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Practice Practice Pointer

Assessment and management of ankle osteoarthritis in primary care

BMJ 2023; 380 doi: (Published 04 January 2023) Cite this as: BMJ 2023;380:e070573
  1. Luke V McCarron, medical student1,
  2. Muntadhir Al-Uzri, orthopaedic registrar2,
  3. Angela M Loftus, general practitioner3,
  4. Annie Hollville, patient author,
  5. Michael Barrett, orthopaedic consultant2
  1. 1School of Clinical Medicine, University of Cambridge, UK
  2. 2Department of Trauma and Orthopaedics, Cambridge University Hospitals, UK
  3. 3Aberfoyle Medical Practice, Northern Ireland
  1. Correspondence to: L V McCarron lm768{at}

What you need to know

  • Ankle arthritis has multiple causes, but osteoarthritis is the most common, and is post-traumatic in most cases

  • Manage patients with ankle osteoarthritis in primary care initially using similar measures to those with hip or knee osteoarthritis—such as analgesia, weight management, and physiotherapy

  • Referral for orthopaedic assessment is appropriate for ankle osteoarthritis that is refractory to medical management, has reached end stage disease, or has a severe impact on quality of life

A 64 year old woman presents with a four month history of progressive ankle pain associated with reduced mobility. She complains that these symptoms are particularly severe after weight-bearing activities.

Joint pain and disability arising from osteoarthritis affects 15% of the world’s population.1 This typically occurs in the knee and hip. Knee osteoarthritis, for example, is eight to nine times more common than ankle osteoarthritis2; high tensile strength of cartilage in the ankle protects the joint from degeneration. The ankle joint is a complex structure of the tibia and talus (talocrural) joint alongside a fibrous tibia-fibula joint. Based on radiological findings, it is estimated that 3.4% of the world’s adult population is affected by ankle osteoarthritis.3 However, ankle pain can be a diagnostic challenge. Ankle osteoarthritis occurs most often secondary to trauma—post-traumatic ankle osteoarthritis.4

In this article we outline the clinical assessment, diagnosis, and management of ankle osteoarthritis in primary care. Although we focus on clinical features of ankle osteoarthritis, other causes and features of ankle arthritis are listed in table 1. In addition, we provide guidance on when referral to an orthopaedic specialist may be of most benefit and what surgical options may be offered.

View this table:
Table 1

Causes of ankle arthritis56

Assessment and diagnosis

Ankle osteoarthritis is diagnosed in a patient with ankle pain and supporting clinical features in the presence of radiographic evidence of …

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