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Ankle osteoarthritis



AO is a degenerative joint disease that primarily affects the tibiotalar joint, leading to pain and disability.
The pathophysiology of AO involves the degeneration of articular cartilage. This degeneration leads to bone-on-bone contact, causing pain and stiffness. Additionally, changes in the subchondral bone have been implicated in the progression of OA. The disease also involves the synovium and joint capsules, leading to inflammation and further joint damage.
The prevalence of AO is estimated at 30 per 100,000 person-years.
Disease course
Clinically, patients with AO typically present with pain, stiffness, and swelling in the affected joint. These symptoms often lead to functional limitations, such as difficulty walking or performing other weight-bearing activities.
Prognosis and risk of recurrence
The prognosis of AO is generally progressive, leading to chronic pain and functional impairment. While interventions such as intra-articular corticosteroid injections and a multimodal approach for pharmacological management can provide short-term benefits, advanced cases may require surgical interventions such as total ankle replacement.


Key sources

The following summarized guidelines for the evaluation and management of ankle osteoarthritis are prepared by our editorial team based on guidelines from the American College of Foot and Ankle Surgeons (ACFAS 2020), the American College of Radiology (ACR 2020), the American Academy of Family Physicians (AAFP 2018), the European League Against Rheumatism (EULAR 2018,2017), and the National Institute for Health ...
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Diagnostic investigations

History and physical examination: as per ACFAS 2020 guidelines, assess for instability and alignment in patients with ankle arthritis.
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  • Diagnostic imaging

Medical management

Management of pain, nonpharmacological measures: as per EULAR 2018 guidelines, offer a personalized management plan with the aim of reducing pain and pain-related distress and improving pain-related function and participation in daily life, guided by shared decision-making, the expressed needs of the patient, clinical assessment, and evidence-based treatment options.
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  • Management of pain (pharmacotherapy)

Nonpharmacologic interventions

Physical therapy: as per ACFAS 2020 guidelines, consider offering physical therapy for the treatment of ankle arthritis.

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  • Shoe modifications

  • Bracing and casting

  • Supplements

Therapeutic procedures

Intra-articular injections: as per ACFAS 2020 guidelines, consider administering intra-articular injections of corticosteroids or nonsteroidal agents as an option for the treatment of patients with ankle arthritis.

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  • Biological resurfacing

Surgical interventions

Indications for surgery: as per ACFAS 2020 guidelines, consider offering periarticular ankle realignment osteotomy to relieve symptoms of ankle arthritis.
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Follow-up and surveillance

Serial imaging assessment: as per EULAR 2017 guidelines, do not obtain routine follow-up imaging in patients with OA unless unexpected rapid progression of symptoms or change in clinical characteristics occurs.