Ankle Arthritis

What ankle arthritis is

The ankle joint works because the ends of the tibia and talus are coated in smooth cartilage. When that cartilage wears down — most often after a fracture or repeated sprains that changed how the joint loads, and sometimes from inflammatory disease or wear alone — the joint becomes painful, swollen, and stiff. Unlike hip and knee arthritis, ankle arthritis is frequently post-traumatic, and it often affects people who were injured young and stayed active on the joint for years afterward.

Symptoms to watch for

• Deep aching pain in the ankle, worse with activity and weight-bearing
• Swelling around the joint, especially after being on your feet
• Stiffness and a shrinking range of motion — hills and stairs get harder
• Pain that lingers after an old ankle injury never quite resolved

How it is evaluated

Evaluation combines your history — especially prior fractures and sprains — a hands-on exam of motion, alignment, and stability, and weight-bearing X-rays, with advanced imaging when the pattern needs more detail. Alignment matters as much as cartilage: a joint wearing unevenly because the foot rolls in or out is planned for differently than one wearing evenly.

Non-surgical options first

Many ankles are managed well without surgery, sometimes for a long time. Depending on your exam and imaging, that can include:

• Activity modification — keeping fitness while reducing the loads that provoke the joint
• Supportive, stiff-soled or rocker-bottom footwear
• Bracing to support the joint and correct mild malalignment
• Physical therapy for strength, balance, and gait
• Other non-surgical measures Dr. Bourke discusses with you based on your joint and medical history

The honest test is function: if these measures keep you doing what matters to you, surgery can wait.

When surgery enters the conversation

Surgery is considered when pain persists despite a genuine non-surgical program and starts dictating your life — limiting work, exercise, or sleep. The surgical spectrum is chosen by how much healthy cartilage remains, your alignment, and your goals:

• Joint-preserving procedures — for earlier or uneven wear, options aimed at cleaning up the joint or realigning load away from the damaged area, where the joint can still be saved
• Total ankle replacement — for end-stage arthritis in suitable candidates, replacing the joint to relieve pain while preserving motion
• Ankle fusion — joining the bones to eliminate painful motion, still the right answer for some patients, particularly with severe deformity, bone loss, or certain high-demand situations

No option is presented as a guarantee. Each has trade-offs, and you will hear them applied to your imaging in plain language before deciding.

Recovery and return to activity

If surgery is part of your plan, recovery is staged around healing and rehabilitation milestones rather than a promised date — protection first, then progressive therapy for motion, strength, and gait. As a former Division I cross-country and track athlete who still races, Dr. Bourke plans return to activity — including what running or higher-impact activity is realistic for your joint and procedure — around what you actually do, not a generic handout.

For referring physicians

Referrals are welcome for ankle arthritis at any stage: post-traumatic arthritis, arthritis with deformity or instability, and patients weighing replacement against fusion. Dr. Bourke’s fellowship training is in reconstructive foot and ankle surgery and trauma. Patients can be directed to call The Orthopedic Group at (703) 777-3262; prior imaging and operative reports are helpful at the first visit.

When to seek a second opinion

Get a second look if you have been told nothing more can be done, if only one surgical option was offered without discussion of the alternatives, if your arthritis follows a fracture, or if a prior ankle surgery has left you with progressive pain. Bring your imaging and records — second opinions and complex reconstruction are a core referral focus of this practice.