Ankle osteoarthritis is classified according to cause and severity:

1. By cause:
   • Primary osteoarthritis: Rare, without identifiable cause, mostly due to age-related wear.
   • Secondary osteoarthritis: Common, due to injuries, misalignments, or systemic diseases like rheumatism.
2. By severity:
   • Mild: Minor cartilage loss with mild symptoms.
   • Moderate: Significant cartilage damage with pain and limited mobility.
   • Severe: Pronounced cartilage loss with bone damage and severe pain.

The causes of ankle osteoarthritis are diverse and can be divided into mechanical, inflammatory, and systemic factors:

• Mechanical causes:
  • Post-traumatic osteoarthritis due to injuries such as ligament tears, fractures, or dislocations.
  • Chronic misalignments, e.g., due to flatfoot or high arches.
• Inflammatory causes:
  • Rheumatoid arthritis or other inflammatory diseases.
  • Infections that damage the joint.
• Systemic causes:
  • Metabolic diseases such as gout or diabetes.
  • Overweight, which increases the load on the joint.

The symptoms vary depending on the severity and progression of the disease, but typically include:

- **Pain:** Pain dependent on stress, which can also occur at rest in advanced stages.

- **Movement restrictions:** Reduced mobility of the ankle joint, especially when walking or climbing stairs.

- **Swelling:** Periodic swelling due to inflammation in the joint.

- **Stiffness:** Especially after rest periods, e.g., in the morning or after prolonged sitting.

- **Instability:** Feeling of giving way or insecurity when walking.

- **Changes in joint shape:** Visible misalignments or deformities in the area of the ankle joint.

The diagnosis is based on a thorough medical history, physical examination, and imaging techniques:

• Medical History:
  • Collection of symptoms, previous injuries, and possible risk factors.
• Physical Examination:
  • Visual and palpation findings to assess swelling, tenderness, and mobility.
  • Functional tests to check stability and load-bearing capacity.
• Imaging:
  • X-ray: Visualization of joint space narrowing, osteophytes, and bony changes.
  • MRI: Detailed analysis of cartilage and soft tissues.
  • CT: Additional use for complex bony deformities or surgical planning.

Conservative Therapy

Most cases can initially be treated conservatively to relieve pain and improve function:

• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Injections of hyaluronic acid or corticosteroids to improve lubrication and reduce inflammation.
• Physiotherapy:
  • Mobilization exercises to maintain mobility.
  • Strengthening exercises to stabilize the joint.
  • Gait training to improve movement patterns.
• Orthopedic Aids:
  • Special insoles or orthopedic shoes to relieve the joint.
  • Ankle braces or splints for stabilization.
• Shockwave Therapy: Promotes blood circulation and stimulates regeneration.

Surgical Therapy

In advanced stages or with persistent symptoms, surgery may be necessary:

• Arthroscopy: Joint lavage and removal of damaged tissue or cartilage debris.
• Joint Fusion (Arthrodesis): Fixation of the ankle joint to avoid pain from movement.
• Joint Replacement (Endoprosthesis): Insertion of an artificial joint to restore mobility.
• Osteotomies: Correction of misalignments to redistribute the load.

The following measures are suitable for preventing and reducing the progression of the disease:

1. Avoidance of overexertion: Adjusted loads and regular breaks during physical activities.
2. Ergonomic movement patterns: Gentle rolling of the foot when walking.
3. Weight control: Reduction of joint stress through a healthy body weight.
4. Regular exercise: Promotion of joint health through sports such as swimming or cycling.
5. Early detection: Timely treatment of injuries or misalignments to prevent long-term consequences.