Symptoms, treatment, exercises, surgery and more

In a healthy ankle, cartilage covers the bone surfaces that meet, serving as protective padding.
In osteoarthritis of the ankle, this protective space slowly decreases because the cartilage gradually wears down. As a result, the bones rub against each other, leading to the formation of painful bone spurs.

Osteoarthritis of the ankle affects about 1% of the population. 2018 research shows that the main cause is trauma, usually due to rotational injury resulting in ligament sprains and bone fractures. It tends to happen in young people.

Symptoms worsen over time and include:

• stiffness and pain that gets worse in the morning
• swelling on one side or all around the joint
• reduced range of motion, which means the joint cannot fully bend
• tenderness to touch or squeeze the joint
• difficulty walking

According to the Arthritis Foundation (AF), treatment includes non-drug measures, medication, and surgery.

Non-drug therapy

Non-drug treatment recommendations include:

Medical treatment

Drug treatments include drugs in the form of:

Pills

The pills include acetaminophen (Tylenol) for pain relief or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), for pain and inflammation relief.

Acetaminophen is the First line treatment, while NSAIDs are the second-line choice.

Creams

Creams or gels may include those that contain any of the following ingredients:

Injection

The injections involve glucocorticoids, such as betamethasone (Celestone Soluspan). They provide short-term pain relief, and doctors only give them to a person three or four times a year.

Surgical treatment

When other treatments don’t manage pain or improve mobility, doctors may recommend one of the following surgeries:

• Arthrodesis: This fuses the ankle bones together.
• Arthroscopic surgery: This involves the removal of bone spurs and loose cartilage, which can help some people. Doctors rarely use it for osteoarthritis.
• Total ankle replacement: This involves removing the bones and cartilage and replacing them with plastic or metal parts.

Full recovery from surgery may take 4 to 9 months, but most people can return to their regular activities within 3 to 4 months.

Experts recommend gentle exercises that don’t strain the ankle, such as:

They also advise avoiding certain sports, such as kickboxing and soccer, and limiting high-impact activities, such as running or tennis.

Additionally, physiotherapists may provide an individualized exercise program to increase range of motion, flexibility, and ankle strength.

A person can also do range of motion exercises at home. They should do them slowly, aiming for a slight stretch. People shouldn’t overdo it or go past the pain point. It is best to consult a doctor before starting new exercises.

As a rule of thumb, experts recommend doing range of motion exercises 3-10 times a day. A person should sit while doing these exercises and maintain good posture with the feet on the floor. Below are a few options:

• Plantar flexion: Push your toes down and lift your heels off the ground as if you were stepping on an accelerator pedal.
• Dorsiflexion: Raise your toes towards the shins. Do this more slowly, but try to place the toes as high as possible while keeping the heels on the floor.
• Ankle circles: Slowly move the pegs in a circle, as if you were trying to write the letter “O”. Make the two circles clockwise and counterclockwise.

The American Academy of Orthopedic Surgeons (AAOS) provides details on the diagnostic process below.

Physical examination

During a physical exam, a doctor will look for swelling and tenderness and ask the following questions:

• When did the pain start?
• Have you had an injury in the past?
• The pain comes and goes or is it continuous?
• Where exactly is the pain?
• Is the pain worse in the morning or does it get worse with walking?

Gait analysis

Doctors ask people to walk to see if their gait reveals any of the effects of osteoarthritis. For example, stiffness and pain can cause lameness, showing the location and severity of the disease.

Gait analysis also includes:

• stride measurement
• assessment of bone alignment while walking
• ankle and foot strength test

Testing

Tests can include x-rays, which can reveal a narrowing of the joint space between the ankle bones, as well as spurs and other changes, such as fractures or breaks. Additionally, doctors may order blood tests to rule out other types of arthritis.

Musculoskeletal ultrasound can also be useful, particularly for the detection of tendon injury or inflammation.

The AF notes that it is not possible to cure or reverse osteoarthritis, but treatment can reduce pain and allow a person to carry out daily activities.

Medical resources paint a slightly different picture of the outlook after surgery. AAOS says that in most cases it reduces pain and allows people to function.

However, a 2019 review warns that surgery has certain drawbacks. After reviewing current surgical options for ankle osteoarthritis, the authors found that they restrict range of motion or have high rates of complications.

Proof links osteoarthritis of the ankle with serious disease. People with the disease tend to have increasingly severe symptoms, culminating in terminal ankle osteoarthritis, one of the leading causes of chronic disability in North America.

Ankle osteoarthritis typically affects someone who is young and has injured their joint. As the cartilage between the ankle bones wears down, a person experiences increasing severity of symptoms, such as pain and stiffness that worsen in the morning.

Experts advise people with the condition to engage in a program of physical therapy or gentle exercise, such as walking or swimming. If the disease progresses, medications can help manage the pain. Surgery is the last resort in treatment as it can lead to complications.