Foot and ankle osteoarthritis

The process of osteoarthritis involves the normal age-related changes of the cartilage joint surfaces. In addition there may be stiffening to the soft tissue surrounding the joints, the joint capsule, swelling, some inflammation and pain.

Osteoarthritis of the ankle joint is when these changes occur at the ankle joint. This may result in some pain and stiffness of the affected joint with a reduced range of movement.

Osteoarthritis can affect any joint in the foot. Another common site for arthritis is the big toe joint. Arthritis in this joint can affect the joints shape, causing a bunion.

Causes and symptoms

Causes of foot and ankle osteoarthritis

Several factors normally combine to cause symptoms of osteoarthritis:

Previous joint damage (from trauma or other conditions such as such as rheumatoid arthritis)
Increased bodyweight
Age (risk increases with age)
Family history (genetics)
Poor ankle-foot alignment (termed biomechanics) such as a flat foot posture

Symptoms of foot and ankle osteoarthritis

The main symptoms of osteoarthritis are:

Pain
Stiffness
Swelling

Pain is most commonly felt across the front of the ankle joint. Pain and stiffness on walking and going up or down stairs can be the main aggravating activity. The foot may become less flexible, particularly on uneven surfaces. Fortunately the presence of osteoarthritis does not always cause pain so it is quite possible to be pain-free despite reasonably advanced arthritis.

Diagnosis of foot and ankle osteoarthritis

Ankle and foot osteoarthritis can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition and by conducting a physical examination. X-rays are not routinely required, but may be requested if symptoms are severe enough that injections or surgery are being considered.

Self management of osteoarthritis

In the majority of cases, the symptoms of ankle and foot osteoarthritis can be managed effectively. The two important things you can do to improve your symptoms are:

Maintain activity levels as pain allows
Lose excess weight

These measures can have significant effects on your symptoms with no side effects or complications. They also have the added benefit of improving your general health.

Footwear

Wearing the appropriate footwear with adequate support under the arch of the foot is often a good way to help improve symptoms. If walking over very uneven ground boots with support around the ankle may also help. If a bunion is present or developing, footwear that is wider across the toe area is recommended as it reduces the pressure to the side of the toe caused by more pointed footwear.

Orthotics

Insoles that offer support under the arch of the foot can be effective at reducing pain. Those with a metatarsal pad can be more effective at easing pain under the ball of the foot.

Painkillers

Various medication can be used to manage your symptoms. It is important to remember painkillers do not treat the arthritis, only the symptoms. Therefore, it is important to use medication along with the other methods described above. Speak to your healthcare professional for advice regarding painkillers.

What other treatments are there for osteoarthritis of the ankle and foot?

Other treatments from steroid injections to surgery are available. However, due to significant risks, these will only be considered once the above methods have been tried and failed.

Exercises for osteoarthritis

When starting an exercise for the first time it is important to ‘start low and go slow’. This means start with gentle exercises concentrating on the movement and slowly progress through weight bearing to resistance exercises.

Pain killers can be used to help you do the exercises. Talk to your doctor for more specific advice regarding pain killers.

Exercise 1: ankle circle

Sit down or lie on your back
Draw circles inwards with your ankle

Exercise 2: seated heel raises

Sit towards the edge of a chair with your feet flat on the floor
Lift your heels so that you are on your toes
Return to start and repeat

Exercise 3: seated toe curls with towel

Smooth the towel out and place one foot on it, flat.
Keeping the heel still, pull the towel toward you by scooping it in with your arch and toes.
Use both sides of your foot (all five toes) and try to create a deep dome under the arch area.
You will only get a little bit of the towel to move each time you extend and pull back.

Exercise 4: single leg mini squat

Stand on one leg with the other leg stretched out in front of you
Your heel should be slightly off the ground
Slowly bend the knee going into a single leg squat position
ALL of your weight should be on this leg
Return to the starting position

Exercise 5: single leg heel raise

Put your hand on a wall or other stable surface for balance
While standing on one leg, raise up on your toes as you lift your heel off the ground
Keep your knee straight

Exercise 6: dynamic step forward and hold

Step forward with one leg
Stop and stand on one leg while keeping the other leg off the floor for a second, then step back

What next?

If you are still experiencing symptoms despite following the above advice, it is important you seek advice from your GP. Your GP may decide to refer you to the musculoskeletal clinic or to a physiotherapist.

Page updated 01/12/2020. Review date 01/01/2024

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