Ankle arthritis is less common than knee or hip arthritis. The most common joint affected is the ankle joint between the leg (tibia) and the ankle (talus). Simple treatments like activity modification, exercise, and shoe selection can help. However, an ankle injection helps in more complex cases. Sometimes, we use a steroid injection into an ankle joint to help with the pain.

Common Causes of ankle arthritis

Ankle arthritis generally affects younger patients in their 40s and 50s compared to hip and knee arthritis patients (who are usually older).  In fact, ankle arthritis can lead to a greater impact on a person’s lifestyle and work capacity compared to hip or knee arthritis. 

The most common cause of ankle arthritis is a previous injury, such as a severe ankle sprain or break. Injuries can cause damage to the cartilage of the joint. Over time, this damage leads to bone-on-bone arthritis, known as osteoarthritis.

Other causes of arthritis include inflammatory arthritis or infection. These conditions lead to early damage and cartilage destruction, precipitating bone-on-bone arthritis.

Finally, lifestyle conditions such as obesity and diabetes make someone more susceptible to early arthritis. How these lifestyle changes cause arthritis is unknown,  but it might be related to a high level of inflammation in the body.

Symptoms of ankle arthritis  

ankle arthritis

Usually, arthritis causes pain around the ankle joint. This pain is worse with activity and better with rest. In general, anti-inflammatory tablets such as ibuprofen help. Other symptoms include ankle stiffness, swelling, deformity, or giving way.

Weight-bearing X-ray or standing CT usually confirms the diagnosis. However, MRI might be helpful in some cases if the X-ray is normal.

Also, other causes of ankle pain need to be ruled out. Examples include a stress fracture or a tumour.

Ankle arthritis treatment, including an ankle injection

Overall, we should try simple remedies first. These treatments include:

  • activity modification
  • Exercise therapy to strengthen the calf and small muscles of the foot
  • orthotics to reduce the load on the arthritic joint
  • Anti-inflammatory tablets such as ibuprofen

Finally, we use an ankle injection to decrease pain and improve function. 

More on an ankle injection

In general, options for pain relief injections for the ankle include cortisone, hyaluronic acid, and platelet-rich plasma.

Cortisone is a potent anti-inflammatory that effectively reduces pain in the short term. However, steroid injection in the ankle joint only lasts a few months. Also, a steroid injection in the ankle joint has side effects if used excessively. Finally, it would be best to have the injection done with ultrasound to improve accuracy and effectiveness.

Hyaluronic acid injections for ankle arthritis

Hyaluronic acid is a naturally occurring substance in bones, ligaments, and joints. Gel injections for the ankle act as a lubricant and can reduce inflammation and pain. Unlike cortisone, hyaluronic acid injections last longer. We also think hyaluronic acid protects the joint. 

We suggest using a high-molecular-weight hyaluronic acid such as Durolane for ankle arthritis. 

Platelet-rich plasma injections for ankle arthritis 

 

platelet-rich plasma

Platelet-rich plasma comes from whole blood, which is spun in a centrifuge. The plasma is then separated from the cells and injected into a joint. We think PRP reduces pain in arthritis, but good evidence is found only in knee arthritis. We still do not have evidence for PRP injection ankle arthritis. A recent study suggested PRP was not effective for ankle joint arthritis. Fifty-two-week follow-up found no difference between PRP and placebo.

Generally, we recommend an ultrasound-guided injection to improve accuracy and effect.

Cortisone shot for sprained ankle: Is it an option?

Yes. A sprained ankle can lead to swelling and inflammation in the ankle joint. Despite medication and physiotherapy, persistent swelling can lead to ongoing pain and reduced ankle function.

Generally, a cortisone shot for a sprained ankle is done with imaging to improve accuracy and direct the cortisone into the area of inflammation.

In one study, a cortisone shot effectively reduced pain, improved function and reduced the need for surgery.

Surgery vs. ankle injection 

We should only consider surgery when simple treatments and injection therapy fail. Options include ankle arthroscopy, ankle fusion, or ankle joint replacement. There is much debate about whether ankle joint replacement is better than ankle fusion. 

Other frequently asked questions on ankle injections: 

Can I drive home after an ankle joint injection?

We suggest you avoid driving immediately after an ankle joint injection. However, most people can drive the day after, although you may be a little sore. 

Other specific foot and ankle conditions: 

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.