The most frequent cause is post-traumatic changes, which disrupt joint congruency and biomechanics. Other predisposing factors include chronic instability, lower limb malalignment, inflammatory diseases (e.g., rheumatoid arthritis), or metabolic disorders.

The main symptoms include ankle pain (initially with weight-bearing, later at rest), joint stiffness, swelling, crepitus, and in advanced stages, limited mobility and limping. The clinical course is often progressive and can significantly impact quality of life.

Diagnosis is based on a detailed history, physical examination, and imaging studies, especially weight-bearing radiographs, which typically reveal joint space narrowing, osteophyte formation, and subchondral sclerosis. MRI can help assess soft tissue involvement and bone marrow edema.

Treatment depends on severity: early stages are managed with conservative therapy. In advanced and disabling cases, surgical intervention may be required.

If left untreated, ankle osteoarthritis may lead to progressive disability, with chronic pain, functional impairment, and loss of independence.