Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Understanding Ankle Arthritis

Ankle arthritis is the progressive loss of the cartilage that cushions the ankle (tibiotalar) joint — the joint between the shin bone (tibia) and the talus bone of the foot. Unlike hip and knee arthritis, which is primarily degenerative (wear-and-tear), ankle arthritis is most commonly post-traumatic — developing years after ankle fractures or severe ligament injuries. Only about 10% of ankle arthritis is primary osteoarthritis without prior injury.

At Balance Foot & Ankle in Howell and Bloomfield Township, Michigan, our goal with ankle arthritis is maximum longevity of the native joint — keeping you active and out of the operating room for as long as possible.

Symptoms of Ankle Arthritis

• Deep ankle pain with weight-bearing activity — walking, climbing stairs, uneven ground
• Morning stiffness that eases after 15–30 minutes of movement
• Swelling around the ankle joint, especially after activity
• Grinding or crunching sensation (crepitus) with ankle movement
• Decreased ankle range of motion over time
• The ankle may feel more stable in some positions than others

Conservative Treatment: What the Evidence Supports

Activity Modification

High-impact activities (running, jumping, sports with cutting movements) accelerate cartilage loss and increase pain. Transitioning to lower-impact activities — swimming, cycling, elliptical — maintains cardiovascular fitness and lower extremity strength without destructive joint loading. This is not “giving up” — it’s strategic management.

Footwear and Bracing

An ankle-foot orthosis (AFO) or a rigid carbon fiber ankle brace limits painful end-range motion, reduces joint loading, and allows significantly longer comfortable walking distances. Rocker-bottom shoes reduce the peak ankle moment during push-off. Many patients manage ankle arthritis exclusively with appropriate bracing and footwear for years.

Intra-Articular Corticosteroid Injections

Fluoroscopy or ultrasound-guided corticosteroid injection into the ankle joint provides short-to-medium term pain relief (weeks to months). Most useful for flares of inflammation. Repeated injections are limited to 3–4 per year to avoid accelerating cartilage loss.

Viscosupplementation (Hyaluronic Acid)

Hyaluronic acid injections into the ankle joint are used for lubrication and mild anti-inflammatory effects. Evidence for the ankle is more limited than for the knee, but many patients report meaningful relief. A series of 3 injections is typically tried.

Platelet-Rich Plasma (PRP)

PRP injections deliver concentrated growth factors from the patient’s own blood to stimulate cartilage healing and reduce inflammation. Evidence in ankle arthritis is growing and results are generally positive. May provide more sustained relief than cortisone in appropriate candidates.

Physical Therapy

Strengthening the muscles around the ankle (peroneal muscles, anterior tibialis, posterior tibialis, and calf) reduces the load the joint itself must bear. Aquatic therapy is particularly effective — allowing strengthening without joint compression. Core and hip strengthening improves gait mechanics and reduces ankle load.

Weight Management

Each pound of body weight translates to approximately 3–5 pounds of force at the ankle during walking. Weight loss is one of the highest-impact interventions for joint pain relief.

When Surgery Becomes Necessary

Conservative care eventually fails to provide adequate function in severe ankle arthritis. Surgical options include:

• Ankle arthroscopy: For early arthritis — removal of loose bodies, bone spurs, and inflamed tissue
• Total ankle replacement (TAR): Resurfaces the joint with metal and polyethylene components, preserving motion. Best for older, lower-demand patients with adequate bone stock and good ankle alignment. 10-year implant survival approximately 80–85%.
• Ankle arthrodesis (fusion): Fuses the tibia and talus together, eliminating the painful joint entirely. Most durable surgical option; trade-off is permanent loss of ankle motion (partially compensated by adjacent joints). Highly effective for pain relief.

Ankle Arthritis in Michigan: A Special Consideration

Michigan winters create challenging terrain — ice, uneven sidewalks, and restricted activity. Our podiatrists help patients optimize their non-surgical management to navigate all four seasons comfortably, and provide surgical planning that accounts for each patient’s specific activity goals, bone quality, and post-traumatic ankle anatomy.

Start Conservative, Stay Conservative as Long as It Works

No surgery perfectly replicates a healthy ankle joint. The goal at Balance Foot & Ankle is to keep your native ankle working and comfortable for as long as possible through evidence-based conservative management — and to ensure that if surgery becomes necessary, you’re making an informed, prepared decision with a surgeon you trust.

Foot or Ankle Pain? We Can Help.

Balance Foot & Ankle — Howell & Bloomfield Township, MI

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📞 (810) 206-1402

When to See a Podiatrist for Ankle Arthritis

Ankle arthritis does not always require fusion surgery. Dr. Tom Biernacki at Balance Foot & Ankle offers a range of conservative and surgical options to manage ankle arthritis pain and maintain as much mobility as possible.

Learn About Our Ankle Pain Treatment Options | Book Your Appointment | Call (810) 206-1402

Clinical References

1. Thomas RH, Daniels TR. “Ankle arthritis: nonoperative treatment.” Foot and Ankle Clinics. 2003;8(2):215-229.
2. Barg A, et al. “Ankle osteoarthritis: etiology, diagnostics, and classification.” Foot and Ankle Clinics. 2013;18(3):411-426.
3. Saltzman CL, et al. “Impact of ankle osteoarthritis on function.” Foot and Ankle International. 2006;27(4):274-280.

Dr. Tom Biernacki, DPM

Affiliate Disclosure: This page contains affiliate links to products we recommend. If you purchase through these links, Balance Foot & Ankle may earn a small commission at no additional cost to you. We only recommend products we use with our patients.

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.