Ankle Arthritis FAQs: Treatment Questions Answered

Unlike knee and hip arthritis, which usually develop from age-related wear and tear, ankle arthritis is most commonly caused by previous injuries. About 70-80% of ankle OA cases are post-traumatic, resulting from fractures, severe sprains, or ligament damage. This means ankle arthritis often affects younger people who had ankle injuries years or decades earlier. The ankle joint also has unique cartilage properties—thinner but initially more resistant to wear than knee cartilage.

Hyaluronic acid injections are NOT FDA-approved for the ankle joint. Any use in the ankle is considered off-label. Research on HA for ankle OA shows mixed results—some studies suggest modest benefit while others show little advantage over placebo. Because of the off-label status, some insurance plans may not cover ankle gel injections. If your doctor recommends them, discuss the limited evidence, realistic expectations, and coverage issues before proceeding.

Recent high-quality research suggests PRP is not effective for ankle osteoarthritis. The PRIMA trial, a well-designed randomized controlled study, found that PRP injections showed no significant advantage over saline placebo injections for ankle OA. Both groups improved similarly, suggesting the benefits patients experience may come from the injection procedure itself or placebo effects rather than the PRP. Based on current evidence, PRP for ankle arthritis is not strongly recommended.

Yes, corticosteroid (cortisone) injections are an effective treatment option for ankle osteoarthritis. They provide anti-inflammatory relief that typically lasts 6 weeks to 3 months. Cortisone is particularly useful for managing flare-ups or as a bridge while pursuing other treatments. However, repeated injections may become less effective over time, and most doctors limit them to 3-4 per year to protect cartilage and surrounding tissues.

The choice between fusion (arthrodesis) and total ankle replacement depends on several factors. Fusion eliminates ankle motion but provides very reliable, durable pain relief—often preferred for younger, active patients or those with significant deformity. Replacement preserves motion and protects adjacent joints but may need revision surgery later and has higher complication rates. Your age, activity level, bone quality, deformity severity, and personal preferences all factor into this decision. Discuss both options thoroughly with an orthopedic surgeon who specializes in foot and ankle conditions.

Post-traumatic arthritis develops after an injury to the ankle joint. This is the most common type of ankle arthritis, accounting for 70-80% of cases. Common causes include ankle fractures (especially those involving the joint surface), severe sprains, chronic ankle instability, and osteochondral lesions (damage to cartilage and underlying bone). Arthritis may develop months to decades after the original injury. The damaged cartilage gradually wears away, leading to pain, stiffness, and progressive joint degeneration.

First-line conservative treatments include physical therapy to strengthen muscles and improve balance, bracing or ankle supports to provide stability, custom orthotics to improve alignment, rocker-bottom shoes to reduce ankle motion during walking, weight management to decrease joint stress, and activity modification to avoid high-impact activities. Anti-inflammatory medications (oral or topical) can help manage pain and swelling. Many patients achieve significant symptom improvement with these approaches before considering surgery.

Surgery is typically considered when conservative treatments—physical therapy, bracing, injections, medications, and activity modification—no longer provide adequate pain relief for daily activities. Signs that surgery may be appropriate include pain that significantly limits walking or standing, inability to perform work or desired activities, pain at rest or at night, and failure of multiple conservative treatments over 6-12 months. Imaging should also show significant joint damage. Most surgeons recommend exhausting non-surgical options before proceeding to fusion or replacement.

Medicare Part B typically covers medically necessary treatments for ankle arthritis including doctor visits, physical therapy, X-rays and imaging, corticosteroid injections, and surgical procedures when indicated. However, coverage for hyaluronic acid injections in the ankle may be limited or denied because this use is off-label (not FDA-approved for ankle). PRP is generally not covered by Medicare. Always verify coverage with your specific plan before treatment, especially for injection therapies.

Yes, bracing is often very effective for ankle arthritis. Ankle braces and supports work by limiting painful motion, providing stability to an unstable joint, and distributing weight-bearing forces more evenly. Options range from simple lace-up braces to rigid ankle-foot orthoses (AFOs) depending on severity. Custom orthotics and rocker-bottom shoes can also help by changing how forces travel through the ankle during walking. A physical therapist or orthotist can help determine which type of brace is most appropriate for your condition.