Ankle Pain: Common Causes and Management

What is ankle pain?

Ankle is a hinge joint that connects the leg to the foot, any discomfort or pain felt in or around the ankle joint is referred to ankle pain. The ankle joint is made up of three ankle bones, the tibia, fibula, and talus, as well as several ligaments, tendons, and muscles that work together to support the three bones and joint, allowing for movement.

Ankle pain can range from mild to severe and can be acute or chronic, depending on the underlying cause. The most common cause of acute ankle pain is an ankle sprain. It may be accompanied by swelling, stiffness, redness, and warmth in the affected area. Ankle pain can make it difficult to walk or bear weight on the affected foot, and in severe cases, it may even limit mobility.

Structure of the ankle joint

The ankle joint is where the lower leg bone (the tibia) meets the foot bone (the talus). It is a hinge joint, which means it can bend and straighten. The ankle joint is supported by several ligaments and tendons that help keep it stable and allow for movement. When we walk, run, or jump, the ankle joint helps us absorb shock and maintain balance. Overall, the ankle joint is a crucial part of our body that allows us to move around with ease.

What are the common causes of ankle pain?

Ankle pain can have many causes, some of which include:

Ankle sprains:

One of the most common causes of ankle pain is a sprained ankle. A sprained ankle occurs when ligaments in the ankle are stretched or torn due to an injury or trauma. If a sprained ankle is left untreated, this can end up developing into chronic lateral ankle pain.

Fractures:

An ankle or heel bone fracture can occur when one or more of the bones in the ankle joint are broken. A broken ankle can be caused by an ankle injury or trauma.

Arthritis:

Osteoarthritis or rheumatoid arthritis can affect the movement of the joint and cause joint pain and stiffness. It is one of the more common causes of ankle pain in older patients.

Tendinitis/Tendinopathy:

These conditions occur when the tendons that connect muscles to bones become inflamed or degenerative, usually due to overuse or repetitive motion.

Achilles tendon pain:

This is a specific type of tendinopathy that affects the achilles tendon, which runs down the back of the ankle and connects the calf muscles to the heel bone.

Bursitis:

Inflammation of the fluid-filled sacs (bursae) that cushion the bones and tendons in the ankle joint.

Gout:

A form of arthritis caused by a build-up of uric acid crystals in the joints, often affecting the big toe but can also affect the ankle.

Nerve damage:

Nerve damage or compression, such as from a pinched nerve, can cause ankle pain.

Assessment of ankle pain

When assessing ankle pain, healthcare professionals typically use a combination of subjective and objective measures to determine the cause and severity of the pain. Here are some common assessment techniques used for ankle pain:

Patient history:

A healthcare professional will typically begin by taking a detailed patient history to understand the nature and onset of the pain. They may ask questions about when the pain started, what activities exacerbate or relieve the pain, and whether there is a history of previous ankle injuries or medical conditions.

Physical examination:

A physical examination will typically be performed to assess the ankle joint, ligaments, soft tissue, surrounding structures. The healthcare professional will assess the range of motion of the ankle, test for stability and strength, and look for signs of swelling or bruising.

Imaging tests:

In some cases, imaging tests such as X-rays, CT scans, or MRI scans may be ordered to help diagnose the cause of the ankle pain. These tests can help identify fractures, ligament tears, or other structural abnormalities.

Laboratory tests:

Blood tests may be ordered to help diagnose conditions such as gout or arthritis that can cause ankle pain.

Special tests:

Special tests such as the anterior drawer test or the talar tilt test may be performed to assess the stability of the ankle joint and help diagnose ligament injuries. These tests help diagnose an ankle sprain.

Functional assessment:

A healthcare professional may assess how the ankle joint functions during specific activities such as walking, running, or jumping to help identify any movement patterns that may be contributing to the pain.

Based on the results of these assessments, healthcare professionals can diagnose the cause of the ankle pain and develop a treatment plan. Treatment for ankle pain may include rest, physical therapy, medication, or surgery depending on the severity and underlying cause of the pain.

Treatment and management of ankle pain

The treatment for ankle pain depends on the underlying cause and severity of the pain. Some common treatments for ankle pain include:

Rest:

Resting the ankle and avoiding activities that aggravate the pain can help reduce inflammation and promote healing. Ankle swelling should be reduced prior to commencing weight bearing exercise.

Ice:

Applying ice to the affected area for 15 minutes each time, several times a day, can help relieve pain and swelling.

Compression:

Wrapping the ankle with an elastic bandage or using a compression sleeve can help reduce pain and swelling and support the joint.

Elevation:

Elevating the affected leg above the heart level can help reduce swelling and improve blood flow.

Physiotherapy:

Soft tissue therapy, exercises and stretches prescribed by a physiotherapist/physical therapist can help strengthen the muscles around the ankle joint, improve range of motion, and reduce pain.

Medications:

Over-the-counter pain relievers like acetaminophen and ibuprofen can help relieve pain and reduce swelling. In some cases, prescription medications may be necessary.

Braces or orthotics:

Wearing an ankle brace or orthotic can help support the ankle joint and improve stability. Orthotics can also act as arch supports when running or walking.

Injection therapy:

Steroid injections or platelet-rich plasma (PRP) injections may be used to reduce swelling, inflammation, and promote healing.

Surgery:

In severe cases, surgery may be necessary to repair a torn ligament or tendon, remove damaged tissue, or stabilise the joint. A walking boot will be required to be worn for a period time following. This decision should be made in conjunction with orthopaedic surgeons.

Referral to another medical professional:

Where rheumatoid arthritis or septic arthritis has been diagnosed, a referral to a Rheumatologist or General Practitioner should be made for further testing.

How long does an ankle sprain take to heal?

The healing time for an ankle sprain depends on several factors, including the severity of the sprain and individual healing capabilities. Generally, it can take anywhere from a few days to several weeks for an ankle sprain to heal completely.

Here is a breakdown of the typical healing timeline for different grades of ankle sprains:

Grade 1 (mild):

Mild sprains involve stretching or slight tearing of the ligaments. Healing usually takes about 1-2 weeks, with symptoms gradually improving during this time.

Grade 2 (moderate):

Moderate sprains involve partial tearing of the ligaments. Healing may take 2-4 weeks, and symptoms may persist for several weeks. Rehabilitation exercises are important during this phase to restore strength and stability.

Grade 3 (severe):

Severe sprains involve complete tearing or significant damage to the ligaments. Healing can take 4-8 weeks or longer, depending on the extent of the injury. Rehabilitation and supervised physical therapy are crucial for regaining full function.

It is important to note that ankle sprains that are left untreated are at risk of becoming chronic. Chronic lateral ankle pain and chronic instability can occur if rehabilitation is not completed following the initial injury.

Prevention of ankle pain

Preventing ankle pain requires maintaining good ankle and foot health, as well as taking precautions to avoid injuries. Here are some tips on how to prevent ankle pain:

1. Wear appropriate footwear: Wear shoes that fit well and provide adequate support for your feet and ankles. Avoid wearing high heels or shoes with a narrow toe box, as these can increase the risk of ankle injuries.
2. Ensure proper warm up: Warm up properly before engaging in any physical activity. Stretch your calf muscles and the muscles around your ankle joint to improve flexibility and reduce the risk of injury.
3. Strengthen the muscles around the ankle: Strong muscles can help support the ankle joint and reduce the risk of injury. Exercises such as ankle rolls, calf raises, and balance exercises can help improve strength and stability.
4. Maintain a healthy body weight: Excess weight can place additional stress on the ankles and feet, increasing the risk of injury and pain. Maintaining a healthy weight through regular exercise and a balanced diet can help reduce this risk.
5. Avoid repetitive strain: Avoid repetitive activities that place excessive stress on the ankle joint, such as running on uneven surfaces or jumping on hard surfaces. Mix up your exercise routine to reduce the risk of repetitive ankle sprains.
6. Wear ankle braces or supports: If you have a history of ankle injuries or weak ankles, consider wearing ankle braces or supports during physical activity to help prevent injury.
7. Take breaks: If you engage in activities that require prolonged standing or walking, take frequent breaks to rest your feet and ankles.
8. Use proper techniques: If you participate in sports, make sure to use proper techniques and form to reduce the risk of injury. For example, use proper landing techniques when jumping and avoid sudden changes in direction.

In summary

Ankle pain can be caused by a variety of factors, including acute trauma (e.g. ankle sprain), overuse, and medical conditions such as arthritis, rheumatoid arthritis, and septic arthritis.

Common symptoms of ankle pain include swelling, stiffness, and difficulty walking. Treatment for ankle pain depends on the underlying cause of the pain but may include rest, physical therapy, medication, or surgery.

To prevent ankle pain, it is important to maintain good ankle and foot health, wear appropriate footwear, warm up properly before physical activity, and avoid repetitive activities that place excessive stress on the ankle joint. Strengthening the muscles around the ankle and maintaining a healthy weight can also help prevent ankle pain.

Taking preventative measures and seeking prompt treatment when necessary, can help reduce the risk of ankle pain and maintain healthy ankles and feet. If you experience ankle pain, it is important to seek medical attention to determine the cause and appropriate treatment.