Lateral Ankle Arthritis

Your ankle joint, medically known as the talocrural joint, consists of the tibia, the fibula and the talus, as illustrated. The ankle joint is a synovial hinge joint, playing an important role in permitting the toes to move from point up (dorsiflexion) to pointing down (plantarflexion). When the cartilage that lines the bones of the ankle breaks down and degenerates, damaging the bones, the ankle can become stiff, painful and restricted in its movement. This is what we refer to as ankle arthritis.

When the arthritic changes are located in the compartment on the outside of the ankle, particularly around the lateral malleolus of the fibula, this is known as lateral ankle arthritis. As ankle arthritis can also affect the integrity of the ligaments that support and stabilise the ankles, lateral ankle arthritis may also lead to damage or weakness of the lateral ankle ligaments: the anterior talofibular ligament, the calcaneofibular ligament, the posterior talofibular ligaments and the lateral talocalcaneal ligaments. Other talocalcaneal ligaments may also be involved.

The symptoms of lateral ankle arthritis depend on the cause and type of arthritis, but may include:

• Pain on the outside of the ankle that may increase with activity and weight-bearing, especially when the ankle is not supported with good footwear
• Pain that is exacerbated by inverting the ankle, which narrows the gap on the lateral ankle
• Stiffness and loss of mobility and flexibility of the ankle
• Swelling at the ankle joint
• Ankle deformity, where the integrity of the joint and bones degrades over time, causing a bulge on the outside of the ankle

Lateral ankle arthritis can have several causes that may alter the types of symptoms you experience and the progression of the disease. These include:

• Osteoarthritis: the ‘wear and tear’ arthritis where the cartilage breakdown is from mechanical factors (meaning from being used) over time.
• Rheumatoid arthritis: an autoimmune disease where the body’s own cells mistakenly attack the joints. Most cases of rheumatoid arthritis affect both feet and legs symmetrically in ‘flares’ or symptomatic episodes, and often other joints are also affected at the same time.
• Post-traumatic arthritis: arthritis can also occur following a previous ankle injury, such as a dislocation, fracture, ankle sprain or ankle ligament rupture. Specifically, an injured joint is about seven times more likely than an uninjured joint to become arthritic, even if the injury is properly treated.
• Infection in another area of your body can also spread and lead to arthritic changes in the ankle

Having arthritis is a long-term condition, and as such, it requires a long-term focused approach with commitments to a healthier lifestyle, instead of a quick and temporary fix. To support your foot and ankle health, mobility and manage your painful symptoms, you may try:

• Continuing to meet your recommended exercise guidelines. It’s common for those with arthritis to ‘slow down’, adapting a more sedentary lifestyle and wanting to avoid using the joints for the fear of further pain. In reality, exercise is proven to support the management of arthritis, improving mobility and pain levels. Gentle walking and swimming are both good, low-impact options.
• Maintaining a healthy diet: the food we consume contains the nutrients that are used by our body and our joints to support their health. Eating a nutrient-packed diet helps your body to best support your joint health.
• Keeping your feet supported in good shoes both indoors and outdoors. A good shoe has the ability to add stability and support to your ankle, helping you manage your symptoms and optimise your mobility. If you need recommendations on a new shoe that will be best for your feet, our podiatrists will gladly help and give you names and styles during your appointment.
• Using heat and ice therapy appropriately. Opt for ice when your ankles are swollen (acute symptoms), and heat when the joints feel tender and creaky (chronic symptoms).
• Epsom salt bath: these may help in managing pain associated with ankle arthritis
• Keeping up your physical therapy: if you’ve been prescribed strengthening or stretching exercises, continue to do these daily to best support your range of motion and foot health.
• For episodes of pain and swelling, non-steroidal anti-inflammatory medications (NSAIDs) may help to temporarily manage your symptoms.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with lateral ankle arthritis, and utilise a range of evidence-based treatment methods to help you get the best outcome for your ankle symptoms.

Every appointment starts with a comprehensive assessment to uncover the causes of your ankle pain and stiffness, including whether any other factors could be at play, like an ankle impingement that is contributing to the problem. We’ll then create a tailored treatment plan based on the results. While the degenerative changes sustained in lateral ankle arthritis are irreversible, there is a lot that can be done to help reduce your pain, improve your comfort, and optimise your mobility and quality of life. We may use:

• Orthotics (insoles): using the results of your assessment, our podiatrists can prescribe custom foot orthotics that will work to add the right support and stability to your ankles. Orthotics can support the lateral ankle in a range of ways. For some, this may look like high medial and lateral sides around your ankle (UCBL style), while for others this may involve extra poron padding and arch support to offload painful areas. 
• Footwear recommendations: your footwear plays a vital role in supporting your everyday comfort and health, as well as housing your orthotics, keeping your feet comfortable, and limiting further injury. This is why we make custom footwear recommendations and take the time to assess your footwear and answer all of your footwear-related questions.
• Brace prescription: we may prescribe an ankle brace or other assisted device to support your movement
• Ankle exercise prescription: we may prescribe some ankle exercises (depending on the severity and cause of your arthritis) to help promote ankle joint strength and mobility.
• Surgery referral: in severe cases, we may refer you to an orthopaedic surgeon to discuss your surgical treatment options, or other options like cortisone injections