Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jan 5;60(1):23-33.
doi: 10.1093/rheumatology/keaa531.

Ankle arthritis - an important signpost in rheumatologic practice

Patrick D W Kiely  1   2 , Mark E Lloyd  3
Affiliations
Review

Ankle arthritis - an important signpost in rheumatologic practice

Patrick D W Kiely et al. Rheumatology (Oxford). .

Abstract

Ankle arthritis is a useful clinical signpost to differential diagnosis in rheumatic disease. Biomechanical features and differences in cartilage physiology compared with the knee may confer protection of the ankle joint from factors predisposing to certain arthritides. The prevalence of ankle OA is low, and usually secondary to trauma. Primary OA of the ankle should be investigated for underlying causes, especially haemochromatosis. New presentations of inflammatory mono/oligo arthritis involving the ankle are more likely due to undifferentiated arthritis or spondyloarthritis than RA, and gout over CPPD. The ankle is often involved in bacterial and viral causes of septic arthritis, especially bacterial, chikungunya and HIV infection, but rarely tuberculosis. Periarticular hind foot swelling can be confused with ankle arthritis, exemplified by Lofgren's syndrome and hypertrophic osteoarthropathy where swelling is due to subcutaneous oedema and osteitis respectively, and the ankle joint is rarely involved.

Keywords: ankle; gout; haemochromatosis; osteoarthritis; rheumatoid arthritis; sarcoidosis; septic arthritis; spondyloarthritis.

PubMed Disclaimer

Figures

<sc>Fig</sc>. 1
Fig. 1
Haemochromatosis arthropathy of the ankle (A) Plain radiograph showing reduced tibio-talar joint space and marginal osteophyte formation. (B) T2 fat suppressed MRI showing periarticular marrow oedema and multiple distal tibia and talar dome subchondral cysts.
<sc>Fig</sc>. 2
Fig. 2
Sero-negative undifferentiated peripheral spondyloarthropathy of the ankle Sagittal Short-T1 Inversion Recovery (STIR) MRI of the left ankle showing joint capsule thickening, synovitis and effusion of the tibio-talar joint extending into the posterior joint recess.
<sc>Fig</sc>. 3
Fig. 3
Septic arthritis of the ankle due to Staphylococcus aureus infection Plain radiograph showing fuzziness of cortical margins of the distal tibia, fibula and both malleoli.
<sc>Fig</sc>. 4
Fig. 4
Lofgren’s syndrome clinical and MRI inversion recovery images Images show (A) lateral, (B) midline and (C) medial sagittal sections of the hind foot with extensive subcutaneous enhancement (arrows) and no ankle joint disease.
<sc>Fig</sc>. 5
Fig. 5
Algorithm of likely differential diagnosis when the ankle joint is affected in early and established arthritis
See this image and copyright information in PMC

References

    1. Brockett CL, Chapman GJ.. Biomechanics of the ankle. Orthop Trauma 2016;30:232–8. - PMC - PubMed
    1. Frelat MA, Shaw CN, Sukhdeo S. et al. Evolution of the hominin knee and ankle. J Hum Evol 2017;108:147–60. - PubMed
    1. Treppo S, Koepp H, Quan EC. et al. Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. J Orthop Res 2000;18:739–48. - PubMed
    1. Cole AA, Kuettner KE.. Molecular basis for differences between human joints. Cell Mol Life Sci CMLS 2002;59:19–26. - PMC - PubMed
    1. Rogers J. Paleopathology of osteoarthritis In: Brandt KD, Doherty M, Lohmander LS., eds. Osteoarthritis. Oxford: Oxford University Press, 1998; 62–69.