Ankle Arthritis Explained

Medically Reviewed By Daniel Wiznia, MD

Ankle arthritis occurs when the cartilage between the bones in your ankle wears away. The bones then rub against each other, causing pain and swelling. Successful treatment begins with identifying the type of arthritis you have. Read on to learn more about the types, causes, symptoms, and treatments of ankle arthritis.

Sex and gender exist on a spectrum. This article uses the terms “female” and/or “male” to refer to sex that was assigned at birth. 

Learn more about the difference between sex and gender here.

Overview

A closeup of a person's legs as they walk along the beach
Raymond Forbes LLC/Stocksy United

The ankle joint contains three bones: the tibia, fibula, and tibiotalar. Spongy cartilage covers the ends of these bones and acts as a shock absorber.

A thin membrane called the synovium surrounds the joints between the bones. This membrane produces a fluid that lubricates the cartilage. The lubrication reduces friction and helps your bones to glide smoothly over each other when you move.

Ankle arthritis happens when the cartilage wears away, and the synovium becomes swollen. The bones then erode because of friction and an atypical immune response.

Types of arthritis that can affect the ankle

Three types of arthritis commonly affect the ankle.

Posttraumatic arthritis

Posttraumatic arthritis (PTA), the main cause of ankle arthritis, can develop after the ankle or foot sustains an injury. Injuries such as an ankle fracture can put pressure on the cartilage, leading to damage.

Learn more about arthritis.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic autoimmune disease that accounts for 5–12% of all ankle arthritis cases. RA usually starts in your arms, legs, and ankles and may progress to other joints if left untreated. It is typically symmetrical, meaning it usually affects the same joint on both sides of the body.

RA begins when a trigger encourages your immune cells to attack the synovium. The swollen membrane then produces an excess of osteoclast cells. These cells normally help to break down and reabsorb bones. In RA, these cells proliferate and erode the bones.

Learn more about rheumatoid arthritis.

Osteoarthritis

Osteoarthritis (OA) of the ankle affects around 3.4% of the population. Due to wear and tear, the cartilage in the joint gradually wears away. The protective space between the bones narrows, so your bones rub against each other. Once the cartilage is damaged, painful bone spurs called osteophytes begin to form Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source .

Primary OA — OA that may develop due to factors such as age or genetics — of the ankle is rare. Secondary ankle OA may develop due to an injury or PTA.

Learn more about osteoarthritis.

Causes and risk factors

Ankle arthritis develops when the cartilage between the bones in your joints wears away. Depending on the type of ankle arthritis that you have, different factors can contribute to your condition.  

Posttraumatic arthritis

Past injuries, even from many years earlier, can lead to PA. According to experts, dislocations and fractures are the injuries that most commonly precede PA.

In addition, researchers state that 12% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of all PA cases can lead to OA.

Rheumatoid arthritis

RA is more prevalent Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source in females than males, with a lifetime risk of 3.6% in females compared to 1.7% in males.

Although researchers do not know the exact cause of RA, it appears that the interaction between a person’s genes and environment contributes to the disorder. Having a relative with RA may increase your chances of developing the condition.

Osteoarthritis

According to a review Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , the following factors can contribute to OA:

  • Age: OA can occur at any age, but it is more common in those over 45 years.
  • Sex assigned at birth: Females are more likely to develop OA.
  • Overweight: Extra weight puts stress on your ankles and may add to symptoms of OA.

Symptoms

Symptoms of ankle arthritis develop slowly and can become more pronounced over time.

People with ankle arthritis may experience the following:

  • joint swelling, warmth, and redness
  • joint tenderness
  • pain that flares up with movement
  • morning stiffness
  • joint enlargement

Learn more about joint pain.

Diagnosis

To diagnose ankle arthritis, your doctor will begin by taking your medical history and performing a physical examination. They may want to observe the way you walk. Pain and joint stiffness affect the way you walk and can help your doctor to reach a diagnosis.

Your doctor may order the following tests:

  • X-rays: X-rays show changes in bone structure and any bone spurs.
  • CT and MRI scans: These scans help to assess the condition of your bones and soft tissues.
  • Blood tests: Blood tests can help to determine which type of arthritis you have. About 45–75% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of people with RA test positive for rheumatoid factor, which may help confirm a diagnosis.

Learn how to recognize RA.

Treatments

There is no cure for ankle arthritis, but there are treatments that can help you manage your condition. The following treatments are helpful for OA and PA.

Nonsurgical treatments

  • Physical therapy: This can increase your range of movement and strengthen your foot and ankle muscles.
  • Braces and shoe inserts: These can help to minimize the pressure on your foot and lessen your pain. Many people use a special custom leather brace called an Arizona brace to avoid surgery.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications help reduce swelling and relieve pain.
  • Steroids: Injections of anti-inflammatory agents can provide pain relief.

Surgical treatments

  • Arthroscopic cleansing: Your doctor can perform this minimally-invasive surgery to remove bone spurs, inflamed synovial tissue, and loose cartilage from around the joint.
  • Arthrodesis: In this procedure, your doctor will fuse the bones of the joint. Joining the bones eliminates motion between them and stops the pain.
  • Arthroplasty: During total ankle replacement, your doctor will remove damaged cartilage and bone and replace them with plastic components.

Learn more about treatments for osteoarthritis.

Treatment for rheumatoid arthritis

The standard of care for RA is early treatment with disease-modifying anti-rheumatic drugs Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source , including methotrexate, hydroxychloroquine, and sulfasalazine.

Learn more about arthritis medications.

Outlook

The outlook for people with ankle arthritis depends on how severely the condition has affected the ankle joint. Some people can manage the condition without complications, while others can experience severe disability.

A study from 2021 found that people with late stage ankle OA ranked their quality of life on par with those with end-stage kidney disease and digestive heart failure. People who have had joint replacements tend to have a good outlook, with success rates greater than 80% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source .

Learn about the joints that arthritis mostly affects.

Complications

Possible complications depend on which type of ankle arthritis you have.

Arthrodesis is usually a successful treatment for OA. However, in some cases, the joint does not fuse, and the plastic components may break. This can lead to pain, swelling, and a second operation.

According to researchers, about 40% Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source of people with RA will face challenges at work and in daily living within 10 years of receiving a diagnosis. RA can contribute to the development of other medical conditions, such as cardiovascular or lung issues.

Learn about arthrodesis and other treatments for ankle arthritis.

FAQ

These are a few common questions about ankle arthritis. Daniel Wiznia, MD, reviewed the answers.

What does arthritis in your ankle feel like?

Ankle arthritis can cause a variety of symptoms, including pain, swelling, warmth, and redness of the ankle joint. It may be stiff in the morning or painful during movement.

What triggers arthritis in the ankle?

While the cause of ankle arthritis is not always clear, triggers include injury, genetic factors, or an atypical immune response.

Summary

Ankle arthritis is a common condition. Depending on which type of arthritis you have, treatment options include nonsurgical and surgical treatments.

Early diagnosis and treatment can help you to manage your condition effectively.

Talk with your doctor about developing a treatment plan that is right for you.

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Medical Reviewer: Daniel Wiznia, MD
Last Review Date: 2022 Nov 30
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