Osteoarthritis in the lower ankle joint can be divided into different categories:

1. Primary osteoarthritis: Rare form that occurs without any identifiable cause.
2. Post-traumatic osteoarthritis: Most common form that develops after injuries such as fractures or dislocations.
3. Inflammatory osteoarthritis: Results from chronic inflammation, for example in rheumatoid arthritis.
4. Osteoarthritis due to misalignments: Develops through biomechanical overloads caused by misalignments such as flatfoot or high arch.

The main causes of osteoarthritis in the lower ankle joint can be divided into several categories:

• Post-traumatic causes:
  • Injuries such as calcaneal fractures or talus dislocations can cause lasting damage to the joint cartilage.
• Misalignments:
  • Congenital or acquired foot misalignments lead to uneven stress on the joint, accelerating cartilage wear.
• Chronic inflammations:
  • Rheumatoid arthritis or other inflammatory diseases damage the joint structures and promote degeneration.
• Excessive stress:
  • Occupational or athletic activities with high stress on the hindfoot can excessively strain the cartilage in the lower ankle joint.

The symptoms of osteoarthritis in the lower ankle joint usually develop gradually and worsen as the disease progresses. The most common complaints include:

• Pain: Localized pain in the hindfoot area that intensifies with exertion, especially on uneven terrain.
• Movement restrictions: Reduced ability to move the foot sideways or adapt to uneven surfaces.
• Swelling: Recurrent swelling in the area of the lower ankle joint, especially after prolonged exertion.
• Stiffness: Feeling of stiffness, especially in the morning or after long periods of rest.
• Grinding or rubbing: Noises when moving the joint, caused by the loss of smooth cartilage.

The diagnosis is made through a combination of medical history, physical examination, and imaging techniques:

- Medical history: The doctor takes the patient's medical history, including previous injuries, deformities, and existing symptoms.

- Physical examination: Palpation of the lower ankle joint for tenderness, swelling, and movement restrictions.

- Imaging techniques:

- X-ray: Visualization of joint space narrowing, osteophytes, and other typical signs of osteoarthritis.

- MRI: Detailed assessment of cartilage damage, soft tissues, and inflammatory processes.

Conservative Therapy

Most cases can be treated without surgery:

• Orthopedic Insoles:
  • Special insoles to relieve the lower ankle joint and improve foot statics.
• Physiotherapy:
  • Stretching Exercises: Promote mobility and reduce stiffness.
  • Strengthening Exercises: Strengthen the foot and calf muscles to stabilize the joint.
• Pain Medication:
  • Use of anti-inflammatory drugs to relieve pain and swelling.
• Injections:
  • Hyaluronic acid or cortisone injections for temporary relief of discomfort.

Surgical Therapy

In advanced stages or with persistent complaints despite conservative treatment, surgery may be necessary:

• Arthroscopic Joint Cleaning: Minimally invasive removal of loose joint bodies or smoothing of cartilage surfaces.
• Joint Fusion (Arthrodesis): A surgical fusion of the lower ankle joint to eliminate pain in severe osteoarthritis.
• Joint Replacement: In rare cases, replacement of the lower ankle joint with a prosthesis may be considered.

To prevent osteoarthritis in the lower ankle joint, the following measures are recommended:

1. Suitable footwear: Shoes with good cushioning and arch support reduce the strain on the joint.
2. Load management: Avoid excessive strain on the hindfoot through balanced training plans and regular breaks.
3. Warming up and stretching: Prepare the muscles with targeted exercises before sporting activities.
4. Regular foot checks: Early detection and treatment of misalignments or overstrain.
5. Weight control: Avoid overweight to reduce the mechanical load on the foot.