Osteoarthritis of the Ankle

By Jennifer Cuthbertson

Your ankles allow you to walk, run and jump. Three bones come together to let us move our feet up and down. The surfaces where these bones meet are covered with cartilage. This smooth tissue protects and pads the bones.

Osteoarthritis causes the cartilage to wear away over time. The bones rub against each other and bone spurs form. Ankle OA causes pain, swelling and a loss of function.
 

There is no single cause of OA. These factors can make it more likely you’ll have OA:

• Age: OA can occur at any time of life, but it is most common in older adults.
• Obesity: Being overweight adds stress to your ankles. Fat cells produce proteins that may make OA worse.
• Injuries: Any ankle injury, even one that happened years ago, can lead to OA.
• Repeated stress: High-impact stress on your ankles over a long period of time can increase risk for OA.
• Genetics: You may have a family history of OA.
• Joint shape: If you have misaligned joints, you are at higher risk.
   

Symptoms of ankle OA come on slowly and get worse over time.

• Pain and stiffness that is worse in the morning and after sitting still for a long time.
• Tenderness when someone touches or squeezes the joint.
• Swelling may happen all around or on one side of your ankle. 
• Decreased range of motion means your ankle won’t bend and flex completely. 
• Difficulty walking due to pain, stiffness and loss of motion.
   

To find out what’s wrong with your ankle, your doctor will talk to you and do some tests.

• Joint swelling and tenderness: Your doctor will look at and feel your ankles.
• Gait: Your doctor will look at the way you walk. 
• X-rays: Bone spurs and cartilage loss can be seen on X-ray.
• Lab tests: Blood tests can help rule out other forms of arthritis.
   

It is not possible to cure or reverse OA, but treatment can help relieve the pain and improve your mobility. 

Non-Drug Treatments

• Try a topical cream that inlcudes ingredients like capsaicin, menthol, camphor or CBD.
• Lose weight to reduce pressure on the ankle.
• Change activities to avoid the ones that hurt the most.
• Go to physical therapy.
• Wear a brace, use a cane or wear shoe inserts.

Drug Treatments

• Pain relievers: oral medications that include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDS; Advil, Aleve) can help ease pain.
• Topical treatments: gels or creams that include NSAIDs (Voltaren), lidocaine (Aspercreme) and salicylates that can be rubbed on the ankle. 
• Steroids: Glucocorticoid injections provide short-term relief and are given only three or four times a year.

Surgical Treatments

If your pain and mobility problems are not relieved with other treatments, surgery may be needed.

• Arthroscopic surgery: Not usually used for OA, but it can be helpful for some people. Your doctor will remove loose cartilage and bone spurs from your ankle. 
• Arthrodesis: Joint fusion surgery reduces pain by eliminating motion in the ankle.
• Arthroplasty: In a total ankle replacement, damaged cartilage and bone are removed and replaced with metal or plastic parts.