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Ankle Joint Arthritis: Causes, Symptoms, Treatment-NSAIDs, Opioids, PT, Surgery

Ankle joint is made up of 3 synovial joints, which includes one primary and two secondary joints.1

Ankle Joint Arthritis

Primary Ankle Joint

  • Talocrural Joint.

Secondary Ankle Joints

  • Subtalar or Talo-Calcaneal Joint.
  • Inferior Tibia-Fibular Joint.

Joints Covered With Synovial Membrane and Cartilage

  • Talocrural Joint
  • Subtalar Joint

Ankle Joint Arthritis

  • Observed in Talocrural and Subtalar Joint.
  • Inflammation of the synovial membrane or cartilages causes severe ankle joint arthritis.

Talocrural Joint-

  • The Talocrural Joint is the hinge joint.
  • Talocrural joint involves tibia, fibula, and talus bone.
  • Lower end of Tibia bone lies on top and medial surface of Talus bone (figure 1).
  • Lower end of fibula lies on lateral side of Talus bone.
  • Joint extends from medial malleolus to lateral malleolus.
  • Joint surface is covered by smooth cartilage and synovial membrane.
  • Arthritis affects synovial membrane and cartilage of the joint.
  • Plantar flexion, dorsiflexion and side-to-side movements of the ankle joint occur at Talocrural Joint.
  • Body weight is transmitted through the joint to the ground.
  • Ankle Joint Arthritis of the Talocrural Joint causes severe pain with ambulation and movement of the joint like dorsiflexion and plantar flexion.

Subtalaror or Talocalcaneal Joint-

  • The subtalar joint is a synovial joint.
  • Joint is formed between Talus and Calcaneal bone.
  • Joint surface is covered with smooth cartilages.
  • Joint is supported by strong ligament, which prevents anterior or posterior subluxation.
  • Minimum movement is observed at this joint during flexion and side-to-side rotation of ankle.
  • Ankle joint arthritis of subtalar joint is extremely pain during standing and changing position.

Inferior Tibio-Fibular Joint-

Ankle Joint Arthritis

  • The joint is between lower end of fibula and lateral lower surface of tibia.
  • Joint prevents lateral sliding and subluxation.
  • Joint is between the lower end of tibia and fibula.
  • Ankle joint arthritis of tibio-fibular joint is rare.

Causes Of Ankle Joint Arthritis

Risk Factors Of Ankle Joint Arthritis

  • Sports Injury
  • Obesity
  • Unfitting Footwear
  • Activities like slip and fall on snow

Ankle Joint Arthritis

Symptoms Of Ankle Joint Arthritis

Chronic Pain-

  • In Early Stage of Ankle Joint Arthritis- Pain is mild to moderate
  • In Later Stages of Ankle Joint Arthritis- Pain becomes very severe.
  • Pain and inflammation during early stage responds to non-steroidal anti-inflammatory medication (NSAIDs)
  • In Later Stages- Chronic pain does not respond to NSAIDs.
  • Pain caused by Ankle Joint Arthritis is mostly localized around ankle joint and occasionally spreads to lower leg and foot.
  • Pain is severe during walking and activities.

Tingling and Numbness-

  • Tingling and numbness is not a common symptom in Ankle Joint Arthritis.
  • Joint inflammation, edema and hypertrophy of synovial joint may irritate adjacent nerve resulting in symptoms such as tingling and numbness.


  • Fever is observed if joint is infected as in septic ankle joint arthritis.

Weight Loss

  • Weight loss is secondary to loss of appetite, chronic severe pain, or infection.

Signs Of Ankle Joint Arthritis

Ankle Joint Stiffness

  • Joint movement like dorsiflexion and plantar flexion is restricted because of joint stiffness.
  • Joint stiffness is because of edema, joint swelling and inflammation causing severe pain during movements.

Ankle Joint Swelling

  • Ankle Joint Arthritis caused by osteoarthritis, rheumatoid arthritis, gout and Pseudogout is associated with joint swelling.
  • Rheumatoid Arthritis of the Ankle Joint causes joint swelling because of synovial joint edema and hypertrophy.
  • Osteoarthritis of the Ankle Joinauses joint swelling because of osteophytes and joint edema.
  • Ankle Joint Gout cauposises joint swelling following uric acid deposition resulting in inflammation, tissue edema and hypertrophy of soft tissue.
  • Ankle Joint Pseudogout causes calcium dets over soft tissue and synovial membrane resulting in inflammation and soft tissue hypertrophy causing joint swelling.

Painful Joint Movements

  • Ankle Joint movements are painful secondary to bony spurs, inflammation and irritation of surrounding nerves.

Ankle Joint Deformity

  • Ankle Joint Arthritis is associated with joint deformity.
  • Joint deformity is caused by:
    1. Osteophytes– Ankle Joint arthritis caused by Osteoarthritis.
    2. Uric Acid Deposits– Ankle Joint Arthritis caused by Gout.
    3. Calcium Deposits– Ankle Joint Arthritis caused by Pseudogout.
    4. Hypertrophy of synovial membrane and joint dislocation– Ankle joint arthritis caused by Rheumatoid Arthritis.

Ankle Joint Instability

  • Ankle joint instability is seseen in Ankle Joint Arthritis caused by Rheumatoid arthritis secondary to subluxation of ankle joint.
  • Instability is also caused byvere pain.

Investigations To Diagnose Ankle Joint Arthritis


Useful investigation to diagnose Ankle Joint Arthritis caused by following diseases-

  • Osteoarthritis
  • Rheumatoid Arthritis


Useful investigation to diagnose Ankle Joint Arthritis caused by following diseases2

  • Osteoarthritis
  • Rheumatoid Arthritis
  • Gout
  • Pseudogout
  • Septic Arthritis

CAT Scan

Useful investigation to diagnose Ankle Joint Arthritis caused by following diseases-

  • Osteoarthritis
  • Rheumatoid arthritis
  • Gout
  • Pseudogout


  • Septic Ankle Joint Arthritis

White Blood Cell Count

  • Septic Ankle Joint Arthritis
  • Rheumatoid Ankle Joint Arthritis

Erythrocyte Sedimentation Rate

  • Septic Ankle Joint Arthritis
  • Rheumatoid Ankle Joint Arthritis

Rheumatoid Factors Test

  • Rheumatoid Ankle Joint Arthritis

Ankle Arthroscopy

  • Arthroscopy helps to find the cause of pain like bone spur or cartilage fragments in the joint resulting in severe pain with movement of the joint or at rest.
  • Arthroscopy can be therapeutic since bone spur and cartilage fragments are removed during the procedure.
  • Uneven bone spurs are shaved to create smooth surface for joint movements.

Watch 3D Video of Ankle Joint Diagnostic Arthroscopy

Watch 3D Video of Ankle Joint Therapeutic Arthroscopy

Treatment Of Ankle Joint Arthritis

Conservative Treatment For Arthritis of Ankle Joint3

  • Restricted activities of ankle joint until ankle joint inflammation is treated.
  • Heat or cold therapy is used to treat joint swelling, edema and pain.
  • Assistive Devices- Cane, walker or wheelchair are prescribed to keep weight off of the ankle joint.
  • Weight Loss- Obese patients often have increased pain because of additional weight transmission through the ankle joint to ground.
  • Daily exercise or Yoga therapy helps to improve joint movements and prevent joint stiffness.

NSAIDS (Non-Steroidal anti-inflammatory Medications) To Treat Ankle Joint Arthritis


  • Chronic pain and joint inflammation,

Medications Prescribed

  • Motrin, Naproxen, Daypro and Celebrex

Opioids To Treat Ankle Joint Arthritis

NSAID Resistant Pain

  • Opioids are prescribed when pain is not responding to NSAIDs treatment.

Opioids During Activities Only

  • If pain is severe during walking and less severe at rest then pain is treated with short acting opioids.

Opioids For Pain At Rest

  • Severe pain at rest is treated with long acting opioids and breakthrough severe pain during activity is treated with short acting opioids.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)-

Rheumatoid Arthritis Resistant to NSAIDs

  • Is Treated with following medications also known as DMARDs
    1. Methotrexate (Trexall).
    2. Leflunomide (Arava).
    3. Hydroxychloroquine (Plaquenil).

Immunosuppressant To Treat Ankle Joint Arthritis

Rheumatoid Disease Is Associated With Exaggerated Immune Activities

  • Following medications are used to suppress hyperactivities of immune system-
    1. Azathioprine (Imuran, Azasan).
    2. Cyclosporine (Neoral, Sandimmune, Gengraf).

TNF-Alpha Inhibitors To Treat Ankle Joint Arthritis

Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PA) Resistant To NSAIDs-

  • RA and Psoriatic Arthritis are treated with TNF-alpha inhibitors.
  • Following medications are used to inhibit secretions of TNF- alpha factors.
    1. Etanercept (Enbrel)
    2. Infliximab (Remicade)
    3. Adalimumab (Humira)
    4. Golimumab (Simponi)
    5. Certolizumab (Cimzia)

Muscle Spasm

Muscle Spasm Around Ankle Joint

  • Is treated with muscle relaxants.
  • Following Muscle Relaxants Are Often Used-
    1. Baclofen
    2. Flexeril
    3. Skelaxin
    4. Robaxin

Physical Therapy For Treating Ankle Joint Arthritis

Physical Therapy As A Primary Treatment

  • Pain
  • Muscle Spasm
  • Joint Stiffness
  • Joint Instability
  • Abnormal Gait

Physical Therapy As Supplemental Therapy

  • Post surgery to improve joint movements
  • Adjuvant therapy with pain medications

Interventional Pain Therapy To Treat Ankle Joint Arthritis

Cortisone Injection For Arthritis of Ankle Joint

  • Cortisone Injection in ankle joint is performed under X-Ray guidance.
  • Cortisone injection is performed to reduce inflammation.
  • Pain not responding to NSAIDs and opioids are treated with frequent cortisone injection scheduled between 3 to 4 months.
  • Cortisone injection is not recommended for Gout and Septic Ankle Joint Arthritis.

Surgical Options For Ankle Joint Arthritis

Ankle Joint Fusion

  • Ankle fusion surgery is indicated for severe ankle joint arthritis not responding to medications, physical therapy and cortisone injection.
  • Surgery involves removal of worn out soft tissue, worn out cartilages, and any fragments floating in the joint. The joint is fused so all the movements are restricted and joint is permanently fused to hold the bones in a solid position.

Ankle Joint Replacement

  • Ankle joint replacement surgery is rarely performed for ankle joint arthritis pain not responding to conservative treatment. The surgery is controversial treatment for Ankle Joint Arthritis. Surgery is extensive and debated because of inadequate research and scientific publications.


  1. Current thoughts on ankle arthritis.Ritterman SA, Fellars TA, Digiovanni CW.R I Med J (2013). 2013 Mar 1;96(3):30-3.Resident in orthopaedic surgery affiliated with Brown University and Rhode Island Hospital.
  2. MR imaging of the paediatric foot and ankle.Iyer RS, Thapa MM.Pediatr Radiol. 2013 Mar;43 Suppl 1:S107-19. doi: 10.1007/s00247-012-2449-4. Epub 2013 Mar 12.Department of Radiology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
  3. Conservative treatment of asymmetric ankle osteoarthritis.Schmid T, Krause FG.Foot Ankle Clin. 2013 Sep;18(3):437-48. doi: 10.1016/j.fcl.2013.06.003. Epub 2013 Jul 29.Department of Orthopaedic Surgery, Inselspital, University of Berne, Freiburgstrasse, Berne 3010, Switzerland.
Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:June 20, 2018

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