Ankle arthritis

In summary: ankle osteoarthritis is the progressive deterioration of the cartilage covering the joint bones. It often appears after a major injury, such as a fracture or severe sprain, but it can also be related to repeated sprains, leg axis alterations or other previous problems. It can cause pain, stiffness and difficulty walking, especially on uneven terrain or when going up and down stairs. Treatment is tailored to each case and aims to reduce pain, preserve mobility and keep you active. In Martorell, Barcelona (Teknon) and Igualada.

Ankle osteoarthritis is the wear and tear of the cartilage in the tibiotalar joint, which connects the leg to the foot and allows movements such as walking, running or standing on tiptoes. When the cartilage deteriorates, the bones may lose part of their protection and the joint becomes less regular and stiffer.

What makes it different from knee or hip osteoarthritis is its origin: here there is often a previous injury —a severe sprain, recurrent sprains or a fracture— that left the joint compromised. Over time, poor alignment or persistent instability can contribute to the progression of the wear. In some cases, there is no single clear cause.

What symptoms can it present

The main symptom is ankle pain, which can occur when walking, standing for long periods or doing physical activity. Some people notice more discomfort on uneven terrain or when having to perform repeated efforts. The pain is not always constant: it can increase at certain times and decrease with rest.

It is also common to experience stiffness, especially after sitting down or in the morning, along with a progressive reduction in movement. The ankle may swell after activity and, sometimes, you may perceive crepitus or a sensation of locking. If there is an associated old injury, a feeling of insecurity or that the ankle “gives way” may also persist.

The intensity of the symptoms does not always match the appearance on imaging tests. For this reason, it is important to assess how the pain limits you, which activities you wish to maintain and how the problem is evolving.

How it is diagnosed

During the consultation, we will discuss the evolution of your symptoms and review any previous trauma, surgeries or sprains. We will examine the ankle’s mobility, its stability, the way you bear weight on your foot and the points where pain arises. We will also observe if there are any leg or foot axis alterations that could overload the joint.

X-rays allow us to assess the joint space, alignment and bone changes associated with the wear. Depending on the symptoms and the information we need, we may complete the assessment with an ultrasound scan, particularly to examine tendons, ligaments and other superficial structures. In selected cases, a more detailed imaging test may be necessary.

Gait analysis can be useful when we want to understand how you distribute loads when walking or what influence your footwear and foot mechanics have. Not everyone requires the same tests: they are indicated based on the examination and clinical suspicion.

How we treat it

The objective is practical: to relieve your pain and maintain mobility and activity. Initial treatment is usually conservative and is adapted to the degree of wear, your age, your work, your sport and the activities you wish to continue doing.

We usually combine ultrasound-guided injections —hyaluronic acid or corticosteroids deposited precisely thanks to ultrasound— with custom-made insoles that help distribute loads better and, if necessary, stabilise the ankle. The objective and suitability of an injection are assessed individually, because not all joints or all people respond in the same way.

Footwear also plays an important role. It may be advisable to wear comfortable, stable shoes with a sole that reduces impact, avoiding models that increase instability or press on the painful area. Physiotherapy and muscle conditioning can help preserve mobility, improve balance and reduce overloading. Physical activity can be adapted, prioritising that which does not clearly increase the pain.

When conservative measures are insufficient and the pain severely limits daily life, we study surgical options. Depending on the location of the wear, the alignment and the overall condition of the joint, techniques to treat specific lesions, correct certain deformities or replace or fuse the joint in selected cases can be considered. The indication depends on a comprehensive assessment and not just an X-ray.

Surgery is reserved for highly limiting cases; if you come to consider it, a second opinion helps you make a calm decision. It is also advisable to consult if the pain persists after an injury, if the ankle swells frequently, if you notice instability or if you have stopped doing activities that used to be part of your routine.