Ankle Arthritis

The ankle joint, also known as the talocrural joint, is made up the tibia, fibula and talus.  It has a complex structure and functionally is a type of hinge joint. The ankle joint is much less commonly affected by arthritis than the hip or knee.  This is mainly due to the unique properties of the ankle cartilage itself which although thin is very resistant to wear and tear.

What is ankle arthritis?

Ankle arthritis is a condition where the cartilage covering of the bones forming the ankle joint are damaged.  It can be caused by wear and tear degeneration (osteoarthritis) or as a result of inflammation in the joint (inflammatory or rheumatoid arthritis).  In arthritic joints the cartilage, which is a smooth white material, becomes damaged and worn out.  This causes bone to rub on bone which is painful. 

What are the symptoms of ankle arthritis?

  • Pain- this is the commonest and most bothersome symptom.  It is generally made worse on walking and being active. 
  • Swelling- this is generally due to fluid within the joint early in the disease process.  As time goes on the swelling can be due to new bone formation.
  • Stiffness- with wear and tear arthritis the stiffness is often made worse with walking and activity.  In rheumatoid arthritis the stiffness is classically worse first thing in the morning and eases with activity as the day goes on.
  • Giving way & locking- the ankle can give way due to pain or lock in a certain position if there are loose bone or cartilage fragments in the joint which cause catching.
  • Deformity- late in the disease process there can also be deformity as a result of damage to the bone and ligaments of the ankle joint.

What are the causes of ankle arthritis?

Anyone can get ankle arthritis but it is commoner with age.  There is not always a clear cause although there are several risk factors

  • Most commonly there is previous ankle trauma- either a fracture around the ankle or ankle sprains.
  • Inflammatory or rheumatoid arthritis.
  • Bleeding disorders such as haemophilia.
  • Previous ankle infection or septic arthritis.

How is it diagnosed?

The diagnosis is generally fairly straightforward. A single consultation with a Consultant Orthopaedic Foot & Ankle Surgeon and routine standing x-rays of the ankle tend to be all that is required.  Blood tests are necessary if there are concerns regarding inflammatory arthritis.  Occasionally the diagnosis is not clear-cut and further tests with CT or MRI scanning may be necessary- these are particularly helpful in early arthritis.

Can ankle arthritis become worse?

People often put up with the pain from ankle arthritis for many years before seeking medical attention.  Over time the problem can become worse, although usually slowly. Pain, stiffness and swelling of the ankle may increase making walking and being active very difficult.  Additionally, the joint itself can become more damaged.  In these situations with bone loss and deformity it is less likely that joint preservation surgery such as arthroscopy, osteotomy or joint replacement will be possible and more likely that a fusion will be required.

How can ankle arthritis be treated?

There are a variety of non-operative measures which can be trialed

  • In the first instance lifestyle modifications should be trialed. Altering sporting activities if possible and resting when pain comes on.
  • Pain killers may be helpful. Your GP will let you know what you can and cannot take. For the majority of people paracetamol and simple non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen or diclofenac are trialed although not always with success. There are a variety of stronger pain killers available but they do have side effects and again your GP will be able to advise you on these.

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