How We Can Help

Treatment is tailored to your symptoms, arthritis severity, foot mechanics and lifestyle. Options may include:

Our goal is to reduce pain, improve function and help you remain as active as possible.

What Is Ankle Arthritis?

The main ankle joint is the tibiotalar joint, formed by the tibia, fibula and talus. The ends of these bones are covered with smooth articular cartilage, allowing them to move against one another with very little friction.

With osteoarthritis, this cartilage becomes damaged and gradually deteriorates. As the condition progresses, the joint may develop loss of cartilage, reduced joint space, bone spurs (osteophytes), inflammation, changes in alignment and reduced movement. These changes can cause pain, stiffness and swelling.

Why is ankle arthritis different from knee or hip arthritis?

Primary osteoarthritis — arthritis that develops gradually without an obvious previous problem — is relatively uncommon in the ankle compared with the hip and knee. A large proportion of ankle arthritis is post-traumatic. That means the joint has previously been damaged by an injury.

Examples include a previous ankle fracture, fracture of the talus, repeated ankle sprains, longstanding ankle instability, previous cartilage injury or previous ankle surgery. Arthritis may not become symptomatic until many years after the original injury. Inflammatory arthritis, previous infection, osteonecrosis and certain neurological conditions can also cause ankle joint degeneration.

What Does Ankle Arthritis Feel Like?

Symptoms vary considerably and often fluctuate. You may have periods where the ankle feels relatively comfortable, followed by flare-ups after increased activity.

• Pain around the ankle joint or a deep aching pain
• Stiffness, swelling and reduced ankle movement
• Pain when walking, especially longer distances or on uneven ground
• Difficulty climbing stairs
• Pain after exercise
• Grinding or clicking sensations
• A feeling that the ankle is unstable, or reduced confidence when walking

Why does my ankle hurt more when walking?

Your ankle absorbs considerable force with every step. When the joint surface becomes arthritic, movement and compression through the damaged area can become painful. Long walks, running, hills, stairs, uneven ground, prolonged standing and sports involving twisting or impact may aggravate symptoms.

This does not necessarily mean you should stop being active. The aim is usually to find the right balance between maintaining activity and avoiding excessive irritation of the joint.

Is My Pain Definitely Coming From the Ankle Joint?

Not necessarily. Several structures around the ankle can produce very similar symptoms, including ankle osteoarthritis, subtalar joint arthritis, tendon problems, ankle impingement, osteochondral lesions, chronic ankle instability, previous ligament injuries, inflammatory arthritis and referred pain.

This is why accurate assessment is important before treatment is started.

How Do We Assess Ankle Arthritis?

Your assessment begins with the history of the problem — where the pain occurs, when it started, previous injuries, fractures, sprains or surgery, swelling, instability, aggravating activities, occupation, sport, previous treatment and your medical history.

We then examine the ankle and foot, including range of movement, pain during movement, joint tenderness, swelling, stability, foot posture, hindfoot alignment, muscle and tendon function, and your walking pattern.

The aim is to determine not only whether arthritis is present, but whether the arthritic joint is actually responsible for your symptoms. This often includes a biomechanical assessment of how the foot and ankle are loading.

Do I need an X-ray?

Not everyone requires imaging immediately. Where ankle arthritis is suspected, weight-bearing X-rays are particularly useful because they show the joint while your body weight is passing through it. They may demonstrate joint-space narrowing, osteophytes, joint deformity, previous fractures, changes in alignment or areas of advanced degeneration.

More complex cases may occasionally require MRI or CT imaging. Clinical symptoms and function remain very important, because the amount of arthritis visible on an X-ray does not always match the amount of pain a patient experiences.

Can ultrasound help?

Diagnostic ultrasound can provide useful information about structures surrounding the ankle and some of the changes occurring around the joint. Depending on the presentation, ultrasound may identify joint effusion, synovial thickening, inflammation, osteophytes, tendon problems or ligament abnormalities.

Ultrasound is particularly useful when performing an ultrasound-guided ankle injection, as the joint and needle can be visualised throughout the procedure.

How Is Ankle Arthritis Treated?

Most patients begin with non-surgical treatment. The objective is to reduce pain, reduce unnecessary joint stress, improve stability, maintain movement where appropriate, improve walking ability and keep you active.

Footwear for ankle arthritis

Changing footwear can sometimes produce a surprisingly significant improvement. Very flexible footwear may require greater movement through a painful ankle. Depending on your symptoms, we may recommend supportive footwear, secure fastening, adequate cushioning, a relatively stiff sole, a rocker-style sole, appropriate heel height and good ankle support.

A rocker-style sole can help the body move forwards while reducing some of the movement required through a painful arthritic ankle.

Orthoses

Orthoses may be useful where the way the foot is functioning contributes to abnormal loading through the ankle. They may help improve foot alignment, alter forces passing through the ankle, improve stability, reduce painful loading and improve walking comfort.

Not everyone with ankle arthritis requires an orthosis. Recommendations are based on your individual biomechanics rather than simply prescribing an insole because arthritis is present. See our biomechanics page for more on how we assess this.

Richie Brace® for ankle arthritis

For patients who need more support than a traditional foot orthosis can provide, a Richie Brace® may be considered. It is a custom-made ankle-foot orthosis designed to provide greater control of the foot and ankle while remaining lower profile than many traditional braces.

For ankle arthritis, the purpose of bracing is usually to reduce painful movement, improve stability and modify the forces passing through the arthritic joint. It may be particularly useful when arthritis is associated with painful joint movement, chronic instability, abnormal alignment, varus or valgus loading, significant walking discomfort, foot or hindfoot deformity, or symptoms not adequately controlled with conventional orthoses.

A Richie Brace cannot restore damaged cartilage or reverse osteoarthritis. Its purpose is mechanical. By controlling excessive or painful movement and improving how forces pass through the ankle, the brace may make standing and walking considerably more comfortable for selected patients.

Exercise and rehabilitation

Arthritis does not automatically mean you should stop exercising. Maintaining strength, movement and general fitness is important. Your programme may include comfortable ankle movement, strengthening around the ankle, balance, proprioception, lower-limb strength and cardiovascular fitness.

During painful flare-ups, high-impact activities may need to be temporarily reduced. Cycling, swimming or appropriate gym-based exercise may allow you to maintain fitness while reducing stress through the ankle.

Injection Treatment for Ankle Arthritis

For selected patients, an injection directly into the ankle joint may form part of the treatment plan. At Happy Feet NI, options may include a corticosteroid injection or a hyaluronic acid injection. Where clinically appropriate, these can be performed under ultrasound guidance. Full details are on our ultrasound-guided injection therapy page.

Steroid or hyaluronic acid — which is better?

They are different treatments and one is not automatically better than the other. Corticosteroid primarily aims to reduce inflammation and pain during a flare. Hyaluronic acid is a viscosupplementation treatment intended to alter the environment within the joint. The most appropriate choice depends on your symptoms, degree of inflammation, stage of arthritis, previous injections, medical history, activity level and treatment preferences.

Why use ultrasound guidance?

The ankle joint is surrounded by important tendons, blood vessels, nerves and other structures. Ultrasound allows us to visualise the anatomy and guide the needle towards the intended joint. This is particularly useful where joint anatomy has been altered by arthritis, previous trauma or surgery.

What Happens During Your Appointment?

Your first appointment focuses on identifying what is causing your pain and what treatment is most appropriate.

When Is Surgery Considered?

Most patients are initially treated without surgery. Surgical assessment becomes more appropriate when pain remains significant despite appropriate treatment, walking is severely affected, everyday activities become increasingly difficult, arthritis is advanced, or quality of life is significantly affected.

For advanced ankle arthritis, the two main definitive surgical options are ankle fusion (arthrodesis) and total ankle replacement. The choice depends on age, activity levels, joint alignment, other joints in the foot, bone quality, medical history and individual expectations.

If we believe you may benefit from a surgical opinion, we’ll explain why and discuss appropriate referral.

Your Ankle Arthritis Treatment Journey

If you have an infographic for this pathway, it can sit here. Until then, the steps below summarise the process.

Why Choose Happy Feet NI?

Ankle arthritis can be complex, particularly when previous injuries, instability, deformity and altered foot mechanics are involved. We don’t simply treat an X-ray. We assess how your ankle moves, how your foot functions and how the condition affects your life.

Depending on your individual assessment, we can provide detailed musculoskeletal assessment, biomechanical and gait assessment, diagnostic ultrasound, footwear advice, orthoses, custom Richie Brace® ankle-foot orthoses, rehabilitation advice, ultrasound-guided corticosteroid and hyaluronic acid injections, referral for further imaging, and referral for specialist orthopaedic assessment where required.

Our aim is to provide a range of non-surgical options while being open and realistic about when specialist surgical treatment should be considered.

The take-home message

Ankle arthritis does not automatically mean surgery. For many patients, combining the right footwear, biomechanical management, exercise, bracing and appropriate symptom-control treatments can significantly improve day-to-day comfort.

The important thing is identifying why your ankle hurts, how advanced the problem is and what you want to be able to do. From there, we can build a treatment plan specifically around you.

Frequently Asked Questions