Ankle & Lower Leg

What It Is

Ankle osteoarthritis is a condition in which the cartilage in the ankle joint gradually wears away. In the ankle, it most often develops after an earlier injury, such as a fracture or repeated sprains; this is called post-traumatic arthritis. Osteoarthritis that develops without a known injury is much less common in the ankle (Valderrabano et al., 2009). Arthritis after an injury can develop many years later (AAOS, n.d.). Whatever the cause, it can become painful, so it is worth getting it assessed.

Ankle Osteoarthritis Anatomy

Osteoarthritis is a common problem, and it becomes more likely with age and after joint injuries (NHS, 2023). The ends of the bones are covered with a smooth, slippery cartilage that helps them glide over each other. In osteoarthritis, this cartilage gradually wears away and becomes frayed and rough, and painful bone spurs can form. The condition progresses slowly, and the pain and stiffness can get worse over time (AAOS, n.d.).

Three bones make up the ankle joint itself. The foot as a whole has 28 bones and more than 30 joints (AAOS, n.d.). Ligaments keep the joints and bones in place. If arthritis develops in one or more of these joints, walking and balance can be affected.

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Ankle Osteoarthritis

Whether your ankle osteoarthritis followed an injury or developed for no obvious reason, it is treated in similar ways. If you have not yet seen a doctor, the most common symptoms are pain and stiffness in the ankle. You may find it harder to move your ankle as you normally would, and you may also have some swelling (NHS, 2023).

Fortunately, there are many treatment options that do not require surgery.

1. Nonsurgical Treatment

Specific exercises can help increase range of motion and flexibility and strengthen the muscles in your foot and ankle (AAOS, n.d.; NICE, 2022). I can build an exercise programme that suits you, alongside hands-on work to ease stiffness and advice on footwear and activity. See the My Approach tab for how I work.

The core treatments for osteoarthritis are therapeutic exercise and, if you are overweight, weight loss (NICE, 2022). Common nonsurgical options are:

Weight control: losing weight if you are overweight reduces the stress on your joints, which can mean less pain and better function (AAOS, n.d.; NICE, 2022).
A walking stick to help with stability and take some of the pressure off the ankle (NICE, 2022).
Suitable footwear (NHS, 2023).
Pain relief: the AAOS says anti-inflammatory medicines (NSAIDs) such as ibuprofen and naproxen can help reduce swelling and relieve pain (AAOS, n.d.). (This medicine information comes from the American Academy of Orthopaedic Surgeons (OrthoInfo), not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)
Shoe inserts, specialist shoes (such as stiff-soled shoes with a rocker bottom) or an ankle-foot brace may help some people (AAOS, n.d.). NICE advises that insoles and braces should not be offered routinely, only when the joint is unstable or loaded abnormally and exercise alone is not enough (NICE, 2022). I can help you work out whether one of these might help you and how to get it, and point you to a chiropodist or podiatrist if you need a custom orthotic.
Physical therapy or podiatry can assess the problems in your foot and ankle and guide your exercise programme. I can also assess your foot and ankle and guide your exercises.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Steroid (cortisone) injection: a medicine injected into the joint that can relieve pain, although the effect is usually temporary (AAOS, n.d.; NICE, 2022).
Ankle fusion (arthrodesis): an operation that joins the bones of the ankle permanently so the painful joint no longer moves (AAOS, n.d.).
Total ankle replacement: an operation that replaces the damaged joint surfaces with metal or plastic parts (AAOS, n.d.).

If you have surgery, follow your surgical team's own instructions for recovery.

How I can help (see the My Approach tab)

An exercise programme to keep the ankle moving and build strength and balance
Hands-on work and gentle joint mobilisation to ease stiffness
Footwear, brace and activity advice
Support with your rehabilitation after surgery, once your surgeon clears you

Tips

If you notice any swelling of the foot and ankle, have it examined by a medical professional for an accurate diagnosis.
Stiffness and reduced movement may be a sign of arthritis in the joints.
See your family doctor or nurse practitioner if you have pain or stiffness that does not go away (NHS, 2023). Difficulty walking because of pain, swelling or stiffness is not normal and should be looked at to find the cause.
Staying active is an important part of managing osteoarthritis (NICE, 2022). If a particular activity makes your pain worse, talk to me about how to adjust it rather than stopping exercise altogether.
I can check your footwear to see if changes would help.
Recovery after ankle surgery can take months, so be realistic about your rehabilitation and work with your physiotherapist or with me right to the end of your recovery.

Treatment

My Approach

Ankle osteoarthritis is a long-term condition, so I treat it as ongoing care rather than a quick fix. My aim is to ease pain and stiffness, keep your ankle and foot moving, and build the strength and balance around them so walking feels easier day to day.

I start by assessing how your ankle, foot and big toe move, the strength of your calf and lower leg, your balance and the way you walk. I also ask about old injuries, your footwear and what you'd like to get back to doing.

When It's Flared

Gentle movement to keep the joint going, rather than stopping altogether
Very gentle joint oscillations and soothing massage to calm things down
Cool applications in the clinic for a hot, swollen joint, and I'll show you how to use ice safely at home
Gentle lymphatic drainage if the ankle is swollen
Pacing your day and adjusting the activities that flare it

As It Settles

Warmth first, then hands-on work for the calf, shin and foot muscles, including trigger point and myofascial work
Mobilising stiff joints of the ankle, back of the foot and toes within a comfortable range, including getting the big toe bending back so you can push off
Calf stretching and assisted ankle bending, such as a belt-guided lunge
Strengthening from gentle, pain-free holds to fuller movement and standing work such as heel raises
Balance practice, holding on if falls are a worry
A home programme to do between visits

For fitness, low-impact options like swimming, water exercise, cycling or walking usually suit a sore ankle better than jumping, hopping or jogging. I'll also look at your footwear, help you work out whether a shoe insert, rocker-soled shoe or brace might help and how to get one, and point you to a chiropodist or podiatrist if you need a custom orthotic.

If you've had an ankle fusion or replacement, I need your surgeon's okay before hands-on treatment, and then I work within their limits.

If the ankle stays painful despite consistent care, injections or a surgical opinion are things to discuss with your family doctor or nurse practitioner, and I'm happy to work alongside that.

What to Expect

Typical Course

Typical course: Early on, most people come weekly, or twice a week if it's flared, then every two weeks with a reassessment at about 6 weeks, and later every few weeks to a month as you manage more on your own. Osteoarthritis is long-term, so the aim is steady improvement: most people notice less pain and stiffness and easier walking within about 6 to 12 weeks of regular exercise, and keeping the exercise going helps hold those gains.

What I Focus On

Assessment

Joint Mobilisation

Calf & Foot Release

Strength & Balance

Footwear & Low-Impact Fitness

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Arthritis of the foot and ankle. OrthoInfo. Available at: https://www.orthoinfo.org/diseases--conditions/arthritis-of-the-foot-and-ankle/ (Accessed: 7 October 2026).
National Institute for Health and Care Excellence (2022) Osteoarthritis in over 16s: diagnosis and management (NICE guideline NG226). Available at: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations (Accessed: 7 October 2026).
NHS (2023) Osteoarthritis. Available at: https://www.nhs.uk/conditions/osteoarthritis/ (Accessed: 7 October 2026).
Valderrabano, V., Horisberger, M., Russell, I., Dougall, H. and Hintermann, B. (2009) 'Etiology of ankle osteoarthritis', Clinical Orthopaedics and Related Research, 467(7), pp. 1800–1806. doi: 10.1007/s11999-008-0543-6

Massage therapy · Kitchener–WaterlooAnkle Osteoarthritis

What It Is

Ankle Osteoarthritis Anatomy

Self-Care & Treatment

How to Treat Ankle Osteoarthritis

1. Nonsurgical Treatment

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Flared

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooAnkle Osteoarthritis

What It Is

Ankle Osteoarthritis Anatomy

Self-Care & Treatment

How to Treat Ankle Osteoarthritis

1. Nonsurgical Treatment

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Flared

As It Settles

Typical Course

References

Related Conditions

Chronic Ankle Instability

Compartment Syndrome - Chronic

Ankle Impingement (Anterior)

Ankle Pronation (Overpronation)

Book a session