Osteoarthritis is a condition that affects the joints, causing pain and stiffness. The ankle is responsible for the foot moving up, down and side to side. The cartilage between the joints is normally smooth to help them glide. In ankle osteoarthritis this becomes thin and rough so movement sometimes becomes painful whilst the joint can also become inflamed.
Osteoarthritis can affect anyone at any age but is more common over the age of 45 years old. The ankle itself can develop post-traumatic arthritis following an injury. Although in many cases there might be no definitive cause. Being over-weight does not help as joints are under more strain and this can enhance symptoms.
Managing weight is important, therefore a balanced, healthy diet is encouraged. If you are over-weight, reduction of this will be beneficial to your feet to reduce joint over-load whilst a balanced diet is important for your overall health.
Smoking does not help bone and soft tissue repair, so cessation is advised.
See our “Healthy Living” section for more information on local stop smoking and healthy weight services
Activity is encouraged, although adaptation is important. At times, high-impact activities might need to be scaled back. Instead, introduce activities that allow your symptoms to recover but keep you active. Monitoring step count or intensity of walking are ways to modify your activity.
Generally, avoiding footwear that aggravates your symptoms is advised. However, we need to be careful about this as sometimes the shoes might not be the aggravator, it might simply be the task you’re doing. We advise wearing a practical, cushioned, stable shoe with a 8-10mm heel support, (such as running trainers or walking shoes) avoid flat and unsupportive options. Walking boots can provide further ankle stability in some cases which can help ease symptoms on longer walks.
The Correct Shoes for Insoles – YouTube
See our footwear page for more information about good footwear
An ankle foot orthosis is used to support the ankle by an external structure to provide stability for the ankle. These might be used in cases whereby surgery is not suitable. However, they can be bulky around the ankle and sometimes they can rub causing discomfort.
You may have been assessed by a clinician and this program is a framework to build on, exercises could be added or taken away accordingly. If you have a foot that is stiff and limited in mobility you may struggle with the later phases. Often in older feet osteoarthritic changes may reduce your ability to perform some of the standing functional exercises and doing seated ones might be more preferable.
Patient symptoms: Pain and difficulty with all activities
Goal: Start to exercise, aim to offer some painful relief in the initial phase.
Warm up while sat down – circulation exercises (moving foot up/down)
The following exercises can help with pain in the initial phase, although progression onto stage 2 is advised if these are relatively easy.
Phase 1: Ankle Mobility
If you prefer to stretch your calf muscles whilst seated you can use a towel or a belt to stretch your calf muscle.
Patient symptoms: Pain has improved with phase 1 but still struggling with functional tasks move onto phase 2 loading. Pain with exercise, morning stiffness, pain when performing heel raises- although tolerable.
Goal: Progressed from phase 1 now time for strengthening.
The following exercises can help build tolerance in the tissues
Phase 2: Calf Stretch Standing
These are administered by a health professional into joints with the aim to reduce pain and swelling. This might provide immediate relief as is often mixed with local anaesthetic whilst the steroid tends to take a few days to work. There is a risk of it not working and an adverse reaction to the steroid is possible.
Versus Arthritis osteoarthritis of the foot and ankle information booklet
Corticosteroid Injections – Information leaflet by Sirona care & health (PDF)
Surgery is only considered when all other treatments have not worked. Not everybody will be a suitable candidate for surgical intervention so this can be discussed with a health professional.
This is key-hole surgery to clean up the ankle joint by removing loose cartilage and bone. Although this may only delay further surgery the time scale is unknown and can be successful for many. As with all surgery there is a risk that your symptoms may also be worse with intervention.
A joint replacement in the ankle is relatively newer than other joints such as hip and knee where it is more established. These tend to work well in older patients who want to maintain mobility in the ankle and do not have an overly deformed ankle joint. There is a higher risk of failure which can require revision surgery which can be more complex if the original replacement was not successful.
An ankle fusion is the most common surgical technique used by stiffening the ankle joint. This could transfer stress to other joints as a downside. It can last well and has good function for walking although it will struggle with impact and running activities. In surgeries such as an ankle replacement and fusion there will be a longer recovery with intensive rehabilitation period to help strengthen the surrounding tissues over the next 18months.
There are risks to foot and ankle surgery
Off-work: There will be a requirement to elevate your foot and rest non weight bearing then semi weight bearing.
Infection: The act of surgery is invasive which is also a risk to infection. In some cases, this can delay healing and will require antibiotic treatment.
Delayed Healing: If the blood supply is not so good or you have poor health this might affect healing time. Smoking has been shown to affect healing to bones and soft tissues. Non-union of bone fixations will require further surgical input.
Blood Clots: A small risk of developing a blood clot after foot surgery. Following the pre and post operative advice will help reduce this risk.
Scarring: Any type of surgery will leave a scar. Occasionally this can cause pain and irritation. If this happens, please discuss this with your consultant.
Metalwork: Occasionally screws or plates can cause pain after surgery. If this is the case, please discuss your concern with your consultant as it may be possible to remove the metalwork once the tissues have healed.
Swelling and Stiffness: The foot can swell as a response to surgery and as part of the healing process. It can take up to six months for swelling to completely settle in some cases. Although in some cases post-surgery there may be increased stiffness in the foot.
Numbness: Can exist in the surgical site if there has been disruption to a nerve.
Chronic Regional Pain Syndrome: Surgery can sometimes result in a swollen, painful and highly sensitive foot. This can be challenging to manage and often patients will be referred to the pain clinic for support.
Contact your general practice if you need further help and guidance, a referral to local musculoskeletal services is required in some instances, and they can advise on appropriate treatment or pathways suitable to you.
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