There are multiple different types of ankle arthritis, some of which are considered more structural, while others fall under the autoimmune and inflammatory umbrella.

This article will focus on exercises for ankle osteoarthritis, which falls under the mechanical category, but some of these may be suitable for other forms of ankle arthritis depending on your specific condition.

The main reason we are focusing on ankle osteoarthritis is because this condition is typically much more amenable to activity-based rehab, and usually, there are less hazards we need to consider in terms of active disease process.

That’s not to say that other forms of ankle arthritis, such as rheumatoid arthritis (RA) and gout, can’t benefit significantly from exercise, but we highly recommend consulting with a rheumatologist, physician, physical therapist, or other healthcare professional prior to initiating a self-guided exercise program, as there is a lot more to consider from a safety perspective in these cases.

What is ankle osteoarthritis?

Osteoarthritis (OA), is considered a degenerative condition that primarily affects the cartilage in joint. It’s often termed a “wear and tear” type of arthritis, which really over-simplifies the process of how osteoarthritis develops in joints.

The reason it is often called associated with the term “wear and tear” because it can be associated with a history of excessive activity or previous injuries and/or trauma, among many other factors that can contribute to the development of ankle osteoarthritis.

Over time, if the cartilage in the ankle joint starts to break down, the ankle joint will be less capable of withstanding the forces placed upon it, which can result in pain and stiffness with movement or weight bearing activity.

Additionally, ankle pain and stiffness can be felt at rest or after activity. For example, a common complaint is people saying their ankles ache at night, especially if there was an increased amount of weight bearing activity that day, and that ankle pain may fluctuate throughout the day as well.

As such, given it doesn’t just affect people in the moment, but realistically at any time, ankle osteoarthritis can have a negative impact on both your physical and mental well being (Yeowell et al, 2021).

The tricky part about osteoarthritis is that the symptoms of ankle pain and stiffness typically prompt people to prioritize rest. While rest and recovery can be an important part of rehabbing any injury or condition, including arthritis pain, relying on this will eventually cause the muscles around the joint to weaken, and the arthritis pain can subsequently get worse over time if not treated properly (Al-Mahrouqi et al, 2018).

Important Considerations for Ankle Arthritis Exercises

Ankle osteoarthritis exercises shoulder combine principles of joint range of motion, stretching of muscles and tendons, and definitely strengthening around the joint.

It’s fairly intuitive for people that working on joint range of motion can help relieve symptoms of stiffness and allow for more comfortable movement. However, the importance of strength can be less intuitive, but it’s equally, if not more, important.

Strengthening around the ankle joint, and even up the chain to the knee, hip, and core, will provide more support for the joint, in which case, the joint won’t have to take the brunt of forces placed upon it, thus helping to reduce ankle arthritis pain.

While strengthening doesn’t provide an overnight fix to ankle pain and stiffness from osteoarthritis, it can slow the progression of this disease while also providing more permanent reduction of symptoms.

Therefore, working on ankle strength and stability is very important to help reduce arthritis pain, particularly in the case of osteoarthritis (Hubbard et al, 2009).

In this article, we will focus on ankle-specific exercises, but do know that strengthening around the knee, hip, and core and also have a beneficial effect on the ankle.

Ankle Osteoarthritis Exercises

The following ankle exercises are some common and simple ways to help treat ankle osteoarthritis and associated ankle pain. We always recommend checking with a healthcare professional to ensure an optimal program for your individual needs, but these exercise may provide you with a starting point, or at least an idea of what to expect.

Ankle Osteoarthritis Range of Motion Exercises

Range of motion exercises are a central tenet to treating any form of arthritis, and over time, this improving and/or maintaining range of motion can help reduce arthritis pain. The following represent different ways to maintain or improve your ankle range of motion.

Seated Foot Slides

Arguably one of the easiest, simplest, and most convenient ankle exercises you can perform to help relieve ankle pain are seated foot slides, and this can be a great way to keep the ankle moving in the early stages of your rehab.

This exercise will focus more on the talocrural joint of the ankle, which is the main joint responsible for ankle plantarflexion and dorsiflexion, which are the largest movements of the ankle.

To perform this exercise, sit in a chair and have your foot on a surface wear it can slide. Usually wearing socks and having your foot on a harder floor, like hardwood or linoleum, will do just fine. For carpet, you may want to put something under your foot that can slide a little easier.

Simply slide your foot forwards and backwards without lifting your sole of your foot off the ground. Go to a point where you feel stiffness, but not pain.

This is a safe exercise for the ankle, so a low level of discomfort is ok given that you won’t be damaging anything, but try and keep any discomfort to a minimal level just to ensure you feel good after.

I recommend starting with 10-15 repetitions in each direction, and performing that 1-3 times throughout the day. This dose can be adjusted depending on how you’re feeling with it.

Ankle Proprioception on a Wobble Board

This exercise is another mobility exercise that will further challenge ankle proprioception. It’s a little more active and will incorporate all primary motions of the ankle: plantarflexion, dorsiflexion, inversion, and eversion.

To perform this exercise, sit in a chair with your knee at approximately 90 degrees of bend (normal sitting position) and place your foot on the middle of the wobble board so that your ankle is in a neutral 90 degree position (again, normal sitting position).

While maintaining full contact on the wobble board, try to perform a circular motion so that the edge of the wobble board gently contacts the ground as you move it around in a circle. This may not be possible in certain positions, so just do your best throughout, and don’t force your ankle into painful positions.

Wobble boards are often adjustable. Start with the lowest setting whereby the board is lower to the ground and then raise the board as needed.

A common cheating pattern to avoid is moving your knee and/or hip. Try to constrain the movement with your ankle, which may feel frustrating, but this will allow you to maximize your range of motion at the ankle joint itself.

I like starting with 5 circles clockwise, then 5 circles counter-clockwise, and performing 1-3 times per day. But just any other exercise, this dose can be adjusted to match your symptoms and time availability.

Ankle Dorsiflexion Passive Range of Motion (PROM)

This exercise will require you to sit in a half kneel position, meaning one knee will be contact with the ground, so if you have knee problems, this may not be the most suitable. In the absence of knee problems, it’s a nice way to target the ankle joint itself rather than a pure muscle stretch.

To perform this exercise, simply “take a knee” so that your leading ankle and knee are each starting in a 90 degree position. Move your body forwards without sliding your foot, which will bring your ankle into dorsiflexion, and then move backwards into relative plantarflexion.

Don’t go too fast and don’t push through pain. You can expect to feel some tension in your Achilles tendon behind your ankle, and you may also feel some restriction on the front of your ankle.

With ankle osteoarthritis, it’s advisable to avoid provoking pain on the front of your ankle with this exercise, but getting to a point of stiffness is usually ok.

Again, I prefer to start with 15 repetitions for this exercises, and doing it 1-3x per day if tolerable, but again, this can be adjusted based on your response to this type of activity.

To target the joint even further, you can add a strong resistance band with a good amount of tension as shown in the images below. This is considered a “mobilization with movement” exercise.

This can help provide more of a joint glide at the end range of motion, and without getting into too much detail, this can help further restore ankle range of motion and improve comfort.

However, it should be pain-free, and may not be suitable in the acute stages of injury, so we recommend checking in with a physical therapist to triple check that it’s safe for you.

Calf Stretching

Calf stretching can help relieve muscle and joint stiffness and improve comfort of the ankle and leg in general, again helping to reduce arthritis pain. In this case, there are two main muscles that can be targeted: the gastrocnemius muscle, and the soleus muscle.

To stretch the gastrocnemius muscle, simply perform ankle dorsiflexion with a straight knee. A common way to do this is to place your foot behind you flat on the floor and lean forwards without lifting your heel until you feel a comfortable stretch behind your leg and ankle.

You can also play around with turning the foot in or out while you do this to target specific portions of the muscle, but his has to be pain-free on the ankle, as well the joints above, namely the knee and hip.

To target the soleus muscle more, you can perform the exact same exercise, but bend your knee slightly, which will keep the soleus on stretch while putting the gastrocnemius on slack. You may feel this stretch shift a little lower more towards the ankle.

These stretches can be done in many other positions. For example, you can do with with a belt or strap in a non-weight bearing fashion, or you can stand on the edge of a step letting your heel drop below the surface of the step.

I prefer starting with 3 repetitions of 30 second holds at least once per day, and the stretch should feel reasonably comfortable.

Eversion and Inversion Stretching

Stretching muscles like the peroneals, tibialis anterior, and tibialis posterior, as well as other tissue on the sides of the ankle joint, is a little less common than the stretches shown above.

However, in certain cases, it can also be helpful, and this will target the subtalar joint of the ankle a little more as well, which is the joint largely responsible for movements of inversion and eversion.

I prefer to do this with my hands as opposed to cranking my ankle on the floor. This may require more mobility than you have available, but we figured we would show it here in case you find it helpful.

Like the calf stretches, I prefer starting with 3 repetitions of 30 second holds performed at least once a day, and the stretch should feel comfortable.

Basic Ankle Osteoarthritis Strength Exercises

Strengthening the ankle is very important to help minimize the progression of ankle osteoarthritis and subsequently reduce pain.

Non-weight bearing ankle exercises are often recommended to allow for an increase of strength around the ankle without provoking symptoms, but weight bearing exercises can also be important, as these more closely mimic daily activities and recreational activities.

Ankle Resistance Band Exercises

Ankle strengthening exercises using resistance bands are a popular way to increase strength of the lower leg muscles through range of motion without provoking the joint. You may also see the term “Theraband”, which is a common and good brand of resistance band for physical therapy purposes.

There are 4 primary ankle strengthening exercises with a resistance band, and very simply, they involve moving into the primary motions of the ankle against the resistance of the band.

Resisted ankle eversion will help strengthen the peroneal muscles (among others). Resisted ankle inversion will help strengthen tibialis posterior and tibialis anterior muscles (among others). Resisted ankle plantarflexion will help strengthen the calf muscles (among others). And finally, resisted ankle dorsiflexion will help strengthen tibialis anterior and extensor dogitorum muscle (among others).

There are many different ways to perform these exercises, but the ones shown below are the most popular (two different versions for ankle eversion and inversion). You can also do these in a seated position, I just find it’s a little easier to cheat with the knee or hip in this case.

I prefer to start with 3 sets of 12 repetitions for each of these exercises, and doing them every other day. That means one day your work, the next day your recover, and repeat. Reduce the reps and increase the tension for more focus on strength, and conversely, increase the reps and reduce the tension for more focus on endurance.

Calf Raises

Calf raises, also known as heel raises, will help strengthen the calf muscles, which are highly important for propulsion, as well as ankle stability and control.

There are a lot of different ways you can adapt calf raises to fit your needs. The most basic way to perform this exercise is to stand on flat ground, rising up onto your toes, and slowly lower back down to the ground.

To reduce the difficulty, you can focus on the ankle plantarflexion with a resistance band exercise that we mentioned above.

To increase the difficulty, you can work through more range of motion (e.g. off the edge of step), you can perform a single leg calf raises (meaning standing on one foot) as opposed to a double leg calf raises, you can add resistance by using a calf raise machine or hold a weight, or more simply, you can increase the dose.

You can also combine some of these elements together. The single leg calf raise off the edge of step is depicted in the images below.

The tempo may vary depending as well based on what you are trying to achieve. However, in most cases, if you are doing this exercise to treat an underlying painful condition like ankle arthritis, it’s usually recommended to go at a slow and comfortable pace.

I prefer to start with 3 sets of 12 repetitions, 3 times per week. Reduce the reps and increase the tension for more focus on strength, and conversely, increase the reps and reduce the tension for more focus on endurance.

Balance and Functional Strengthening for Ankle Osteoarthritis

It may take a little while for you to get to functional strength and stability exercises for your ankle arthritis, especially if your condition is severe or you have other injuries you are managing as well.

Given these are usually a little more advanced, consult with your local physical therapist if there is any doubt of the suitability of these exercises.

Single Leg Balance Variations

Working on balance will help improve your ankle strength and stability in a functional manner, especially when single leg balance is involved, as every muscle around the joint will need to be engaged to maintain balance.

The tricky part is finding the right level of challenge for your current condition. The images below will show some progressions of balance exercises from basic to advanced. It can be as simple as standing on one foot, or a bit more complex to really challenge balance and proprioception.

The correct exercise for you should feel challenging and potentially like a lot of hard work for the muscles, but should not elicit a lot of pain in the ankle joint itself, and should not be so challenging that you risk falling over altogether.

The dose will vary highly based on the severity of your ankle arthritis and your current capabilities. I prefer to focus more on exposure, meaning little bits of practice more frequently throughout the day or week.

For example, one may choose to perform 5 reps of 20s holds each day, and if more convenient, may split those reps up throughout the day. Again, this will depend on exactly what you’re trying to achieve.

If standing on one foot is too painful, then something like tandem balance depicted above may be a good starting point, as you can get a little more support from the other foot.

Conversely, if you’re feeling really good with these, you can increase the challenge of these exercises by targeting ankle proprioception a little further, which can be done by performing balance exercises with eyes closed. Of course, this must be done in a safe environment to prevent falling.

Functional Strength and Stability

If not too aggravating, strengthening functional movement patterns can go a long way to improving your quality of life if you have ankle arthritis, especially if you are an active individual that is trying to stay active.

There are countless ways to strengthen your ankle with functional movement patterns, but we will focus on the squat movement in this article, as this is a very important and common movement pattern that we perform throughout the day and with sports or other recreational activity.

Just like the balance exercise, we will show some progressions of squat exercises that will challenge ankle stability, and by way of the movement performed, will also help strengthen the knee and hip. As such, if you have any knee or hip problems, it’s once again important to double check with a physical therapist that these exercises are indeed suitable for you.

When we get in to more advanced ankle exercises like these, it’s really important to remember that the dose will be highly variable, perhaps even changing day-to-day depending on how you are feeling, so it’s hard to recommend a default amount of sets and reps.

In order to find the optimal sets and reps for these exercises, remember that the main principle is quality over quantity. Don’t compromise proper form for the sake of more reps, as this will create a safety hazard, and will just defeat the purpose anyway.

Additionally, challenge and discomfort can be expected, but if you are reproducing your familiar pain and it causes a reduction in your ability to function for the next day or two, that may be a little much. As such, try to find a dose that is tough, but tolerable, and allows you to complete the exercise with proper form.

Lastly, if you try these and find them way too hard, don’t be discouraged. It may simply mean starting with resistance band exercises or balance exercises first in order to build up.

I see this all the time in the clinic, where people feel like they should be able to do an exercise and can’t, and pushing through with bad form yields negative results. Remember this is rehab, not a test, so try to be mindful of where you’re at, and if anything, use the desire to perform advanced exercises as a motivator to build up to them properly.

Summary

Ankle arthritis can be a painful and debilitating condition, but that doesn’t mean it can’t be managed with conservative therapy. Exercise is one of the more proven ways to help alleviate symptoms associated with osteoarthritis while also improving function.

The exercises above represent just a fraction of the exercises available for ankle osteoarthritis, and we hope it provides you with some food for thought and a good starting point on your path to recovery.

References

Al-Mahrouqi, M. M., Macdonald, D. A., Vicenzino, B., & Smith, M. D. (2018). Physical impairments in adults with ankle osteoarthritis: a systematic review and meta-analysis. journal of orthopaedic & sports physical therapy, 48(6), 449-459.

Hubbard, T. J., Hicks-Little, C., & Cordova, M. (2009). Mechanical and sensorimotor implications with ankle osteoarthritis. Archives of physical medicine and rehabilitation, 90(7), 1136-1141.

Yeowell, G., Samarji, R. A., & Callaghan, M. J. (2021). An exploration of the experiences of people living with painful ankle osteoarthritis and the non-surgical management of this condition. Physiotherapy, 110, 70-76.

Disclaimer:

The content here is designed for information & education purposes only and is not intended for medical advice.