Ankles

Ankle Anatomy

An inside look at the structure of the ankle.

Although it is typically referred to as a single joint, the ankle is actually two joints:

The true ankle joint, which is composed of three bones:

• the tibia, the larger and stronger of the two lower leg bones, which forms the inside part of the of the ankle
• the fibula, the smaller bone of the lower leg, which forms the outside part of the ankle
• the talus, a small bone between the tibia and fibula and the calcaneus, or heel bone.

The subtalar joint, which is composed of two bones:

• the talus
• the calcaneus

The ends of the bones are covered by articular cartilage. The space in the joint is lined with a thin membrane called the synovium, which cushions the joint and secretes a lubricating fluid, called synovial fluid.

Several strong bands of connective tissue, called ligaments, hold the bones of the ankles together. They include the following:

• anterior tibiofibular ligament, which connects the tibia to the fibula
• lateral collateral ligaments, which connect the fibula to the calcaneus and provide stability to the outsides of the ankles
• deltoid ligaments, which attach the tibia to the talus and calcaneus and provide stability to the insides of the ankles

A number of tendons run through the ankle, attaching muscles of the lower leg to the bones of the foot and ankle. The major tendons include the following:

• Achilles tendon, which attaches the calf muscle and calcaneus
• flexor hallicus longus, which runs along the inside of the ankle and attaches to the big toe
• flexor digitorum, which runs along the inside of the ankle and attaches to the other toes
• peroneal tendons, a set of three tendons which run along the outside of the ankle and attach at the 5^th metatarsal (the shaft of the small toe) and the bottom of the foot
• posterior tibialis tendon, which attaches at the mid-foot and helps maintain the foot's arch
• anterior tibialis tendon, which runs down the front of the leg and attaches to the bones of the midfoot. These tendons pull the foot toward the body and help control their motion.

Ankle Pain Causes

Arthritis and Diseases that Affect the Ankle

From joint inflammation to sprains, problems that may be to blame for ankle pain.

Many forms of arthritis and related conditions that affect the joints, muscles and/or bones can cause problems like pain, stiffness and swelling in the ankles. Here are some diseases that can affect the ankles.

• Osteoarthritis (OA). The most common form of arthritis, osteoarthritis is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. This breakdown causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. In the foot, the most commonly affected joint is the big toe, but OA can also affect the ankle.

• Rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic inflammatory disease of the joints that occurs when the body’s immune system – which normally protects us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. The result can be joint damage, pain, swelling, inflammation, loss of function and disability. In about 90 percent of people with rheumatoid arthritis, the joints of the feet are ankles are affected.

• Juvenile arthritis. Juvenile arthritis is the term used to describe arthritis when it begins before age 16. There are several different types of juvenile arthritis that can cause pain and swelling in the ankles.

• Gout. Gout is a form of  arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, including the ankles. After years with the disease, lumps of uric acid, called tophi, may form beneath the skin around the ankles.

• Calcium Pyrophosphate Dihydrate Crystal Deposition Disease (Pseudogout). Like gout, pseudogout occurs when crystals form within the joints. With pseudogout, however, the crystals are formed of a salt called calcium pyrophosphate dihydrate. Although pseudogout occurs mostly in older people, it can affect younger people, particularly if they have other health problems. Also like gout, pseudogout can cause intense pain and swelling, which often comes up overnight. Pseudogout most commonly affects the knees, but it can also affect other joints, including the ankles.  

• Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation and swelling of the joints, eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder. The ankles, knees and joints of the feet often are the first joints affected by reactive arthritis. Reactive arthritis also can cause inflammation of the tendons, including the Achilles tendon at the back of the ankle.

• Lupus. Lupus is a chronic autoimmune disease, meaning the body's immune system creates antibodies that attack healthy tissues, including the joints, skin, heart, lungs and kidney. In some people with lupus, arthritis affects the ankles. However, swelling of the ankles may be a sign of kidney involvement.

• Psoriatic arthritis. Psoriatic arthritis is a form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage of cases the joint disease develops before the skin disease. Psoriatic arthritis commonly involves the ankle.

• Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within the joint. Infectious arthritis is often caused by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi and can affect the ankles. Untreated, infection can lead to joint destruction.

• Scleroderma.   Literally translated "hard skin," scleroderma is an umbrella term for disorders that involve the abnormal growth of the connective tissue supporting the skin and internal organs. In some cases skin thickening over the joints, such as the ankle, can cause joint stiffness.

Ankle Injury

Although many forms of arthritis and related conditions can affect the ankles, the most common cause of ankle pain is a sprain. A sprain occurs when the ligaments that support the ankle become stretched or torn. Here is what you need to know about sprained ankles and some other common ankle injuries.

• Sprains. The most common ankle injury, sprains occur when the ligaments that normally support the ankle become stretched beyond their normal range. This happens when the foot twists, turns or rolls as a result of fall or misstep. Doctors grade sprains on a scale of one to three, based on the severity of the damage, with one representing slight stretching and some damage to the ligament fibers and three representing a complete tear of the ligament.

• Ankle fractures. A fractured, or broken, ankle may include a break in one of the bones that make up the ankle, or it could consist of several breaks in different bones. An ankle fracture can occur if you twist or roll your ankle while walking, running, going up or down stairs or while playing sports, such as sliding into base during baseball. It can also result from tripping or falling or the impact of a car accident. A broken ankle can cause the same symptoms as a sprained ankle – severe pain, swelling, bruising, tenderness to the touch, or deformed appearance – so it can be hard to distinguish between the two.

In some cases a fracture occurs because a ligament tears and pulls a piece of bone with it. This is called an avulsion fracture.

If you have an ankle injury, it's important to see a doctor who can X-ray the ankle to see if it is broken or sprained.

Learn more about ankle fractures from the American Academy of Orthopaedic Surgeons.

• Achilles tendinitis. Achilles tendonitis is inflammation of the Achilles tendon, the largest tendon in the body, which runs from the calf to the heel bone.
  
  • Noninsertional Achilles tendonitis affects fibers in the middle of the tendon.
  • Insertional Achilles tendonitis affects the lower portion of the tendon where it attaches to the heel bone.

Both types can result from repetitive stress to the tendon or from overstressing the tendon during exercise. Damaged tendon fibers can calcify and bone spurs can form where the tendon attaches to the bone.

Symptoms may include pain and stiffness of the tendon – which may occur from either inactivity (such as first thing in the morning) or after activity – thickening or swelling of the tendon or bone spurs.

Learn more about Achilles Tendonitis from the American Academy of Orthopaedic Surgeons.

• Achilles tendon rupture. An Achilles tendon rupture is a break in the Achilles tendon. Most ruptures occur during strenuous activity. The break itself may cause a loud pop and feel like the ligament has been kicked or shot. Symptoms of a ruptured tendon may include severe pain and swelling, difficulty walking and the inability to stand on the toes of the injured foot.

Ankle Pain Diagnosis

Ankle Imaging Tests

Noninvasive tests that help your doctor see inside your ankles.

Imaging tests can allow your doctor to see the structures inside your ankle noninvasively. The most common imaging tests to diagnose ankle problems are:

• X-ray (radiography). A standard X-ray is a simple test in which an X-ray beam (a form of electromagnetic radiation) is passed through the ankle to create a two-dimensional picture of the bones that form the joint. Your doctor can use X-rays to view:
  
  • joint space. Narrowing of the space between the bones, which are normally covered by cartilage, can be a sign of arthritis and its severity.
  • bone spurs. Bony overgrowths at the joint are a sign of osteoarthritis.
  • fractures. Broken ankles will show up on X-rays, however, small cracks in the bone may not. 

In some cases, a contrast dye is injected into the ankle to enable the doctor to better see the joint on X-ray. This is called arthrography.

• Computerized axial tomography (CAT) scan. Also called a computed tomography (or CT) scan, this noninvasive test combines X-ray equipment with sophisticated computers to produce multiple images, which are combined to depict cross-sectional slices of internal structures. CT scans may be used to diagnose ankle fractures that don't show up on X-ray. They also show soft tissues, such as cartilage, ligaments and muscles, more clearly than traditional X-rays, so they are more useful for diagnosing certain ankle problems, including arthritis and sprains.
  
  
• Magnetic resonance imaging (MRI). This procedure uses a strong magnet linked to a computer to create a picture of the internal structures in black and white and shades of gray. Because an MRI shows the soft tissues, as well as the bones, it is particularly useful for diagnosing injuries to the cartilage, tendons and ligaments, as well as areas of swelling.
  
  
• Bone scan. This technique can be used to view stress fractures caused by repetitive trauma. It involves injecting a small amount of radioactive material into the bloodstream. The material collects in the bones, particularly areas of new bone growth where fractures are healing, enabling doctors to see those areas with a scanner.

Lab Tests for Diagnosing Ankle Problems

Tests that tell what's going on inside your body.

Often a sample of blood or joint fluid can help you doctor confirm a diagnosis. For example, a blood test showing high blood levels of rheumatoid factor – an antibody that acts against the blood component gamma globulin – or an antibody called anti-cyclic citrullinated peptide antibody (anti-CCP) may suggest rheumatoid arthritis. High levels of antinuclear antibodies (ANAs), abnormal antibodies directed against the cells' nuclei, could suggest lupus or another inflammatory disease.

Tests of fluid drawn with a needle from the joint may reveal crystals of uric acid, confirming a diagnosis of gout; calcium pyrophosphate dehydrate, confirming pseudogout; or a bacterium, suggesting that joint inflammation is caused by an infection.

Diagnosing Ankle Problems

From blood work to X-rays, tests your doctor uses to find the cause of ankle pain.

Diagnosing an ankle problem will begin with a physical exam and assessment of your medical history. During the medical history your doctor will ask you questions such as:

• What symptoms are you experiencing?
• When did you first start noticing them? Were they the result of an injury?
• Are your symptoms worse after activity or rest? Are there certain activities that make them worse – or better?
• Do you recall having an illness or accident around the time your symptoms began?
• Are you experiencing symptoms in any joints besides the ankle(s)?
• Do any of your family members have arthritis or other ankle problems?
• Do you have other medical problems that could be causing your symptoms?

During the physical exam your doctor will look at and touch your ankles and any other joints you may be experiencing problems with. Your doctor will be looking for areas that have tenderness, pain or swelling, as well as indications that the joint may be damaged. Depending on the findings of the history and exam, your doctor may order lab tests and imaging tests to help make or confirm a diagnosis.

Ankle Pain Treatment

Medications to Treat Ankles

What you need to know about the many medications used for ankle problems.

Medications to ease pain, relieve inflammation, slow bone loss, modify the course of an inflammatory disease or prevent joint damage are an important part of treatment for many ankle problems. The medications used to treat arthritis and other problems that affect the ankles will depend largely on the form of arthritis or related condition you have. The types of medications commonly used in arthritis treatment are:

Nonsteroidal anti-inflammatory drugs. Including more than a dozen different drugs, some of which are available without a prescription, nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help ease arthritis pain and inflammation. They are used for all forms of arthritis.

Corticosteroids. These quick-acting drugs, similar to the cortisone made by your own body, are used to control inflammation. If inflammation is due to a systemic inflammatory disease, your doctor may prescribe oral corticosteroids. If inflammation is limited to one or a few joints, your doctor may inject a corticosteroid preparation directly into the joint.

Analgesics. Analgesics are among the most commonly prescribed drugs for many forms of arthritis. They also may be used to relieve pain from ankle sprains, fractures and other injuries. Unlike NSAIDs, which target both pain and inflammation, analgesics are designed purely for pain relief. For that reason, they may be safe for people who are unable to take NSAIDs due to allergies or stomach problems, for example. When used as prescribed, they’re also an appropriate, and possibly safer, choice for people whose arthritis causes pain but not inflammation.

If pain is in the soft tissues, you may find relief from an analgesic salve, rub or balm available over the counter under trade names such as Aspercreme, Ben-Gay, Capzasin-P, Eucalyptamint, Icy Hot, Voltaren Gel and Zostrix. These topical preparations work through a variety of active ingredients and may be helpful if you are unable to take oral medications, or if medications fail to relieve pain or reduce it to a manageable level.

Disease modifying anti-rheumatic drugs. Disease-modifying anti-rheumatic drugs (DMARDs) are drugs that work slowly to modify the course of inflammatory disease. Different DMARDs may be useful for a number of different forms of arthritis, including rheumatoid arthritis, lupus and psoriatic arthritis, all of which can affect the ankles. 

Gout medications. Some medications for gout are designed to reduce levels of uric acid in the blood to help prevent future attacks of joint pain and inflammation. Others are designed to relieve the pain and inflammation of an acute attack. Many people with gout take both types of medication.

Biologic response modifiers. The newest category of medications used for rheumatoid arthritis and a few other inflammatory forms of arthritis are the biologic agents. There are currently eight such agents approved by the FDA. Each blocks a step in the inflammation process without suppressing the entire immune system. In addition to rheumatoid arthritis, certain biologic agents may be used in juvenile arthritis, ankylosing spondylitis and psoriatic arthritis.

Osteoporosis medications. Osteoporosis medications are those used to slow the loss of bone or help the body build new bone. Although they are not used specifically to treat ankles, strong bones are less prone to fracture. Osteoporotic ankle fractures are not common, but they can occur.

Surgery for Ankle Pain

Ankle replacement, fusion and other surgical options.

If an ankle is fractured or arthritis interferes with function and causes pain that can't be controlled with medication, surgery may be an option – or a necessity. Here are some of the most commonly performed ankle surgeries.

Fracture repair. The most common reason for ankle surgery is to repair bones that have been fractured. The exact procedure used will depend on which bone is broken and how severely. Surgery may require the placement of hardware, such as metal plates and screws, to hold the bone pieces in place while they heal.

Read about the most common types of ankle fractures and the surgeries to repair them from the American Academy of Orthopaedic Surgery  

Ankle arthroscopy. Ankle arthroscopy is a minimally invasive surgery performed by inserting a lighted scope and narrow instruments through small incisions in the skin over the ankles. Surgeons may use the procedure to remove pieces of cartilage or bone debris from the joint space or to evaluate or repair a damaged ligament.

Read more about ankle arthroscopy from the Arthroscopy Association of North America. 

Ankle fusion. This procedure involves surgically removing the surfaces of the joints affected by arthritis and joining the bones with plates and screws until they grow together, or fuse. While the procedure leaves the ankle without up-and-down or side-to-side movement, it can be an effective and permanent pain relief option for ankles affected by arthritis. If one ankle is fused, it is important that the opposite ankle still has good mobility.

Ankle replacement. Although the procedure is far less common than hip or knee replacement, replacing a damaged ankle may be an option when arthritis interferes with joint function and causes pain that is not relieved by medication.  During ankle replacement, the surgeon makes an incision in the front of the ankle, removes the damaged bone and joint cartilage, reshapes the involved bones and then attaches the parts of the artificial joint, often with a special glue. The surgeon creates a bone graft between the ends of the tibula and places screws through the two bones to support and stabilize the ankle.

Ankle distraction arthroplasty. This innovative procedure uses an external fixator, or frame, much like scaffolding, which is assembled around the lower leg and foot and surgically attached with pins and wires. The frame pulls the damaged joint surfaces apart and, in recent MRI studies, has been shown to reverse the effects of arthritis by allowing the dense bone underneath the cartilage to soften, and in return, allowing cartilage lost from arthritis to regenerate through the body’s natural healing process. Unlike ankle replacement or ankle fusion, ankle distraction arthroplasty preserves the joint and its natural motion. Performed successfully in Europe for years, this procedure is relatively new to the U.S. and not widely performed in this country.

Cartilage stimulating procedures, such as neo-cartilage tissue formation, are often performed in conjunction with distraction to help speed the process. Stem cells are harvested from the patient’s pelvis with a needle and injected into the ankle joint.

Ankle Care

Ways to Prevent Ankle Pain and Get Around

Splints, canes and other ways to get around with ankle pain.

Many ankle injuries can be treated simply at home with over the counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin IB) and naproxen (Aleve). If you cannot tolerate NSAIDs or you are already taking anti-inflammatories for arthritis, however, contact your doctor before taking an OTC pain-reliever.

Within 48 hours of the injury, you should also begin self-care measures. Use the acronym RICE to help remember these treatments:

• Rest. Take a break from activity. Avoid walking on your injured ankle.
• Ice. Place an ice pack on your ankle for 15 to 20 minutes at a time to reduce pain and swelling.
• Compression. Wrap a compression bandage around the ankle to reduce swelling.
• Elevation. As much as possible, keep your foot elevated to reduce swelling. Use a stool when sitting at your desk or place your foot on pillows when relaxing on the couch.

Whether you have an acute injury or chronic arthritis, medications don't always relieve pain completely. And if you have surgery, you'll likely need some help getting around while you heal. At times when you need extra help with pain relief or mobility, here are some techniques and devices worth trying.

Hot and cold. While cold is helpful for reducing inflammation from a new ankle injury, it also can be helpful for chronic pain or for the pain and inflammation of an arthritis flare. For aching ankles without acute inflammation, heat may provide relief.

Canes. If placing weight on your ankle causes pain, your doctor or physical therapist may recommend a cane. There are many different types of canes. The most common type has a single tip, but if you have trouble balancing, your doctor may recommend a quad, or four-point cane. Your doctor can advise the best way to use your cane, but generally you should hold it in the hand opposite the painful ankle.

Ankle Braces. Ankles braces can support the ankle during recovery from an injury or surgery or help reduce the risk of re-spraining a sprained ankle. Braces fall into two basic categories – rigid and functional. Rigid braces immobilize the entire ankle, while functional braces allow some movement. There are many variations on each of the different types.

Electrical Stimulation. Electrical stimulation of muscle tissue (called neuromuscular electrical stimulation) around the ankle may be useful for strengthening the muscles that support the joint and relieving pain in and around the joint. A number of studies have shown the treatment to be effective, however, studies have focused specifically on the treatment for knee osteoarthritis.

Weight Loss. Because the ankles bear the weight of the body, excess body weight can put more stress on ankles, leading to or worsening ankle pain. Weight loss, in turn, may help reduce ankle pain.

Preventing Ankle Problems

Tips to reduce your risk of ankle problems.

Some of the same measures you take to relieve ankle problems, such as losing weight or wearing a brace, can also help prevent ankle pain and injuries.

Here are some other tips for reducing your risk of ankle problems:

Be safe with sports. Using the right gear can reduce your risk of ankle injuries during sports. For example, research has shown that the use of breakaway bases – bases that are specially designed to dislodge when baseball players slide into them – significantly reduces foot and ankle injuries in recreational baseball and softball games. Several studies have shown that semirigid ankle braces can help prevent sprained ankles in high-risk sports, such as basketball and soccer. An even safer option is to choose low-impact sports, such as biking or swimming or other aquatic exercises.

Select proper footwear. Spiked heels offer little stability, and sandals and flip-flops do nothing to protect the heel or control pronation (an inward rolling motion of the foot) that can become excessive with ankle arthritis. An enclosed shoe with a heel no higher than one-and-a-half inches offers the best protection. Shoe inserts and insoles not only provide shock absorption, but also keep your ankle from rolling.

Sit right. Avoid sitting with your feet crossed behind you and pointed down. This puts pressure on your toes that can lead to ankle stiffness and soreness

Condition your ankles. Strengthening the muscles of the lower leg through resistance band exercises will help keep your ankles stable and injury free. To increase flexibility and range of motion, try calf stretches against a wall, or, in a seated position, write out the letters of the alphabet using your feet.

Prevent Ankle Pain

Learn to love your ankles. Take steps to keep ankles pain- and sprain-free.

Are you rankled by arthritis ankle pain or frustrated by recurring ankle sprains? While ankles are one of the most commonly injured joint, the good news is there are simple steps that you can take to prevent arthritis ankle pain and injury, and keep you on your feet.

Skip the stilettos. “If you walk on a spiked heel, you have much less stability,” says James A. Nunley, MD, chief of orthopaedic surgery at Duke University Medical Center in Durham, N.C. For ankles weakened by osteoarthritis, he recommends shoes with a wide, low, flared heel or lateral post shoes, like running sneakers.

“You are less likely to roll your ankle because your shoe is wider and it takes much more to roll it over,” says Dr. Nunley

Scrap the flats. Sandals and flip-flops fall flat on safety too. “When you go to that flatter shoe, you lose some of the support for the arch,” says Ronald D. Jensen, a podiatrist and president of the American Podiatric Medical Association. “A lot of people who get arthritis in their ankles begin to get a deformity in their ankle called pronation and this consists of an inward rolling toward the arch of both the foot and the ankle. If you’re in a flat shoe, there’s nothing to resist this painful movement.”

Sandals also lack heel protection, so the heel can wobble twisting your ankle. For the most support and stability, choose everyday footwear choose an enclosed, laced-up shoe with a heel no higher than 1-½ inches.

Get a lift. Shoe inserts and insoles not only provide shock absorption, they also keep your ankle from rolling. “Modifications to the shoe to try to tip the foot in can take the stresses off those lateral ligaments,” says Dr. Nunley, who heads Duke’s Orthopaedic Research Laboratory.

He recommends over-the-counter one-quarter-inch lateral heel inserts for those whose ankles have a tendency to roll. In shoes without proper internal support, a three-quarter-inch insole provides arch support and reduces ankle pressure.

Brace yourself. Elastic ankle braces, such as sports bandages or compression socks, reduce ankle swelling and associated arthritis joint stiffness and pain. While they offer little support, elastic braces affect proprioception – our ability to sense where our limbs are in space.

“Many people when they get swollen also get numbness in the foot,” says Jensen. “By using a compression sock and reducing the swelling, they have better feeling and it makes it safer for them to walk because they can feel the ground better.”

For extra support and to control painful movement, particularly in those with tendonitis of the ankle, Jensen recommends a lace-up or stirrup brace. Hiking boots or hi-top sneakers made of firm leather or other thick material also serve as effective braces.

Avoid uneven ground. Cobblestone pathways, bumpy hillsides and shifting sand can wreak havoc on ankles affected by arthritis that have a limited range of motion. Stepping on uneven ground is a common cause of ankle sprain. If all else fails – for example, while on vacation in an historic town with hilly terrain – follow the footwear rules above.

Sit smart. Avoid sitting with your feet crossed behind you and pointed down. This puts pressure on your toes that can lead to ankle stiffness and soreness.

“The best way to sit at a desk is to have your feet flat. If your heels don’t touch the ground, consider a foot rest,” says Suzanne Hawson, a physical therapist with University Foot and Ankle Institute in Valencia, Calif.

Condition your ankles. Strengthening your peroneal muscles – the muscles in your shin that support your ankles – through resistance band exercises will keep your ankles stable and injury free. Towel crunches with your feet also can help build strength and stability, says Hawson. Place a towel under your foot and scrunch the towel under your toes.

“Many of the muscles that cross the ankle joint have insertions in the foot. Stronger foot muscles help to support the ankle joint,” she says.

To increase flexibility and range of motion, Hawson suggests simple calf stretches against a wall, or, in a seated position, moving your ankle to write out the letters of the alphabet using your big toe as the tip of the “pen,” and doing 10 repetitions of ankle circles in both directions.

Switch sports. To preserve ankle health, avoid high-impact sports, such as running, or sports that require cutting from side to side, such as basketball, tennis and soccer. Beware the seemingly benign golf. (Most golf courses aren’t flat).

“If you hit a sand trap, you have to climb in and out and that’s when you are most likely to twist your ankle,” says Dr. Nunley, who advises golfers to wear a stirrup brace for added support.

Choose low-impact sports, such as biking, swimming or other aquatic exercises. “The buoyancy of the water helps to de-weight the ankle and allows the muscles to get strong without stressing the ankle joint,” says Hawson, whose specialty is sports rehabilitation. Whatever sport, stretch your ankles properly before and after.

Watch your weight. Extra weight puts added pressure on ankle joints. “Even people who are moderately overweight can suffer the consequences of a more rapid progression of their arthritis,” says Jensen. Above all, stay active to maintain a healthy weight and to keep your ankles strong and flexible.