Navigating ankle arthritis

Ankle arthritis brings pain and swelling, starting mildly with activity-related discomfort and escalating into a persistent ache. In his latest online article, Mr Shelain Patel explores the symptoms, causes, and effective management of this joint disorder, providing insights for individuals and healthcare professionals.

What are the common symptoms of ankle arthritis?

Pain and swelling are hallmark features of ankle arthritis. In the early stage, this will only be mild and related to activity but as the condition progresses, a continuous dull ache with sharp pain on bearing weight will occur. Swelling around the ankle may make it harder to wear shoes and boots, whilst stiffness at the ankle could lead to subtle changes in walking such as a limp.

What causes ankle arthritis, and are there any risk factors associated with it?

Over 80 percent of ankle arthritis cases relate to trauma. This can range from repeated ankle sprains which injure and stretch the ligaments to broken bones around the ankle.  Both sprains and breaks increase the forces going through the ankle which then wears out the lining of the joint (known as cartilage). Other less common causes include inflammatory diseases such as rheumatoid arthritis or a history of infection within the joint. 

How is ankle arthritis diagnosed, and what are the available treatment options?

A triple assessment of history, examination and imaging can diagnose ankle arthritis. Imaging might be an x-ray which is usually a sufficient in moderate to severe cases. In early arthritis, MRI or CT may be more useful. Treatments range from simple aids such as braces and using shoes with a ‘rocker’ sole. Physiotherapy to help strengthen the leg and work on improving an individual’s biomechanics is low risk and should be tried. A more invasive option is to inject steroid and local anaesthetic. Other agents such as stem cells, PRP and hyaluronic acid are available but none have been shown to be superior to steroid injections. Finally, if all non-surgical treatment fails then an operation may be offered. Most times, this will be either an ankle fusion or replacement but this will depend upon many factors including a patient’s age, occupation, expectations, and functional level.

Can I still engage in physical activities with ankle arthritis, or should I limit my movements?

As with many aspects of medical care, undertaking physical activity is a balance of what is necessary for the whole body versus the preservation of the body part. Avoiding all physical activity will reduce the forces going through the ankle joint but this is not a healthy approach for the vital organs such as the heart and lungs. Some physical activity is thus preferrable to maintain patients’ health and wellbeing. Progression of arthritis will be accelerated with high impact activities such as running or contact sports so switching to low impact exercises is better. These include pilates, yoga, cycling and swimming which are all good alternatives.

What is the long-term outlook for individuals with ankle arthritis, and what can be done to manage the condition effectively?

The outlook very much depends upon the stage at which a patient presents. If the diagnosis is made early, then steps can be taken to slow down progression. Diagnosis in the later stages of disease is unfortunately more likely to result in surgery. Effective management involves the input of both the patient and their treating doctor or allied health professional to form a common goal with realistic expectations.  

Mr Shelain Patel is an esteemed consultant orthopaedic foot and ankle surgeon. You can schedule an appointment with Mr Patel on his Top Doctors profile.