Osteoarthritis of the Foot and Ankle
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Osteoarthritis of the foot and ankle is wear and tear in the joints that causes pain and stiffness. In the foot it most often affects the big toe joint. In the ankle it usually follows an earlier injury. About 1 in 6 older adults have foot osteoarthritis that causes pain and shows up on an X-ray, and ankle osteoarthritis is less common. The main symptoms are pain, stiffness and swelling that can make walking harder. Care starts with simple steps such as suitable footwear, staying active and pain relief, and surgery is considered only if these don't help.
What is it?
Osteoarthritis (often shortened to OA) means joint pain and stiffness caused by a joint wearing down over time. It is the most common joint disease, and it is one of the most frequent and troublesome health problems for middle-aged and older people.
In the foot, osteoarthritis most often affects the big toe joint. When this joint becomes stiff and worn, it is called hallux rigidus. Ankle osteoarthritis is mostly the result of an injury earlier in life.
Who does it affect?
Foot osteoarthritis is common in older adults. About 1 in 6 (16.7 per cent) have osteoarthritis in the foot that causes pain and shows up on an X-ray. The big toe joint is the most common spot. Estimates for it vary, from about 2.5 to 7.8 per cent of people over 50.
Foot osteoarthritis is more common in women, becomes more common with age, and is more common in people from lower socioeconomic groups. About 3 in 4 people with painful foot osteoarthritis say their foot symptoms are disabling.
Ankle osteoarthritis that causes pain and shows on an X-ray looks less common, at about 3.4 per cent of adults aged 50 and over. It is more common in women, in people aged 50 to 64, and in people with routine or manual jobs. Because ankle injuries often happen when people are young, people with ankle osteoarthritis can be younger than you might expect.
Signs and symptoms
Pain and stiffness are the main symptoms. A foot or ankle with arthritis may also be swollen, tender, hard to move, stiff in the morning, and painful when you walk. Joints can sometimes look red or feel warm. Ankle arthritis can have a big effect on quality of life.
In the big toe, the pain and stiffness are usually worse on stairs or when running. Many people find stiff-soled shoes, such as boots, are more comfortable. Flexible shoes, such as tennis shoes and sandals, tend to make it worse. You may also notice the big toe doesn't bend as far as the one on your other foot.
Not all foot or ankle pain is arthritis. Ongoing pain, stiffness or swelling is worth having checked.
What causes it?
Ankle osteoarthritis is usually caused by an earlier injury, such as a broken ankle. A small number of cases have no clear cause other than genetics. If ankle arthritis appears with no history of injury, it is unusual, and your doctor may look for an underlying condition such as haemochromatosis (an inherited condition).
The cause of big toe osteoarthritis is often unclear. An injury to the joint, repeated small injuries over time, and other forms of arthritis such as gout and rheumatoid arthritis can all damage the joint. Bunions, hammer toes, mallet toes and overlapping toes can also be linked to arthritis in the feet.
It isn't yet clear how much body weight, foot shape, footwear, or work and sport contribute to osteoarthritis in the foot and ankle.
How is it diagnosed?
Diagnosis is mainly based on your story and an examination. Your podiatrist, physiotherapist or GP will ask about your pain, how bad it is and how it affects you. They will look at and move your foot or ankle. For the big toe, they will check how far it bends compared with your other foot.
An X-ray can confirm arthritis, but you don't always need one if your symptoms are typical. Some hospital services do take standing X-rays as part of the usual assessment. An X-ray or other imaging can also help if your clinician wants to rule out other conditions. For the big toe, a CT scan or MRI is not usually needed.
It helps to note where the pain is, what brings it on (such as stairs or running), how long morning stiffness lasts, and which shoes feel better. Tell your clinician about any past ankle fracture, bad sprain or other injury, even from years ago.
Treatment
Care usually starts without surgery. Most of these steps are usual practice rather than proven in large trials, so expect to try them and then review with your clinician whether they are helping.
Looking after it at home
Ease off the activities that bend the big toe sharply, such as stairs and running, rather than stopping all activity. For ankle arthritis, it can help to avoid running, squatting and carrying heavy loads. Ice packs can help with swelling.
Footwear matters. For the big toe, look for shoes with a high, wide toe box. A rocker-bottom sole (a curved sole that helps your foot roll through each step) can be added if needed. For the ankle, rocker-soled shoes are suggested and flat shoes are best avoided. Changes to footwear are linked with less foot pain and better function in people with big toe arthritis.
If you are overweight, losing a little weight may reduce inflammation and strain on your feet and ankles. How much it helps isn't clear yet.
Pain medicines can help. Anti-inflammatory medicines may ease flare-ups in the big toe, and paracetamol or ibuprofen are sometimes suggested for ankle pain. Check any pain medicine, including anti-inflammatories, with a pharmacist or your GP first.
Treatment from your podiatrist
Your podiatrist can check your footwear, show you exercises, and talk about shoe inserts (orthoses). Exercises for ankle arthritis include strengthening, stretching and balance work. Your physiotherapist can also help with exercises.
For big toe arthritis, inserts that support the arch and inserts that stiffen the shoe probably make little or no difference to pain, function or quality of life. Some health services still list orthoses among the usual measures, so your podiatrist may still suggest them. Ask what to expect and when you will review how they are going. Side effects from inserts in a trial were generally minor and short-lived.
Other options
A single injection of hyaluronic acid (a gel-like substance) into the big toe joint gives no important benefit. If you are not improving, ask your GP, podiatrist or physiotherapist about a specialist review. It helps to take a list of what you have already tried.
Surgery
Surgery is considered if footwear changes, orthoses, pain relief and physiotherapy don't work. Operations include fusing a joint so it no longer moves, or replacing it. It isn't yet clear how the different operations compare, or what recovery is like after each. Surgery carries risks, so talk through the options, what benefit to expect, and what recovery involves with a foot and ankle specialist.
Recovery
How foot and ankle osteoarthritis changes over the years isn't yet clear, and it varies from person to person. Many people manage their symptoms well with simple steps, but it is best to be patient and review your progress regularly.
Foot and ankle pain in middle and older age is most often in the toes or forefoot. About two-thirds of people with it have moderate difficulty with some part of daily life, so it is worth getting help early.
A simple record of your pain, stiffness and what you can do, such as how far you can walk or how you manage stairs, helps you and your clinician see changes over time. If things get worse unexpectedly, tell your clinician. A scan or X-ray may then be useful.
Preventing it
No proven way to prevent foot and ankle osteoarthritis, or to stop it coming back, has been shown. What you can do is look after your feet and ankles day to day. Choose supportive shoes, ease off activities that make the joint worse, keep active within your comfort, and keep to a healthy weight if you can. If you injure your ankle or foot, get it checked and let your clinicians know about the injury in future.
When to see a podiatrist
When to book
Book an appointment with your podiatrist, GP or physiotherapist if you have ongoing pain, stiffness or swelling in your foot or ankle, if it is getting in the way of walking or your usual activities, or if the steps you have tried at home aren't helping. It is also a good time to book if you would like to talk about injections or surgery.
When to get help sooner
Call your local emergency number if your leg, foot or toes suddenly turn cold and pale or blue, with pain or numbness. Call it too if you suddenly become short of breath, have chest pain, or cough up blood. If you have a painful, hot, swollen joint and also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number. The following needs urgent medical assessment: see your GP today, or go to an urgent care clinic or the nearest emergency department. This includes a joint that suddenly becomes very painful, hot, red and swollen, especially with a fever or feeling unwell, as a joint infection can need treatment quickly. It also includes not being able to put weight on your foot straight after an injury, or still not being able to after 48 hours, and a foot or ankle that suddenly changes shape or gets worse in shape quickly. Get the same urgent assessment after a sudden or high-impact injury, if the pain is severe, if your foot or ankle is hot, red or very swollen, if you have new tingling or numbness in your foot, or if your calf is painful, swollen, warm or red. If you have diabetes or numb feet, a red, hot, swollen foot or a sudden change in foot shape needs urgent assessment, and any new foot problem should be checked through your diabetes foot care team. See your GP soon if you have pain at night or pain that doesn't ease with rest, weight loss you can't explain (such as more than 10 kg in 3 months), or pain that isn't improving with treatment.
Frequently asked questions
Is hallux rigidus the same as big toe arthritis?
Yes. Hallux rigidus is the medical name for osteoarthritis of the big toe joint, where the joint wears down and becomes stiff and painful. It is the most common place for arthritis in the foot. Your podiatrist may use either name.
Can an old ankle sprain or fracture cause arthritis years later?
Yes. Most ankle arthritis follows an earlier injury, and it can appear years after a broken ankle or even after several severe sprains. This is why it helps to tell your clinician about any past ankle injuries, even if they seemed to heal well.
Is exercise safe if I have arthritis in my foot or ankle?
Staying active is usually part of care, but get advice from your GP or another health professional before starting exercises if you have a health problem, injury or symptoms, feel unwell, have had a recent heart attack or operation, or are pregnant or recently gave birth. Stop straight away if you get pain or feel unwell.
Is all foot and ankle pain arthritis?
No. Frequent foot pain affects about 24 per cent of adults aged 45 and over, and frequent ankle pain about 15 per cent. Many things can cause it, and only some of that is osteoarthritis. A podiatrist, GP or physiotherapist can help work out the cause.