When lifestyle changes are not enough, non-surgical medical interventions can help ease the symptoms of ankle arthritis.
Cushioning shoe inserts can reduce the pressure put on the ankle joint when walking as well as discourage ankle rolling. A doctor can recommend appropriate premade inserts or custom inserts. A doctor may also recommend “rocker” shoes, which have soles rounded from front to back. The rounded soles require less flexion of the ankle while walking; however, some people find rocker soles difficult to get used to and are less stable wearing them.1
Orthopedic Supportive Devices (Orthotic Devices)
Certain orthopedic products may be used to help stabilize or take pressure off the ankle. Some examples include:
- Elastic braces that wrap around the ankle and foot, providing more ankle support.
- A hard plastic brace that wraps around the back of the ankle and bottom of the foot, limiting ankle mobility and reducing pain.
- A cane (used on the opposite side of the affected ankle) or a walker may be necessary for people with end-stage ankle arthritis.
A physical therapist can teach an ankle osteoarthritis patient specific exercises to stretch the ankle joint’s soft-tissues and build surrounding muscles, thereby increasing the support strength of the joint and making it less prone to further cartilage loss. In contrast to treatment for hip osteoarthritis and knee osteoarthritis, which emphasizes physical therapy, little has been written regarding physical therapy for ankle arthritis. Generally speaking, a physical therapy program to treat ankle arthritis should progress gradually and take into account the patient’s specific needs and co-existing conditions.
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The medications listed below can be used to alleviate symptoms and slow the progression of ankle osteoarthritis. Doctor and patient should discuss medication in the context of the patient’s lifestyle, severity of pain and medical history. Potential side effects and interaction with other drugs and vitamins/supplements should also be considered.
- Oral analgesics. Pain relievers, such as acetaminophen (e.g., the active ingredient in Tylenol) have relatively few side effects and relieve pain.
- Oral non-steroidal anti-inflammatory drugs (NSAIDs). Anti-inflammatory medications, such as aspirin, ibuprofen (e.g., Advil), naproxen (e.g., Aleve), or cox-2 inhibitors (e.g., Celebrex) may reduce pain, swelling, and inflammation caused by ankle osteoarthritis.
- Topical medications. Topical medications come in the form of creams, sprays, gels and patches and are applied directly to the skin over the painful joint.
Topical analgesics. The creams contain counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from joint pain. These creams are often sold over the counter and are available in most drug stores. Examples of brand names include Ben-Gay, Icy-Hot and Zostrix. Most can be used in combination with oral pain medications.
Topical non-steroidal anti-inflammatory drugs (NSAIDs). Research shows topical medications containing the NSAID diclofenac may relieve isolated pain due to knee and hand osteoarthritis.2 Like topical analgesics, topical NSAID creams should be applied directly to the painful ankle. Topical NSAIDs are sold under the names Voltaren, Flector, Pennsaid, and Solaraze and require a prescription.
Lidocaine patches. Adhesive patches containing 5% lidocaine can be applied directly to the arthritic ankle and may reduce or alleviate osteoarthritis pain.3 Lidocaine is a topical numbing agent that interrupts pain signals to the brain. These patches are available only with a prescription.
Topical medications may be a good choice for people who want to minimize the gastrointestinal side effects sometimes caused by oral medications. However, side effects are still possible. Patients should always discuss new medications with their doctor or pharmacist and read drug labels and instructions.
For some patients, lifestyle changes and medical treatments listed above may not be enough, and injections may be considered.