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What is ankle arthritis?

Arthritis means inflammation and wear of a joint. In the ankle, this happens when the smooth cartilage that cushions the ends of the bones wears away, leaving bone rubbing against bone. This causes pain, stiffness, and swelling, and can make walking and standing increasingly uncomfortable over time.

Ankle arthritis is less common than arthritis of the hip or knee, but it can be just as disabling when it develops.

What causes it?

There are three main types:

Post-traumatic arthritis is the most common cause of ankle arthritis, accounting for around 70–80% of cases. It develops months or years after an ankle injury, such as a fracture or severe sprain, even if the injury healed well at the time. The joint surface never fully recovers, and it gradually wears down.

Osteoarthritis is "wear and tear" arthritis that develops with age, repetitive stress, or joint alignment problems, without a specific prior injury.

Inflammatory arthritis, such as rheumatoid arthritis, is caused by the body's immune system attacking the joint lining. This tends to affect several joints, not just the ankle.

Symptoms

  • Pain in the ankle, often worse with activity and better with rest

  • Stiffness, particularly first thing in the morning or after sitting

  • Swelling around the joint

  • A feeling of grinding, catching, or instability in the ankle

  • Reduced range of movement, making it harder to walk on uneven ground, climb stairs, or squat

  • In later stages, pain even at rest or at night

How is it diagnosed?

Diagnosis usually starts with a discussion of your symptoms and medical history, followed by an examination of the ankle's movement, stability, and alignment. X-rays are typically used to confirm arthritis and assess how severe it is. Occasionally, a CT or MRI scan is needed for more detailed planning, particularly if surgery is being considered.

Treatment options

Treatment is tailored to the severity of the arthritis, your symptoms, and your activity level. It usually starts with the least invasive options and progresses only if needed.

Non-surgical treatment is the first step for most people and can be very effective:

  • Activity modification and weight management to reduce load on the joint

  • Physiotherapy to maintain strength and flexibility

  • Simple pain relief and anti-inflammatory medication

  • Supportive footwear, insoles, or an ankle brace to reduce strain

  • Steroid injections to calm inflammation and ease pain, usually for a limited period

Surgical treatment may be considered if symptoms continue to significantly affect daily life despite non-surgical measures. Options include:

  • Arthroscopy (keyhole surgery) to remove loose fragments or bone spurs in milder cases

  • Ankle fusion (arthrodesis), which joins the bones of the ankle together to eliminate painful movement. This is a well-established, reliable option for relieving pain, though it reduces the joint's flexibility.

  • Ankle replacement (arthroplasty), which replaces the worn joint surfaces with an artificial implant, aiming to relieve pain while preserving more natural movement than a fusion.

Your surgeon will discuss which options are suitable for you, based on your age, activity level, the pattern of your arthritis, and your personal priorities.

Living with ankle arthritis

Many people manage ankle arthritis successfully for years with non-surgical care alone. If symptoms progress, effective surgical options are available, and most patients see a significant improvement in pain and quality of life afterward.

If you're experiencing ongoing ankle pain or stiffness, an assessment can help identify the cause and the right treatment path for you.

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