What could be causing your ankle pain and what should you do?
Ankle pain can happen suddenly or slowly over time. It could be from an obvious injury like a sprain, or vary from medical conditions such as osteoarthritis or gout.
Anatomy of the Ankle Joint
Your ankle is a ‘hinged’ joint, composed of three articulating bones (the tibia, fibula and talus) and supported by a network of muscles, ligaments and tendons.
All responsible for the movement and stability of your foot.
Ankles take on high loads of stress on a daily basis and can therefore be very prone to injury.
Pain or discomfort in your ankle(s) could be caused by a number of things, which is why it is important to seek advice and treatment.
Common causes of Ankle related Pain
Ankle sprains are one of the most common causes of ankle pain which occur when your ankle ligaments tear or are ‘overstretched’.
They can vary in severity from a mild “twisted” or “rolled” ankle sprain through to severe complete ligament ruptures, avulsion fractures or broken bones.
Sprains can occur in any age group and when:
- Awkwardly planting or landing your foot when running
- Landing unbalanced from a jump/hop
- Stepping onto an irregular surface
- Sports that involve swift direction changes
Depending on the severity, ankle sprains can present with a wide variety of symptoms including:
- A ‘popping’ sound at time of injury
- inability to put weight on the affected foot
- general stiffness.
Other causes of Ankle Pain
More gradual onsets of ankle pain can be caused by other means and can be directly or indirectly related to ankle sprains.
1) Chronic ankle instability from previous sprain(s) can cause either medial or lateral ankle pain which can be as much as a small ‘niggle’ to a more constant dull throbbing and feelings of ‘unsteadiness’ with walking or running. These are often hard to treat but pain will persist if not attended to.
2) Tendon related foot and ankle pain can be tricky to diagnose as well as treat.
Several tendons can be found around the ankle joint including the achilles, peroneals and tibialis anterior and posterior.
The muscles of these tendons are all responsible for control and stability of the ankle joint, which can acutely cause pain if instability, weakness, or instances of overload through exercise are present.
This can result in a swollen and stiff ankle with particular directions of movement more painful than others depending on the area affected.
Morning pain and stiffness usually accompanies any tendon related pain, as well as discomfort with or after prolonged exercise or mobility.
3) Osteoarthritis (OA) is a common cause of ankle pain in older populations due to wear and tear of the joint, which can make most weight-bearing activities (i.e. walking) uncomfortable. Morning pain and stiffness is again accompanied in arthritic instances of ankle related pain which may or may not ease once “warmed up”.
4) Gout is another form of arthritis which can affect any joint in the body. This condition is often very painful and many describe the feeling of gout as though their joint is on fire. An acute flare of gout causes swollen, red, hot and stiff joints with intolerable pain, which in the foot and ankle makes walking and day to day activities very difficult.
5) Other causes of ankle pain can also be nerve related – either local or referred. Tarsal tunnel syndrome is a condition that occurs when the posterior tibial nerve is compressed. This is a large nerve that runs down the back to the side of the lower leg and passes behind the inside ankle bone (medial malleolus). People with tarsal tunnel syndrome with often complain of pain and numbness on the outside portion of the bottom of the foot. Nerve related pain can also be referred from further up in the leg or even spine. This may or may not be accompanied with local back, hip or leg pain or can sometimes feel like a ‘line of pain’ leading down into the ankle or other symptoms such as pins and needles or a burning sensation.
Diagnosis and Treatment
As you can probably tell, diagnosing ankle pain is not always a simple task and therefore treatment must be tailored to each individual accordingly. A Physiotherapist will take a history of your ankle pain together with special tests and watching how your ankle generally moves to diagnose your pain.
Treatment after any acute ankle injury (such as a sprain) should always consist of the RICED principles (rest, ice, compress, elevate, do no harm).
Following this period regaining active movements of the ankle joint needs to occur (e.g drawing letters of the alphabet with your ankle) as well as improving strength, balance and proprioception through specific exercises as guided by your Physiotherapist.
These can include:
- double/single leg calf raises
- single leg balance with eyes open/closed/standing on foam/wobble board.
For most ankle related pain, a short period of reducing or modifying high impact or weight-bearing activities can be helpful in the early interim, especially in instances where tendinopathy or acute episodes of arthritic related pain are present. Alternative activities such as bike riding or swimming can be safe and even beneficial during this time, however should be advised by a health professional before commencing. Depending on assessment findings, other specific non-weight bearing strengthening exercises may be prescribed that include theraband resisted movements of the ankle joint.
It is always important to have your ankle pain properly assessed so that we know exactly what the cause is and what the best management strategies for you will be.
Any of the Physiotherapists at myPhysioSA are equipped with the skills to assess and recommend treatment for ankle injuries.
Book an appointment at any one of our clinics for ankle injury assessments.
Stephanie Korolis, myPhysioSA Physiotherapist – SPARC