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Ankle Pain: Isolated Symptom, or Sign of Arthritis?

Ankle pain

Key points

  1. Arthritis in your ankle is usually post-traumatic arthritis or rheumatoid arthritis. Osteoarthritis in the ankle is very rare.
  2. Post-traumatic arthritis may not cause pain until years after the initial injury.
  3. Ankle pain is not necessarily caused by arthritis. Other causes include tendonitis, infections, fractures, gout, and neuropathic pain.

Whether ankle pain is caused by arthritis or something else, it can send you to the doctor looking for answers. If you visit your doctor for ankle pain, they’ll examine the ankle joint. This is where the tibia (shinbone) rests on the talus (top foot bone).

If you’re experiencing arthritis, you may have:

  • pain
  • tenderness
  • swelling
  • stiffness
  • reduced range of motion

If you have pain, you may feel it mainly in the front of your ankle. This discomfort can make it difficult for you to walk.

Types of ankle arthritis

People tend to associate arthritis with the knees, hips, and wrists, but it can also occur in the ankles. When arthritis occurs in the ankles, it’s often due to an old injury, such as a dislocation or fracture. Doctors call this “post-traumatic” arthritis.

Another cause is rheumatoid arthritis (RA), which affects the whole body, including the ankle area. Primary osteoarthritis (OA), which results from degeneration or “wear-and-tear” over time, rarely occurs in the ankles.

Post-traumatic arthritis

Ankle arthritis can be a delayed response to a major sprain, dislocation, or fracture. Your doctor will ask about any history of injury. A big sprain can injure the cartilage and lead to joint instability. This can cause degenerative changes.

Evidence of damage usually shows up on X-rays within about two years after the injury. It may be decades until you notice severe pain.

Rheumatoid arthritis

Your doctor may also ask about pain in other joints. Additional discomfort may indicate systemic inflammation, such as RA.

Your doctor may want to see you standing while barefoot to check your leg alignment. The soles of your shoes may also reveal wear patterns. This can also confirm alignment problems related to RA in your ankles.

Diagnosis

To diagnose arthritis, your doctor will take your medical history and ask about injuries and previous infections. They also may request X-rays. The technician will take images of your ankle from multiple angles while you stand. A radiologist will examine your ankle joint alignment and the narrowing in your joint space.

Your doctor will also examine the way you walk, studying your cadence, speed, and stride length. Your doctor will be able to diagnose whether you have arthritis based on these tests and observations.

Talking with your doctor may reveal what activities lead to ankle twinges. If walking uphill hurts, you may have arthritis in the front of your ankle. If the back of the ankle hurts when you walk downhill, the rear of the joint may have problems.

Discomfort as you walk on uneven ground may suggest an unstable ankle. That could be an indication of problems in the subtalar area, which is below the ankle joint. Instability and swelling suggest weakened ligaments.

The gait test

The gait test usually involves you walking or running on a treadmill while your doctor observes. How your foot hits the ground also tells a story. For example, if your ankle motion is restricted, you may raise your heel from the floor prematurely and bend your knees in a choppy fashion.

Your doctor or arthritis specialist will examine the rotation of your foot relative to your lower leg. Your overall lower limb alignment will give clues as to how well your hips, knees, and ankles are doing.

Treatment

If you have ankle arthritis, you may need to rest your ankle to minimize the pain. If you enjoy exercise, your doctor may recommend swimming and cycling, in order to protect your ankle.

The small ankle joint bears five times your body weight on each step, so weight reduction can help.

Medications are also common in treating arthritis. Your doctor may recommend aspirin, naproxen, or ibuprofen. For more severe arthritis, they may prescribe you disease-modifying antirheumatic drugs (DMARDs).

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