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Ankle Osteoarthritis

Ankle Osteoarthritis

What is Ankle Osteoarthritis?

Your ankle joint is a ‘hinge joint’ meaning it can move up (dorsiflexion) and down (plantarflexion). It is made up of three bones: the lower end of your shin bones (the tibia and fibula), and your heel (the talus bone). Cartilage, a smooth, rubbery coating that acts as your body’s shock absorbers, covers all three bones, keeping the ankle stable and allowing its movements to be smooth and painless. Ankle osteoarthritis (OA) occurs when the cartilage surrounding your tibia, fibula and talus bones wears away, eventually exposing the bone. As the disease progresses, painful bone spurs called osteophytes can form in place of the cartilage.

Causes | Symptoms | Treatment

What Causes Ankle Osteoarthritis?

Despite the ankle is a joint that holds a lot of the body’s weight, ankle osteoarthritis is not very common due to the denseness and toughness of the cartilage. In fact, ankle osteoarthritis is 9 times less common than knee OA. The main cause of ankle osteoarthritis is a previous ankle injury, but other factors that can increase your risk of developing it include:

  • Age: especially being over 40
  • Being overweight
  • A family history of osteoarthritis
  • Genetic defects in the cartilage or ankles
  • Long-term, repetitive strain on your ankles, such as a physically demanding profession like mining, or repeated motion like marathon running
  • A condition that puts additional strain on your ankles such as being flat-footed or having high arches
  • Gender: women are more likely to get osteoarthritis

Diagram of Ankle Osteoarthritis. Ankle osteoarthritis effects your ankle joint, which is made up of three bones: the tibia, fibula, and the talus bones.

What are the Signs and Symptoms of Ankle Osteoarthritis?

The most common symptom of ankle osteoarthritis is a pain in the lower shin, back of the foot, or middle of the foot. Most often, the pain develops slowly over time, but it can appear suddenly. Other signs and symptoms of ankle osteoarthritis include:

  • Pain, swelling, or tenderness of the ankle joint
  • Stiffness, and/or a locking or sticking feeling of the ankle, especially after long periods of sitting or resting
  • A crunching, clicking or snapping sound known as crepitus during movement of the ankle joint
  • Decreased range of motion and pain while doing routine activities such as walking, or stepping on the gas or brake pedal while driving
  • Pain during or after strenuous activity
  • A weakness of the ankle, causing the ankle to buckle, give out or lock during walking

How is Ankle Osteoarthritis Treated?

There is no cure for ankle OA, but there are several treatment options that you can follow to help manage your pain and improve your quality of life. Here we’ll explore the most common treatment options, ranging from conservative to invasive:

Self Care and Lifestyle Modification for Ankle Osteoarthritis

Making small changes to your daily routine can reduce the stress on your ankle joint and have a huge impact on your pain levels and functionality:

  • Switch to low-impact activities, like walking instead of jogging or swimming instead of tennis
  • Maintain a healthy weight
  • Minimize activities that put stress on your ankle joint, like climbing the stairs
  • Strengthen your ankle and increase flexibility and range of motion with an exercise routine prescribed by a physiotherapist
  • Apply cold therapy to relieve pain and reduce inflammation

Assistive Devices for Ankle Osteoarthritis

Using assistive devices can help take the strain off of your ankle joint. A doctor, physiotherapist, chiropractor or occupational therapist can recommend which device is best for you and help fit you to the device:

  • A cane or walker can take stress off of the ankle
  • A brace can help support your ankle, or shift weight away from the affected area
  • Custom orthotics can add support and absorb the shock from your regular activities

Medication for Ankle Osteoarthritis

Pain management can be necessary for managing ankle osteoarthritis:

  • Over-the-counter medications like ibuprofen and acetaminophen can be used to reduce pain and inflammation
  • Topical medications, including creams, sprays, gels and patches can be applied directly to the skin where the pain is. Those with counterirritants such as eucalyptus can be bought over-the-counter, whereas others containing non-steroidal anti-inflammatory drugs (NSAIDs) may require a prescription from your doctor
  • Steroid injections may be prescribed and administered by your doctor to reduce swelling and pain in the ankle

Physiotherapy for Ankle Osteoarthritis

Studies show that physical activity is a safe and effective treatment for ankle osteoarthritis. Exercise reduces pain as well as improves movement in the joint, balance, and stability. Physiotherapy aims to improve function and slow the progression of ankle osteoarthritis using a combination of treatments including:

  • Strengthening, endurance and balance exercises
  • Pool therapy
  • Massage therapy
  • Joint mobilizations
  • Bracing, taping, or orthotics
  • Pain reducing treatments such as:
    • Therapeutic ultrasound
    • TENS
    • Electrotherapy

pt Health is the exclusive physiotherapy partner of the Arthritis Society. Learn More about our specialized arthritis and osteoarthritis treatment program.

Surgery for Ankle Osteoarthritis

Surgery is the most invasive form of treating ankle osteoarthritis and would be considered by your doctor only if other, more conservative treatments do not provide enough relief from your pain. After any surgical procedure, there will be a period of recovery and a physiotherapist will work with you to help regain strength and restore range of motion to your ankle:

  • During ankle debridement, osteophytes and bone spurs are removed, and rough cartilage is smoothed out to remove the irritation from the joint
  • In an ankle arthrodiastasis, an external device is secured to the talus and tibia with metal pins to stretch out the ankle joint and increase the space between the talus and the tibia. The device is worn for approximately 3 months and is then removed
  • An ankle fusion (arthrodesis) surgery fuses the tibia, fibula and talus together, increasing the stability of the ankle joint and removing the friction and pain that was caused by the worn cartilage rubbing against each other. With this option, ankle flexibility is greatly reduced, which can put stress on other joints of the body, such as the knee and hip
  • Total or partial ankle replacement surgery (arthroplasty) is the most drastic means of treating ankle osteoarthritis and occurs when the damaged cartilage and bone are removed and replaced by artificial surfaces