Ankle Arthritis

Ankle arthritis: symptoms and treatment options

Ankle arthritis describes damage and loss of the smooth cartilage that allows the tibia and talus to move against one another. It can cause pain, swelling, stiffness and difficulty walking. Unlike arthritis of the hip and knee, ankle arthritis frequently follows an earlier fracture, major sprain or ligament injury. Symptoms may appear years after the original event.

Causes and symptoms

Previous ankle fracture, cartilage injury or recurrent ligament instability (post-traumatic arthritis).
Degenerative joint change, inflammatory arthritis and altered ankle alignment.
Pain with walking or standing, swelling after activity, stiffness, loss of movement, altered gait and sometimes deformity.
Pain severity does not always match the appearance of an X-ray; treatment should be based on symptoms and function as well as imaging.

Assessment and imaging

Assessment includes examination of ankle movement, alignment, tenderness, stability, walking pattern and the joints below the ankle. Weight-bearing X-rays of the ankle and foot are central to assessing joint-space loss and deformity. CT or weight-bearing CT can clarify bone shape and alignment for selected operations; MRI may help where cartilage, tendons or another diagnosis needs evaluation. Not every patient requires an MRI.

Treatment without surgery

Many people find worthwhile symptom relief with lower-impact exercise, adapted activities, physiotherapy, a supportive ankle brace, rocker-soled footwear, walking aids where needed and weight management if appropriate. Simple pain relief or anti-inflammatory medication may help when medically safe. Corticosteroid injection can provide temporary relief for some patients, but it does not restore cartilage. Evidence for injections such as PRP or hyaluronic acid in ankle osteoarthritis is insufficient to recommend them routinely as restorative treatments.

When is surgery considered?

Surgery is considered when pain and loss of function remain substantial despite appropriate non-surgical treatment, and when the likely benefits justify the risks. The choice depends on disease distribution, deformity, soft tissues, bone quality, instability, adjacent-joint disease, general health and activity goals.

Arthroscopy and joint-preserving surgery

Arthroscopy may help selected patients with early disease dominated by a painful bone spur, loose body or impingement. It is unlikely to provide durable relief from widespread end-stage cartilage loss. Selected deformity-correcting osteotomies (such as a supramalleolar osteotomy, which realigns the lower tibia) may be considered in carefully chosen patients with uneven joint loading; these are not suitable for every arthritic ankle.

Ankle fusion (arthrodesis)

Fusion removes the damaged cartilage and joins the tibia to the talus using fixation while the bones heal. It can often be done arthroscopically (keyhole) through small incisions, or as an open operation when deformity needs correcting. It aims to reduce pain and give a stable ankle, but intentionally eliminates movement at the ankle joint. Other foot joints still move, so patients can often walk and undertake a range of activities, sometimes with changes to footwear or gait. Potential issues include nonunion, malalignment, wound problems, and loading of neighbouring joints over time. Smoking substantially increases the risk of the bones not joining.

Total ankle replacement (arthroplasty)

Replacement inserts metal components with a plastic (polyethylene) bearing to relieve pain while preserving some ankle movement. It can suit selected patients with end-stage arthritis, adequate circulation, suitable bone and soft tissues, and correctable alignment. Implant wear, loosening, infection, fracture and future revision are important considerations. Replacement is not automatically preferable to fusion, and neither option restores a completely normal ankle.

Recovery and risks

Fusion and replacement both involve swelling control, wound care, protection of the ankle and a staged rehabilitation programme. Weight-bearing restrictions vary by operation and healing. Recovery continues over months. Risks shared by major ankle surgery include wound complications, infection, blood clots, nerve or vessel injury, persistent pain and further surgery. As a general guide, the ankle is usually protected in a cast or boot for about 6–12 weeks, swelling settles over several months, and full recovery commonly takes 9–12 months. Most people can drive about 12 weeks after an ankle fusion and 6–8 weeks after an ankle replacement (see When can I drive after foot or ankle surgery?). Mr Senthi will give you a recovery plan for your operation. Contact the rooms promptly if you develop a fever, increasing wound redness or discharge, severe worsening pain or calf swelling after surgery; call 111 for chest pain or breathlessness.

Common questions

Can ankle arthritis be reversed?
Established cartilage loss usually cannot be reversed, but many patients can manage pain and function without surgery.

Does ankle fusion mean I cannot walk normally?
Many patients walk well after union, although ankle movement is lost and walking is subtly altered, most noticeably on slopes and uneven ground.

How long will an ankle replacement last?
No precise lifespan can be promised. International registry data, including New Zealand’s, suggest that roughly three-quarters or more of ankle replacements are still working without revision at 10 years, but revision is more common than after hip or knee replacement.

Does arthroscopy cure severe ankle arthritis?
No. Arthroscopy has a limited role for specific mechanical problems and generally does not solve diffuse advanced arthritis.

Seeking specialist advice

Persistent pain, deformity or restriction despite appropriate treatment may justify a foot-and-ankle assessment. This page offers general information and is not a personalised recommendation for fusion or replacement.

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