Ankle osteoarthritis
Ankle osteoarthritis is less common than knee or hip OA but can be very limiting. It often follows previous sprains, fractures, instability or years of repetitive load. Patients commonly describe stiffness, swelling, pain with walking and reduced confidence on uneven ground.
Common symptoms
- Stiffness first thing in the morning or after rest
- Pain with walking, stairs, hills or prolonged standing
- Swelling around the ankle joint
- Reduced ankle bend affecting squats, gait and balance
- Pain flare-ups after sport, long days on feet or uneven surfaces
Why it develops
- Previous ankle fractures or severe sprains
- Chronic instability leading to abnormal joint loading
- Cartilage wear and inflammatory flare-ups over time
- Altered movement patterns from calf weakness or restricted mobility
Assessment
- Look at gait, ankle bend, calf strength, single-leg balance and instability history
- Assess swelling, joint-line tenderness and surrounding tendons
- Review footwear, orthotic use and work or sport demands
- Ultrasound can help identify associated synovitis, effusion or tendon involvement
Treatment options
- Mobility restoration where possible
- Calf and lower-limb strengthening
- Balance and proprioception work
- Load management, footwear advice and graded return to walking
- Injection options may be discussed in selected cases when pain remains a major barrier
When to get assessed
Assessment is useful if symptoms are persistent, recurring, limiting work or sport, or if you are unsure whether physiotherapy, imaging or injection is the most appropriate next step.
How ultrasound can help
Ultrasound is not automatically required for every patient. It is most useful when it will change management, improve diagnostic confidence or guide treatment safely.
Where injection fits
Injection is considered only where clinically appropriate after discussion of risks, benefits and alternatives. The aim is usually to reduce pain enough to progress rehabilitation, not to replace rehabilitation.