One hundred thirty-five patients with ankle osteoarthritis were randomized to receive either a single corticosteroid injection (n = 61) or a dual injection protocol of corticosteroid plus hyaluronic acid (n = 74). The corticosteroid-only group received one intra-articular injection consisting of corticosteroid, bupivacaine, and saline. The dual group received an initial injection of corticosteroid, hyaluronic acid, bupivacaine, and saline, followed by two additional weekly injections of hyaluronic acid alone. The primary outcome was change in the Ankle Osteoarthritis Scale (AOS). Secondary outcomes included Visual Analogue Scale (VAS), SF-36 scores, and complication rates. Assessments were conducted at baseline, 6 weeks, and 12 weeks. Overall, the results revealed significantly greater improvement in AOS scores in the dual injection group at both 6 and 12 weeks, while VAS scores showed a greater early reduction in the corticosteroid-only group at 6 weeks, with no difference at 12 weeks. No significant group differences were found for SF-36. The study concludes that dual intra-articular injections of corticosteroid and hyaluronic acid yield superior outcomes for ankle OA compared to corticosteroid alone, particularly in terms of sustained symptom relief.