The main differential diagnosis of ankle osteoarthritis is: First, when talar osteonecrosis is present radiographs will show hyperplasia in the tibial talar joint and there is depression of the talus with necrosis, which is mainly suitable for ankle osteoarthritis with osteophytes and gap reduction need to be differentiated. Second, ankle arthritis needs to be distinguished from reactive arthritis, such as rheumatoid arthritis or gouty arthritis and other reactive arthritis, which can also show local inflammatory reaction and hyperplasia, and there can be obvious differences on the X-ray. Thirdly, osteoarthritis of the ankle joint should be distinguished from certain fractures, such as invisible fractures or crack fractures, which are also similar to osteoarthritis of the ankle joint.