• Deep ache in the front or inside of the ankle that worsens with walking

• Stiffness after sitting, then pain that builds over the day

• Swelling around the joint, especially after activity

• A catching or grinding sensation

• Difficulty with hills, stairs, and uneven ground

• In later stages, a change in the way the foot sits on the floor

A prior ankle fracture is the most common cause. Chronic instability, inflammatory arthritis (including rheumatoid disease), and—less often—primary osteoarthritis also wear the joint. Years may pass between the original injury and daily pain.

Standing ankle X-rays show joint-space narrowing, bone spurs, and alignment. The exam documents motion, swelling, and whether the hindfoot is still well aligned.

Many people stay active for a long time without an operation if the joint is braced.

• Activity change: keep walking and cycling; reduce impact and long hills

• A lace-up brace, Arizona-style gauntlet, or ankle-foot orthosis to limit painful motion

• Rocker-sole or stiff-soled shoes that roll the foot through stance

• Weight management when it applies

• Anti-inflammatory medication and occasional joint injection

When pain limits walking despite bracing, surgery depends on how much cartilage remains and whether the ankle is still aligned. Arthroscopy can clean loose bone and inflamed tissue in early disease. Realignment osteotomy is used in selected patients with wear on only one side of the joint. End-stage arthritis is treated with ankle fusion (arthrodesis) or total ankle replacement. Fusion is durable and reliable. Replacement preserves some motion and is considered in lower-demand patients with good alignment and healthy bone. Recovery after either reconstructive operation is measured in months.

See a foot and ankle orthopedic surgeon if ankle pain lasts more than a few weeks, an old fracture site has become painful years later, or bracing no longer gets you through the day.