From the Guidelines
Physical therapy (PT) can be very helpful for mild ankle arthritis by improving joint mobility, strengthening surrounding muscles, and reducing pain, as evidenced by the benefits of therapeutic exercise for knee and hip osteoarthritis 1.
Key Recommendations
- A typical PT program would include range-of-motion exercises, strengthening exercises for the ankle and lower leg muscles, balance training, and gait retraining, usually recommended 2-3 times per week for 6-8 weeks.
- For pain relief, start with acetaminophen (up to 3000mg daily in divided doses) or NSAIDs like ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily).
- Weight management is crucial as excess weight increases joint stress.
- Supportive footwear with cushioning and arch support, possibly with custom orthotics, can improve comfort and function.
- Activity modification to avoid high-impact exercises while maintaining low-impact activities like swimming or cycling helps preserve joint health.
- Bracing or ankle sleeves can provide additional stability and reduce pain during activities.
- Cold therapy (15-20 minutes several times daily) helps reduce inflammation, while heat therapy can relieve stiffness. These interventions work by reducing inflammation, strengthening supportive structures around the joint, decreasing mechanical stress on the arthritic surfaces, and improving overall joint biomechanics, as supported by the 2019 American College of Rheumatology guideline for the management of osteoarthritis 1.
Considerations for Exercise
- Exercise recommendations should focus on the patient’s preferences and access, as these may be important barriers to participation 1.
- A substantial body of literature supports a wide range of appropriate exercise options, and most patients with osteoarthritis can participate in and benefit from some form of exercise 1.
- Supervised exercise programs, often by physical therapists and sometimes in a class setting, are more effective than when performed by the patient alone 1.
Individualized Approach
- The decision to initiate an exercise program should be made through shared decision-making between the treating clinician and the patient, considering the patient's pain level and functional limitations 1.
- While there is no uniformly accepted level of pain at which a patient should or should not exercise, clinical trials of exercise for osteoarthritis include patients with pain and functional limitations, and improvements in osteoarthritis-specific outcomes have been demonstrated 1.
From the Research
Mild Ankle Arthritis Management
- Physical therapy (PT) can be beneficial for mild ankle arthritis, although the provided study does not specifically discuss PT as a treatment option 2.
- The current standard of care for nonoperative management of ankle arthritis includes:
- Nonsteroidal anti-inflammatory drugs
- Corticosteroid injections
- Orthotics
- Ankle braces
Other Recommendations
- There is limited research on other modalities for treating ankle arthritis, making it difficult to determine their effectiveness 2.
- Operative interventions, such as arthrodesis and total ankle arthroplasty, are considered for end-stage degenerative arthritis, with arthrodesis being the gold standard 2.
- Total ankle arthroplasty is gaining evidence for its superiority in functional outcomes, but more high-quality studies are needed to determine the most appropriate patient population for this procedure 2.