when symptoms remain troublesome despite appropriate non-operative treatment.
What is the best operation for ankle arthritis?
There is no universally appropriate operation. Treatment depends on the individual patient.
Is ankle replacement better than fusion?
Replacement and fusion have different advantages and limitations. The choice should be individualised.
Can ankle arthritis be caused by an old fracture?
Yes. Post-traumatic arthritis can develop years after an ankle fracture.
Can ankle arthritis be treated with injections?
Injections may provide temporary relief in selected patients but do not reverse the underlying arthritis.
Can ankle replacement correct deformity?
Some deformities can be corrected as part of ankle replacement surgery, sometimes requiring additional procedures.
Book a consultation
If you have persistent ankle pain, stiffness or diagnosed ankle arthritis and would like to understand your treatment options, a specialist foot and ankle assessment can help establish the cause of your symptoms and determine whether non-operative treatment, ankle replacement, fusion or another approach is appropriate.
Book a consultation with Mr Shelain Patel, Consultant Orthopaedic Foot & Ankle Surgeon in London.