Non-Surgical Options to Avoid Ankle Replacement in NJ

Clifton Physical Therapy
Non-Surgical Options to Avoid Ankle Replacement in NJ

Who This Article Is For and Why It Matters

This article is written for people in New Jersey who have been told they may need ankle replacement or ankle fusion surgery, but are not fully comfortable moving forward yet.

If you are dealing with long-standing ankle pain, instability, swelling that does not go away, or post-traumatic ankle arthritis, you may feel stuck between living with pain and committing to a major surgery. Many patients reach this point after years of physical therapy, walking boots, medications, or cortisone injections that worked at first but slowly lost effectiveness.

For some patients, surgery is necessary and appropriate. This is especially true when the ankle joint is severely deformed, structurally unstable, or unable to support body weight. But for others, surgery is considered elective, meaning it is a choice rather than an emergency.

In our experience at Clifton Physical Therapy, many patients are surprised to learn that non-surgical options may still exist, even after surgery has been recommended.

Why Ankle Replacement or Fusion Is Often Recommended

Most ankle replacement and ankle fusion recommendations follow a familiar pattern. It usually starts with ligament damage or a significant ankle injury. Over time, that instability causes abnormal joint motion. Cartilage wears down. Swelling becomes constant. Bone spurs form. Eventually, the ankle becomes stiff, painful, and unpredictable. By the time surgery is discussed, many patients report:

  • Daily ankle pain that limits walking or standing

  • Pain medications or anti-inflammatories working less and less

  • Cortisone injections providing shorter relief each time

  • Needing to change how they walk to avoid bone-on-bone pain

  • Difficulty working, exercising, or enjoying hobbies like golf or long walks

From a surgical standpoint, ankle fusion removes pain by eliminating motion. Ankle replacement preserves motion but introduces hardware that must tolerate daily weight-bearing forces. Research consistently shows that both options can help some patients, but both also carry meaningful risks, including revision surgery, nonunion, persistent pain, and long recovery periods.

When Surgery May Be the Only Realistic Option

It is important to be clear and honest. Non-surgical care is not appropriate for everyone. Surgery may truly be necessary when:

  • The ankle bones are structurally unable to support body weight

  • Severe deformity exists after trauma or multiple surgeries

  • Large bone spurs have already locked the ankle into near-fusion

  • Hardware failure or bone collapse has already occurred

  • Advanced degeneration leaves almost no usable joint space

In these cases, delaying surgery may worsen outcomes or increase risk. Non-surgical care cannot rebuild collapsed bone or correct severe mechanical deformity.

That said, many patients are told surgery is the only option before reaching these extremes. This is where careful evaluation matters. Advanced ankle arthritis often progresses due to instability, not just cartilage loss.

The Role of Ankle Instability in Degeneration and Pain

One of the most overlooked drivers of ankle arthritis is chronic ankle instability. When key ligaments, especially the anterior talofibular ligament and calcaneofibular ligament, are damaged, the ankle no longer moves normally. Even small amounts of extra motion can cause uneven cartilage wear. Over time, the body responds with inflammation, swelling, and eventually bone spur formation in an attempt to stabilize the joint. Research shows that patients with long-standing ankle instability are significantly more likely to develop:

  • Osteochondral cartilage lesions

  • Bone spurs at the tibia or talus

  • Reduced ankle motion and impingement

  • Progressive pain and stiffness

This matters because many patients are told they have “bone-on-bone” arthritis without a full discussion of why it developed. In some cases, improving ligament support, muscle strength, joint control, and load distribution can meaningfully reduce symptoms, even when arthritis is already present.

Non-surgical care at this stage is not about reversing arthritis overnight. It is about restoring as much stability, function, and movement quality as possible so the ankle can tolerate daily life with less pain.

Evidence-Based Non-Surgical Options That May Help Delay Surgery

Even in advanced ankle arthritis, there are strategies to reduce pain, improve function, and slow degeneration. These approaches are not quick fixes—they require consistent effort—but they can make a meaningful difference.

1. Physical Therapy and Targeted Strengthening
Focused therapy can improve ankle stability, strengthen surrounding muscles, and restore proper gait mechanics. Strengthening the ligaments and muscles around the ankle reduces abnormal joint stress and may decrease pain caused by instability.

2. Prolotherapy and Platelet-Rich Plasma (PRP) Injections
These treatments stimulate the body’s natural healing process. Prolotherapy involves small injections that encourage ligament tightening, while PRP uses components from your own blood to promote tissue repair. Both approaches target the root cause—instability—rather than just masking pain.

3. Stem Cell Therapy
Reserved for select cases, stem cell injections may support cartilage repair and improve joint function. While results vary, they offer a regenerative approach without the need for surgery.

4. Joint Lubrication and Anti-Inflammatory Treatments
Hyaluronic acid injections can act as a shock absorber in the joint, reducing friction and pain. Cortisone injections remain an option but are often less effective over time.

5. Custom Orthotics and Supportive Footwear
Properly fitted orthotics can redistribute weight, reduce stress on the ankle, and improve alignment, decreasing the likelihood of further cartilage damage.

Lifestyle Adjustments and Exercise Modification

Low-impact activities, anti-inflammatory diet changes, and weight management reduce stress on the ankle and support long-term joint health.

While these treatments cannot fully reverse advanced arthritis, research and clinical experience show they can significantly improve pain, stability, and mobility—sometimes enough to delay or even avoid surgery.

What Physical Therapy Can and Cannot Do for Advanced Ankle Arthritis

Physical therapy plays a central role in non-surgical management, but it has limits.

What it can do:

  • Strengthen muscles around the ankle to improve support

  • Restore balance, coordination, and walking mechanics

  • Reduce pain caused by instability

  • Help manage swelling and inflammation

  • Improve calf strength to reduce cramping

What it cannot do:

  • Regrow lost cartilage

  • Replace bone that has collapsed

  • Remove large bone spurs already causing mechanical block

Physical therapy works best in combination with regenerative injections, orthotics, and lifestyle strategies. Together, these approaches aim to optimize function and reduce the need for surgery.

Who Is and Is Not a Good Candidate for Non-Surgical Care

Not every patient can avoid ankle replacement or fusion. Non-surgical management is most effective for those who:

  • Have moderate to advanced arthritis but maintain some joint mobility

  • Experience instability-driven pain rather than complete bone-on-bone collapse

  • Are committed to regular therapy, exercise, and lifestyle changes

  • Prefer to avoid surgery when possible

Patients with severe structural deformity, extensive bone spurs locking the ankle, or failed prior surgeries may find surgery unavoidable. However, even in these cases, non-surgical approaches can improve recovery, manage pain preoperatively, or maintain function while preparing for surgery.

When to Reconsider Surgery and How to Make the Decision

Surgery may become necessary if:

  • Pain persists despite non-surgical care

  • Ankle instability leads to frequent subluxations or falls

  • Mobility becomes severely limited

  • Quality of life is significantly affected

When considering ankle replacement or fusion, it is important to have a detailed discussion with your orthopedic surgeon, including:

  • Likely recovery timeline and complications

  • Potential need for revision surgery

  • Impact on work, sports, and daily activities

  • Alternative non-surgical strategies and their expected outcomes

The Bottom Line

Ankle replacement and fusion can be effective for certain patients, but they are not the only path. For many, a combination of physical therapy, regenerative injections, orthotics, and lifestyle adjustments can relieve pain, improve stability, and delay surgery.

If you’re struggling with ankle pain or instability and want to explore non-surgical options before considering surgery, call Clifton Physical Therapy today at (973) 241-1338 to schedule a consultation.

What patients are saying

"I recently had ankle surgery and Clifton PT has been nothing short of amazing! My goal was to get back to playing soccer as quick as possible before the college season started and so far I'm right on track. Izzy, Bianca, Tiff, and John have gone above and beyond to make sure I'm back to 100%. Couldn't be more grateful to be treated by the best team ever!." - Nat Rufino

All the therapists at Clifton Physical Therapy are awesome, but I spend most of my time with Izzy and Bianca—and they’ve been amazing. They’re enthusiastic, knowledgeable, and always take the time to explain what I’m doing and what my issues are. Their positive energy and clear communication make a big difference in my recovery." - Bryan Tompkins

"Going Clifton physical therapy was one of the best thing that came out of my back pain! Every single staff member is amazing and cares for your recovery! I have been with them for the past couple of months and now continuing their workout program! I can’t recommend them enough! Tiffany, Izzy, Bianca and everyone else I have worked with there! Can’t rave about them enough!!." - Monica Mehta

"Clifton Physical Therapy has been a great place for me to heal my meniscus tear. The staff is very knowledgeable and friendly, and has been extremely helpful in guiding me through my recovery. I highly recommend their services.." - Kelly Bevando


Clifton Physical Therapy


✆ Phone (appointments): (973)-241-1338


Address: 1059 Bloomfield Ave, Clifton, NJ 07012