Ankle Swelling & Inflammation

Ankle pain, swelling, stiffness, and inflammation are very common in people with rheumatoid arthritis (RA). One study found that about 90 percent of people with RA experience ankle or foot problems at some point in their condition.1-3

Trouble walking up ramps and climbing stairs are usually the first signs that RA has affected your ankle joints. As the condition gets worse, simple walking and standing often become painful. RA can cause the joints in your ankle to become inflamed and swollen. This can lead to nerve damage that causes numbness and tingling in the feet. RA can also lead to deformities of the ankle and foot.1-3

How does RA affect the ankle?

The ankle forms the angle where the foot meets the leg. Although it is usually referred to as a single joint, it is two joints. They include the true ankle joint and the subtalar joint.4

The space in these joints is lined with a thin barrier called the synovium. The synovium cushions the joints and releases a fluid that makes it easier for your joints to move. This is called synovial fluid.4

Rheumatoid arthritis is an autoimmune condition. This means that the body’s immune system attacks its own healthy tissues. RA specifically affects the synovial joints by causing them to swell and thicken. This leads to extra synovial fluid, which in turn creates more swelling and inflammation. This causes pain and stiffness in the ankle joints. The extra synovial fluid also stretches out the synovium, which makes your joints far less stable.5,6

In some cases, RA is symmetrical, which means it affects the same joints on both sides of the body. As the condition gets worse, ligaments, joints, and cartilage become more damaged. This leads to increased pain and inflammation, as well as deformities.5,6

The exact cause of RA is not known. Researchers believe that some people have genes that can make them more likely to have RA. However, people with these genes do not automatically develop RA. There is usually something that triggers the condition, like an infection. This causes the immune system to start attacking the joints.5,6

How is RA ankle pain treated?

There is no cure for RA, but there are different ways to help you manage the inflammation, pain, and stiffness that affect the ankle joints. Treatment depends on your symptoms and how severe they are. The goals of treatment are:3,7

  • Stop or reduce inflammation
  • Relieve symptoms
  • Prevent joint and organ damage
  • Improve function and well-being
  • Reduce long-term complications

Treatment includes lifestyle changes, medicines, and surgical options.

Non-surgical treatments for RA ankle pain

Many people find that they can improve many of their symptoms with non-surgical treatments, especially in the early stages of RA. Common non-surgical options include:3

  • Limiting or stopping activities that make your pain worse. Low-impact exercises like biking and swimming can help you stay healthy while reducing the impact on your ankle joints.
  • Applying ice to your ankle joints for 20 minutes, 3 to 4 times per day. This can help reduce pain, especially when you ice your joints after physical activity. Do not apply ice directly to your skin.
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen to help reduce pain and inflammation
  • Wearing a lace-up ankle brace to support the joints of the back of the foot and ankle. If you have a very stiff ankle, talk to your doctor about getting a custom-molded plastic or leather brace.
  • Getting steroid injections into your ankle joints can help reduce inflammation

If the above options do not control your RA symptoms, your doctor may prescribe disease-modifying anti-rheumatic drugs (DMARDs). These are drugs that are designed to stop the immune system from attacking the joints. This slows or prevents joint deformity. There are both benefits and risks of DMARDs, so talk to your doctor about whether these drugs are right for you.8

Surgical treatments for RA ankle pain

If your ankle joint symptoms do not respond to medicine or lifestyle changes, your doctor might recommend surgery. The most common surgical options include:3

  • Ankle fusion (arthrodesis) – During this procedure, a surgeon fuses the bones of your ankle into one piece. This surgery limits joint motion, which reduces pain.
  • Total ankle joint replacement (arthroplasty) – During this procedure, a surgeon removes your arthritic cartilage and part of the bone from the ankle joint and replaces it with metal and plastic parts. This procedure is usually considered for people who have already had ankle fusion surgery or those with severe RA damage to the ankle joints.

Learn more about ankle surgery

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Written by: Jonathan Simmons & Heather Morse | Last reviewed: October 2020