Ankle arthritis is a common condition and this article should provide anyone suffering from painful stiff ankles an easy to follow guide to ankle exercises for arthritis.
Do you need to know about ankle exercises for arthritis?
This article will be of benefit to anybody suffering from arthritis of the ankle, or if they think they could have ankle arthritis prior to seeking professional help. The guide should be used as an overview of ankle exercises for arthritis and to support any manual therapy that might be undertaken to help manage this painful condition. Pain is a common feature of this condition but one of the major symptoms is the stiffness that accompanies the reduction in function in the joint.
What is ankle arthritis?
The ankle is a highly flexible joint that can bear an incredible amount of weight. Each step a person takes effectively puts up to 5 times that person’s body weight onto the ankle joint. Those suffering from ankle arthritis will experience pain, swelling, and stiffness in the joint after walking, jogging, or other similar activities. Sometimes even just waking up and beginning to move the joint can cause pain in the ankle joint and in the surrounding tissues.
Ankles are not as prone to arthritis as other joints in the body but when it does occur it’s because the patient has worn down the joint between the tibia and the talus. The tibia is the shin bone, while the talus makes up the upper part of the rearfoot and the lower part of the ankle joint.
What are the causes of ankle arthritis?
There are several factors that can contribute to the onset of ankle arthritis, such as:
- Prior injury to the ankle – The most common cause of ankle arthritis is from the previous injury to the ankle joint. Patients who have sustained an ankle fracture, for example, may find that they have damaged cartilage. If the cartilage is damaged, this can lead to what is known as accelerated arthritis. Osteonecrosis is also possible at this point and this happens when blood flow has been restricted. This, in turn, can lead to ankle arthritis.
- Patient weight – Larger burdens are placed on several joints the more a patient weighs. The main joints affected by excess body weight include the hips, knees, ankles, and also the feet. Extra weight can be a factor in patients developing arthritis and they will also often see accelerated cartilage damage in the joints.
- Rheumatoid arthritis (RA) – Rheumatoid disease and in particular RA can increase the likelihood of patients developing ankle arthritis. Inflammation of, and damage to, joint cartilage and synovial linings can lead to serious complications later which will need medical treatment.
- Infection – Joint infections can actually damage cartilage cells. Sadly, because cartilage cells cannot regrow, infections of the joint can lead to permanent damage and destruction of the articular cartilage.
How common is ankle arthritis?
When compared with instances of arthritis in other joints such as knee and hip, ankle arthritis is quite rare. While early degradation of the cartilage does occur, it rarely progresses to a more serious level. The ankle has a much smaller surface area of contact than hips or knees do, and this means that weight and pressure distribution are different. It is one of the differences between the ankle and other joints that lowers the rate at which arthritis develops when compared to other joints.
Ankles are prone to injury from rolling over (inversion injury) and trauma which makes the ankle a prime candidate for developing this condition.
Stages of ankle arthritis
There are three stages of ankle arthritis, with each stage increasing in severity compared with the stage before it.
Early-stage arthritis of the ankle
In the early stages of ankle arthritis, naturally occurring fluids are still flowing into the joint cavity and aiding the movement of the joint. Cartilage, however, has started to degrade, wear thin and bone spurs will start to form. Patients will find that ankle joints will start to feel uncomfortable, especially after extended periods of being stood or walking around. This is often a good time to start with ankle exercises for arthritis as it’s important to keep the joint mobile (within reason) and encourage pain-free movement where possible and prevent fibrosis or adhesion in the joint and joint capsule.
Mid-stage arthritis of the ankle
Ankle arthritis symptoms become harder to ignore. As the pain begins to worsen throughout the day, patients may also find that the joint gives way unexpectedly. Running, jogging, or even just walking for long periods can result in a lot of pain for the patient. There may also be some stiffness in the mornings. Cartilage continues to be worn down and the spaces between the bones that make up the ankle will begin to narrow. At this point, bones will thicken and spurs start appearing along the joint margins.
Late-stage arthritis of the ankle
At this point, joint cartilage is almost completely gone, with little space between joint bones which will limit the range of motion possible. The ankle joint will be stiff and some instances, completely immobile. Lubricating fluids that are normally present to aid movement are now gone or severely reduced. This means friction between bones is increased which will damage the bones and articular surfaces further. Walking or even simply moving the ankle joint now can cause large amounts of pain and ankle exercises for arthritis may actually be quite painful at this stage, so one must take care.
What are the symptoms of ankle arthritis?
The most common symptom of ankle arthritis is pain around the joint, and this is also the chief reason why people seek medical treatment rather than arthritis itself. Other symptoms of ankle arthritis can include:
- Stiffness of the ankle joint
- The area around the ankle joint swells
- The occurrence of bone spurs which give the joint a lumpy appearance
- Joint deformity
- Instability or giving way in the ankle joint
Although less common, nerve irritation can also occur which can cause tingling in the feet and toes. This is largely due to the position of the nerves as they cross over the ankle joint.
Imaging for ankle arthritis
X-ray imaging will be made use of in order to reach a clinical diagnosis. As X-ray allows you to clearly image bones and aspects of the joints (bony elements and alignment) it is a useful way of being able to quickly and cost-effectively image the joints. Compared with an x-ray of a healthy ankle, an image of the ankle that has developed arthritis will show several things. Spaces between joints are narrower, bone spurs are easily spotted along the joint, cartilage is thinner or in some cases gone entirely (although this is better imaged with MRI scanning). Imaging is an important aspect of prescribing ankle exercises for arthritis as this may affect the prescription of which exercises to be carried out.
Treatment options for ankle arthritis
Ankle arthritis can be treated in several ways, with treatment options falling into two camps: Surgical and nonsurgical. Nonsurgical options include:
- Steroid injections for the joints
- Anti-inflammatory medication to reduce joint swelling
- Painkillers
- Arch supports for the feet
- Braces which help support the joint
- Physical therapy
- Weight control / diet adjustments
- Ankle exercises for arthritis
Depending on the severity of the ankle arthritis, it may be recommended the patient undergoes a surgical option. Two of the surgical options available are:
Fusion – This surgical treatment method is also called arthrodesis. The process involves, as the name would suggest, fusing the bones together. This is done with the aid of screws, rods, or plates. Once the ankle has healed, the bones will remain fused.
Joint replacement – This type of treatment is rare since it is only used for the most extreme of cases. During this procedure, the ankle joint itself is completely replaced using artificial implants.
Ankle Exercises for Arthritis
Exercises can be divided into several stages this completely depends on the stage of arthritis and the tolerance of the patient to carry out ankle exercises for arthritis.
The stages of ankle exercises for arthritis can be divided into several stages.
Mobility ankle exercises for arthritis
Passive range of motion ankle exercises for arthritis
- Passive ROM ankle dorsiflexion-plantarflexion –
To perform this exercise you will need assistance. Lay on your back with both the knees straight. Now the assistant will perform an ankle movement himself. Directing the ankle upwards, towards you and then back in the opposite direction.
- Sitting, Long and short peroneus stretching in passive ankle plantarflexion and supination (inversion) (auto-assisted) –
To perform this exercise you will need assistance. Sit on a chair and place the injured leg over the good leg in a figure 4 position. Now the assistant will try to move your ankle downwards towards the floor, and at the same time to move the ankle joint outwards as shown in the video.
Sitting, Ankle Passive mobility with hands –
Sit on a chair and place both feet in front of you. Place your hand on the top part of the ankle and then move it inwards and outwards as far as you can move.
- Passive ROM ankle circumduction –
To perform this exercise you will need assistance. Lay on your back with both the knees straight. Now the assistant will perform an ankle movement himself. Directing the ankle in a circular motion. Performing this in both directions.
Active range of motion ankle exercises for arthritis
- Ankle dorsiflexion/plantarflexion AROM, on a table –
In long sitting on top of a table/bed or a plinth, place your ankles over the edge of the table. Now move the ankles upwards towards you and then downwards towards the floor.
- Active ankle range of motion in dorsiflexion –
Lay on your back and bend one knee and place it on the ground. Now try to bend your ankle upwards towards the ceiling and then back towards the floor.
- Long sitting ankle inversion/eversion –
In long sitting, place the injured foot straight in front of you. Now try to curl your foot inwards and then outwards. Making sure not to create the movement using your knees.
- Seated active ankle mobility (dorsiflexion, plantar flexion, eversion, inversion, circumduction) –
Lay on your back and place the injured leg in front of you with a straight knee. Now try to move your ankle upwards, downwards curling it in as well as out, and at the end perform circular motions of the ankle.
- Sitting, Ankle active dorsiflexion and plantarflexion with foot glide on the floor –
Sit on a chair and place both legs in front of you. Now try to move the affected ankle forwards, away from you and backward, towards the chair.
Strength ankle exercises for arthritis
- Seated isometric ankle eversion resisted with wall –
Sit on a chair (with the injured side closest to a wall. Now place a small pillow between the wall and your ankle. Now try to push your ankle outwards against the pillow. Try not to use your knee movement to perform the exercise.
- Sitting, Active ankle inversion towel slide –
Sit on a chair with your feet in front of you. Then place a towel on the floor closet to your injured foot. Place your foot on the towel and try moving it inwards by curling your ankle inwards.
- Sitting, Active ankle eversion towel slide –
Sit on a chair with your feet in front of you. Then place a towel on the floor closet to your injured foot. Place your foot on the towel and try moving it outwards by curling your ankle outwards.
- Ankle Dorsi Flexion W-Band –
In long sitting, anchor a looped elastic band in front of you. Now place your injured foot inside the loop and try to cull the band towards you by curling your ankle towards you.
- Long sitting, Resisted ankle plantar flexion with elastic –
In long sitting hold on to a looped elastic band with your hands. Now place the opposite end of the band around your ankle and then try to push the foot down towards the floor (pushing against the resistance of the band).
- Seated ankle inversion with the band –
Sit on a chair with your feet in front of you. Then place a looped elastic band around your injured ankle. Hold on to the band away from your legs. Now try to move your foot it inwards by curling your ankle inwards against the resistance of the band.
- Standing ankle dorsiflexion (weight-bearing) –
Stand to face a wall and place your injured foot 4 cm away from the wall. Place the opposite foot behind you as shown in the video. Now try to bring your knee as close to the wall as possible.
- Ankle dorsiflexion mobilisation with belt –
In standing, anchor a looped elastic band behind you. Place the band around your injured ankle and place that injure foot behind you and the good leg in front of you. This should look like a split stance. Now try to perform a mini squat by bending your back leg.
- Ankle Plantar Flexion-bent knee Calf Raise –
Sit on a chair with your knees bent at 90 degrees. Now try to lift your heels off the floor whilst going onto your tiptoes.
- Ankle Plantar Flexion-straight Double leg Calf Raise –
Stand with your feet shoulder-width apart in a comfortable stance. Now try to lift your heels off the floor whilst going onto your tiptoes.
- Double leg calf raises on a step –
Stand on an edge of a step/stair with your feet shoulder-width apart in a comfortable stance. Now try to lift your heels off the floor whilst going onto your tiptoes. Make sure to complete the full range of motion of the ankle by lowering yourself below the line of the step.
- Bosu double leg calf raise –
Stand on top of a Bosu ball, Make sure you stand in a comfortable stance and then perform calf raises, whilst trying to keep your balance.
Proprioception/ Balance ankle exercises for arthritis
- Supine AROM – proprioception ankle alphabet –
Lay on your back with the injured leg straightened. Now lift off your ankle off the ground and then try writing the letters of the alphabet using your ankle joint movement alone.
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- Unipodal/single-leg stance with eyes open –
- Unipodal/single-leg stance with eyes open –
Stand next to a chair, and try to balance yourself on one foot. Try not to hinge yourself through the hip, Instead, let the ankle correct your position. Aim for 10 seconds.
- Alphabet-standing –
In standing place your injured foot on top of a ball (medicine ball, football). Now try to balance yourself and at the same time try to create the letters of the alphabet using the ball and the movement of your ankle joint.
- Unipodal/single-leg stance eyes closed –
Stand next to a chair, and try to balance yourself on one foot, then close your eyes. Try not to hinge yourself through the hip, Instead, let the ankle correct your position. Aim for 10 seconds
- Single leg balance while throwing a ball on the wall –
Stand close to a wall with a ball in your hand. Now stand on one foot and try to throw the ball onto the wall and try catching the rebound. You can increase the distance covered as you progress through the exercise.
- Double leg balance on Air Pad –
The aim of this exercise is to introduce an uneven surface to balance training. Stand on an Air pad in a comfortable stance and try to aim to keep your balance for 10 seconds.
- Proprioception/balance on board (2 feet) –
The aim of this exercise is to introduce an uneven surface to balance training. Stand on a balance board in a comfortable stance and try to aim to keep your balance for 10 seconds.
- Single leg balance on Air Pad –
The aim of this exercise is to introduce an uneven surface to balance training. Stand on an Air pad with one foot and try to aim to keep your balance for 10 seconds.
- Proprioception / balance on board (1 foot) –
The aim of this exercise is to introduce an uneven surface to balance training. Stand on a balance board with one foot and try to aim to keep your balance for 10 seconds.
- Bosu Standing On 1 Foot / Stabilization –
The aim of this exercise is to introduce an uneven surface to balance training. Stand on a Bosu with one foot and try to aim to keep your balance for 10 seconds.
- Standing on the trampoline, Unipodal/single-leg stance with eyes closed –
The aim of this exercise is to introduce an uneven surface to balance training. Stand on a trampoline with one foot and try to aim to keep your balance for 10 seconds.
Stretching ankle exercises for arthritis
- Standing ankle dorsiflexion stretch –
Stand on one leg and then bend the affected leg as far back towards your bottom. Now place your hand on the mid-portion of your ankle and try pulling it further towards your bottom.
Soft tissue release
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- Ankle dorsiflexor self-release (ball) –
- Ankle dorsiflexor self-release (massage stick) –
Taping
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- Ankle stability taping –
How to plan ankle exercises for arthritis
To find out more about how many of each of these exercises I should be doing based on my condition then you can use this as a rough guide to finding out more about how to know this.
How to plan exercises, sets, reps and rest intervals.?
At this stage, you need to be thinking about visiting someone who can assess your condition and diagnose it properly to ensure you categorise your condition correctly, and then you can apply the correct type of exercises for this.
For more information about ankle exercises for arthritis
This article was written by our team of specialist therapists at Perfect Balance Clinic. If you would like more specific advice about how our team can help you with this condition or symptoms you may be having, please complete the contact form below and one of the team will get back to you shortly.
