Why does my ankle hurt?

You might wonder if you just pushed too hard on your run yesterday, or if you've logged a few too many squats over the years. Maybe you're suspicious that your new pair of shoes isn't supportive enough, or that an old ankle injury is flaring up after being on your feet all day.

Or, perish the thought, could it be arthritis?

"People with ankle arthritis often have some associated pain, but not everyone that has ankle pain has ankle arthritis," says Dr. Kevin Varner, orthopedic surgeon at Houston Methodist.

What is ankle arthritis?

The term "arthritis" can be a bit of a misnomer when it comes to the ankle joint, Dr. Varner notes, so some initial clarification is in order.

Rheumatoid arthritis — a chronic inflammatory condition that causes stiffness, discomfort and swelling in the joints, among other things — is what we often think of when we hear the word "arthritis." And while it can lead to ankle joint pain, it's not the most common reason for it. (Related: What Makes Arthritis Flare Up?)

"The vast majority of ankle arthritis is a degenerative condition," explains Dr. Varner. "Cartilage in the ankle joint has worn away, and instead of having smooth gliding surfaces in the joint, there are rougher surfaces that lead to bones rubbing against each other."

This irritation leads to pain, but not necessarily inflammation — herein lies the misnomer of the term ankle "arthritis."

What causes degeneration of ankle cartilage? Dr. Varner says that it's not related to being "too active." For instance, you don't become more prone to developing the problem just because you've run marathons your whole life.

"By far and away, the most common cause of ankle arthritis is post-traumatic change after an ankle injury," says Dr. Varner. "This typically occurs due to a high-energy fracture — during a car accident, for instance — but it can also be the result of multiple sprained ankles or osteochondral injury" (damage to the cartilage and underlying bone in a joint).

The instability, malalignment and laxity that occurs from such injuries accelerates wear and tear of ankle cartilage, making degeneration — and the resulting pain — more likely. Other causes of ankle arthritis include inflammatory diseases (like rheumatoid arthritis) and joint infections, though these are less likely, as well as your genetics.

"Similar to knee and hip arthritis, having a family history of ankle arthritis can predispose a person to developing it as well," adds Dr. Varner.

What does arthritis in the ankle feel like?

How can you tell if ankle joint pain is due to arthritis or something else? Dr. Varner says this can be tough to discern on your own since the signs can vary from person to person.

Ankle arthritis symptoms can include:

• Activity-related ankle pain or discomfort
• Start-up ankle pain or discomfort
• Swelling of the ankle joint
• Stiffness of the ankle joint
• Catching, sticking or locking in the ankle joint

For instance, one person might struggle with ankle pain that becomes more troublesome as their activity picks up throughout the day. But another might experience the opposite effect — stiffness and pain after waking up or sitting for a long period of time, then the joint loosening up as they get moving again.

Dr. Varner adds, though, that there is one near-constant hallmark of the condition.

"Some people with ankle arthritis experience pain, some experience swelling, but the vast majority have a pre-existing ankle injury history," explains Dr. Varner.

If you are experiencing sore ankle joints, consult your doctor. He or she will ask you about your specific symptoms and health history and perform a physical examination or other tests needed to diagnose or rule out ankle arthritis.

What is the best treatment for ankle arthritis?

The good news? From lifestyle measures to oral medications and other treatments, there's plenty to try when it comes to relieving ankle arthritis.

Ways to help manage ankle arthritis symptoms include:

• Activity modification
• Exercise (low-impact workouts only)
• Weight loss, if overweight
• Eating a well-balanced diet
• Avoiding non-supportive footwear, like flip-flops and heels
• Choosing supportive footwear or using orthotics
• Wearing an ankle brace
• Over-the-counter pain medication
• Topical pain relief gels
• Nonsurgical treatments, such as steroid, joint lubricant or platelet rich plasma (PRP) injections

(Related: Which OTC Pain Reliever Is Right for Me?)

"It's important to avoid activities that lead to pain and discomfort, but this does not mean being inactive," Dr. Varner adds. "Exercise helps keep the joint strong, mobile and functional, which can relieve symptoms."

Fortunately, there are plenty of low impact exercises a person with ankle arthritis can do, such as walking, swimming, biking, Pilates and yoga. Avoid explosive and high-impact exercises that overload the ankle joint, such as activities that involve jumping.

Living with ankle arthritis: When to consider surgery

Most ankle arthritis responds well to activity and lifestyle modifications, but not always.

"When conservative treatments don't work, we discuss the severity of their arthritis — how much it's limiting their activity or keeping them from the lifestyle they desire," explains Dr. Varner. "It's a very individualized conversation, which sometimes leads us to discuss surgery."

There are three main types of surgical procedures used to help treat ankle arthritis:

• Ankle arthroscopy – a minimally invasive surgery used to clear out mechanical problems, like bone spurs, that have developed in the ankle joint
• Ankle fusion – a surgical procedure that welds the ankle joint together
• Ankle replacement – a surgical procedure that replaces the damaged ankle joint with an artificial one

Each option comes with a few pros and cons, and Dr. Varner points out that the type of ankle surgery selected is a decision that must be personalized to specific indications.

"It's important to review the options with your doctor," he adds. "Which is right for you depends on the amount and severity of arthritis, your occupation, your lifestyle goals and other personal factors."