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Ankle Osteoarthritis

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Other Names

  • Osteoarthritis of the ankle
  • Degenerative joint disease (DJD) of the ankle
  • Tibiotalar Osteoarthritis
  • Fibulotalar Osteoarthritis
  • Ankle Arthritis


  • This page refers to osteoarthritis (OA) of the Ankle Joint
    • Herein referred to as 'Ankle OA'



  • Approximately 1% of the adult population have ankle OA[1]


  • Osteoarthritis (Main)
    • Progressive, degenerative condition
    • Result of loss of articular cartilage
    • Typically becomes more severe, frequent, and debilitating over time


  • Primary Ankle OA [1]
  • Secondary Ankle OA
    • Rheumatoid Arthritis
    • Hemochromatosis
    • Hemophilia
    • Clubfoot
    • Avascular talus necrosis
    • Osteochondrosis dissecans
    • Post infectious arthritis
  • Posttraumatic Ankle OA (most common)
    • Ankle ligament lesions
    • Tibial plafond fracture
    • Tibial shaft fracture
    • Talus fractur
    • Varus ankle alignment

Associated Conditions

  • See secondary OA above


  • Ankle (talocrural) joint is formed by articulations of

Risk Factors

  • Older Age

Differential Diagnosis

Clinical Features



  • Standard Radiographs Ankle
    • All views must be weight-bearing
    • AP view
    • Lateral view of the foot
    • Mortise view of the ankle
    • Saltzman view of the hindfoot



  • Used to evaluate cartilage and periarticular soft tissues and tendons around the ankle joint


  • Single-photon emission computed tomography/computed tomography (SPECT-CT) [2]
    • Used to evaluate degenerative changes and their biological activities
    • Helps assess other osteoarthritic changes in other nearby bone


  • Grading System by Giannini [3]
    • Stage 0 - Normal joint or subchondral sclerosis
    • Stage 1 - Presence of osteophytes without joint-space narrowing
    • Stage 2 - Joint-space narrowing with or without osteophytes
    • Stage 3 - Subtotal or total disappearance or deformation of joint space
  • Grading System by Cheng (Based on Weight-Bearing Radiographs) [4]
    • Stage 0
      • No reduction of the joint space
      • Normal alignment
    • Stage 1
      • Slight reduction of the joint space
      • Slight formation of deposits at the joint margins
      • Normal alignment
    • Stage 2
      • More pronounced change than mentioned above
      • Subchondral osseous sclerotic configuration
      • Mild malalignment
    • Stage 3
      • Joint space reduced to about half the height of the uninjured side
      • Rather pronounced formation of deposits
      • Obvious varus or valgus alignment
    • Stage 4
      • Joint space has completely or practically disappeared





Rehab and Return to Play


Return to Play


  • Chronic Pain

See Also


  1. 1.0 1.1 Valderrabano V, Horisberger M, Russell I, Dougall H, Hintermann B. Etiology of ankle osteoarthritis. Clin Orthop Relat Res. 2009;467(7):1800-1806. doi:10.1007/s11999-008-0543-6
  2. Barg A, Pagenstert GI, Hügle T, et al. Ankle osteoarthritis: etiology, diagnostics, and classification. Foot Ankle Clin. 2013;18(3):411-426. doi:10.1016/j.fcl.2013.06.001
  3. Giannini S, Buda R, Faldini C, et al. The treatment of severe posttraumatic arthritis of the ankle joint. J Bone Joint Surg Am 2007;89 Suppl 3:15.
  4. Cheng YM, Huang PJ, Hong SH, et al. Low tibial osteotomy for moderate ankle arthritis. Arch Orthop Trauma Surg 2001;121(6):355
Created by:
John Kiel on 7 July 2019 08:08:56
Last edited:
3 October 2022 23:47:36