Osteoarthritis of the ankle happens when the cartilage between the bones wears down. This can cause stiffness, swelling, and pain in the joint. Treatment for ankle osteoarthritis includes non-drug methods, medications, and surgery.

Diagnosis involves a physical examination, gait analysis, X-rays, and blood tests. Following diagnosis, doctors may recommend weight loss, exercise, and a change in activities to reduce or manage symptoms.

If treatment is necessary, the first-line choice is acetaminophen (Tylenol), but other medications are available, including creams to apply to the joint. When such treatment does not manage pain, doctors will consider surgery.

This article discusses the symptoms, diagnosis, and outlook for people with osteoarthritis of the ankle. It also explores exercises and treatment for the condition.

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In a healthy ankle, cartilage covers the bone surfaces that meet, serving as protective padding.
In osteoarthritis of the ankle, this protective space slowly decreases because the cartilage gradually wears away. As a result, the bones rub against each other, leading to the formation of painful bone spurs.

Osteoarthritis of the ankle affects around 1% of the population. Research from 2018 shows that the main cause is trauma, usually from a rotational injury resulting in ligament sprains and bone fractures. This tends to occur in younger people.

Symptoms worsen over time and include:

  • stiffness and pain that is worse in the morning
  • swelling on one side or all around the joint
  • reduced range of motion, meaning the joint cannot bend completely
  • tenderness upon touching or squeezing the joint
  • difficulty walking

According to the Arthritis Foundation (AF), treatment includes non-drug measures, medications, and surgery.

Non-drug treatment

Non-drug treatment recommendations include:

Drug treatment

Drug treatments include medications in the form of:

  • pills
  • creams
  • injections


Pills include acetaminophen (Tylenol) to relieve pain or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), to alleviate pain and inflammation.

Acetaminophen is the first-line treatment, while NSAIDs are the second-line choice.


Creams or gels may include those with one of the following ingredients:


Injections involve glucocorticoids, such as betamethasone (Celestone Soluspan). They provide short-term pain relief, and doctors only give them to a person three or four times per year.

Surgical treatment

When other treatments do not manage pain or improve mobility, doctors may recommend one of the following surgical procedures:

  • Arthrodesis: This fuses the bones of the ankle.
  • Arthroscopic surgery: This entails the removal of bone spurs and loose cartilage, which can help some people. Doctors seldom use it for osteoarthritis.
  • Total ankle replacement: This involves removing bone and cartilage and replacing them with plastic or metal parts.

Complete recovery from surgery may take 4–9 months, but most individuals can resume their regular activities in 3–4 months.

Experts recommend gentle exercises that do not put stress on the ankle, such as:

They also advise avoiding certain sports, such as kickboxing and soccer, and limiting high impact activities, such as running or tennis.

Additionally, physical therapists can provide an individualized exercise program to increase the ankle’s range of motion, flexibility, and strength.

A person can also do range of motion exercises at home. They should do them slowly, aiming for a slight stretch. People should not overdo or move past the point of pain. It is best to check with a doctor before starting any new exercises.

As a general rule, experts recommend doing range of motion exercises 3–10 times per day. A person should sit while doing these exercises and maintain good posture with feet on the floor. Below are some options:

  • Plantar flexion: Push toes down and bring heels up off the floor as if pressing down on a gas pedal.
  • Dorsiflexion: Raise toes toward the shins. Do this more slowly, but try to get the toes as high as possible while keeping the heels on the floor.
  • Ankle circles: Move the ankles slowly in a circle, as if trying to write the letter “O.” Do both clockwise and counterclockwise circles.

The American Academy of Orthopedic Surgeons (AAOS) provides the below details on the diagnostic process.

Physical examination

In a physical examination, a doctor will look for swelling and tenderness and asks the following questions:

  • When did the pain start?
  • Did you have an injury in the past?
  • Does the pain come and go, or is it continuous?
  • Where exactly is the pain?
  • Is the pain worse in the morning, or does it worsen when walking?

Gait analysis

Doctors ask people to walk to see if their gait reveals some of the effects of osteoarthritis. For example, stiffness and pain may cause limping, showing the location and severity of the condition.

Gait analysis also includes:

  • measurement of stride
  • assessment of bone lineup during walking
  • strength test of ankle and foot


Tests may include X-rays, which can reveal narrowing of joint space between ankle bones, as well as spurs and other changes, such as fractures or breaks. Additionally, doctors may order blood tests to rule out other types of arthritis.

Musculoskeletal ultrasound can also be of assistance, particularly for tendon injury or inflammation detection.

The AF notes that it is not possible to cure or reverse osteoarthritis, but treatment can reduce pain and enable a person to perform their everyday activities.

Medical resources paint a slightly different picture of the outlook after surgery. The AAOS states that in most cases, it reduces pain and enables people to function.

However, a 2019 review warns that surgery has some downsides. After examining current surgical options for ankle osteoarthritis, the authors found they either restrict range of motion or have high rates of complications.

Evidence links osteoarthritis of the ankle to significant illness. People with the condition tend to experience increasing severity of symptoms, culminating in end-stage ankle osteoarthritis, a top cause of chronic disability in North America.

Osteoarthritis of the ankle typically affects someone who is young and has injured the joint. As the cartilage between bones in the ankle wears away, a person experiences increasing severity of symptoms, such as pain and stiffness that is worse in the morning.

Experts advise people with the condition to engage in a physical therapy program or gentle exercises, such as walking or swimming. If the condition progresses, medications can help manage the pain. Surgery is the last resort in treatment because it can involve complications.