Ankle Pain: Symptoms, Causes, Risks, Complications, Diagnosis, Treatment and Prevention

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A woman holding her ankle during Sport exercise because of a ankle pain

1Overview

The ankle is a hinged joint that makes it possible for the foot to move in two primary directions – plantar flexion, which is away from the body and dorsiflexion, which is toward the body. The ankle is important in regular activities such as walking and running.

The various elements in the ankle provide stability to the ankle joints, which is a weight-bearing joint in the body when standing, running or walking. Subsequently, the Achilles tendon, the large tendon of the calf muscle is an important part of the ankle and foot.
If it becomes torn or damaged, this may lead to permanent disability and chronic pain.

Ankle pain refers to any discomfort or pain the ankles. This pain is caused by many factors. Ankle pain is usually due to an ankle sprain but there are other causes such as arthritis, gout, tendonitis, nerve compression, ankle instability, poor structural alignment of the foot and infection.

However, an ankle sprain is one of the common culprits of ankle pain, accounting for about 85 percent of all injuries involving the ankle.

2Symptoms

The ankle joint is where the bones of the legs and feet meet. It’s responsible for the up and down motion of the foot. When the ankle is damaged, inflamed or sprained, many signs and symptoms might appear, including:

  • Ankle swelling
  • Redness
  • Bruising
  • Instability
  • Inability to bear weight on the affected ankle
  • Burning pain
  • Stiffness
  • Tingling or numbness
  • Weakness in the affected foot

3Causes

The major causes of ankle pain include:

Ankle injuries

Sprains and strains – These are very common injuries affecting the muscles and ligaments in the ankle joint. These are caused by suddenly changing positions or moving fast suddenly. In some cases, ankle pain may be due to falling or colliding with a person or an object, especially those who participate in contact sports.

Ankle fractures – Fractures or break in the bones could lead to ankle pain. Ankle fracture may result from falls, or if you twist or toll the ankle while running, walking, going up the stairs or playing sports. Other causes of ankle fractures include vehicular accidents, falling from the stairs or a severe blow to the foot.

Achilles tendon rupture – An Achilles tendon rupture is a break in the Achilles tendon as a result of the strenuous activity. The break may cause a loud popping sound, severe pain, inability to move or walk and inability to stand on the toes.

Diseases affecting the ankle joint:

Many conditions and diseases can lead to ankle pain

Osteoarthritis (OA) – Osteoarthritis is a condition wherein there is a breakdown of the cartilage that acts as a cushion at the ends of the bones. The cartilage prevents the bones from rubbing against each other. Osteoarthritis is commonly seen in weight-bearing joints such as the knees and ankles.

Juvenile arthritis – This type of arthritis begins at the age of 16. This condition may lead to the ankle swelling and pain.

Rheumatoid arthritis (RA) – Rheumatoid arthritis is a chronic inflammatory and autoimmune disease of the joints. This results when the immune system mistakenly attacks the synovium, the membrane that lines the joints. Just like any other arthritis, this may lead to inflammation and pain.

Gout – Gout is a type of arthritis that affects the joints. It results when there are excessive amounts of uric acid in the body, which are deposited as needle-shaped monosodium urate crystals in the joints. This is extremely painful and can affect any joint in the body, especially the big toe and sometimes, the ankle.

The other causes include:

  • Nerve damage or injury like sciatica
  • Infection in the joint
  • Blocked or compressed blood vessels

4Risk Factors

Risk factors may increase the tendency of a person to develop ankle pain, including:

  • Sprained ankle
  • Obesity or being overweight
  • Bone fracture
  • Injury
  • Pronation of the foot
  • Flat feet
  • Autoimmune diseases
  • Stress on the ankle joint like for athletes who overuse the joint

The other risk factors for developing ankle injuries include:

  • Poor athletic conditioning
  • Not warming up before activity
  • Muscle and ligament fatigue
  • Carrying excess weight
  • Being female in athletes who are more than 30 years old
  • History of ankle injuries or sprains
  • Participation in high-risk sports
  • High-arched foot
  • Weak muscles
  • Loose joints
  • Sports participation
  • Walking or running on uneven surfaces
  • Improper shoes or footwear

5Complications

Ankle pain due to injuries is common. The common complications linked to ankle pain and injury include:

Chronic pain – Prolonged pain is the most common complication of ankle injuries.
The pain is usually as a result of the trauma to the joint, tendons and muscles of the foot.

Persistent inflammation – The chronic or persistent inflammation of the ankle can be caused by many factors, such as crushed blood vessels, compression of the ankle joints and unhealed fractures or torn ligaments.

Joint stiffness – Joint stiffness in the ankle is another complication of ankle injuries.
The stiffness or rigidity of the ankle can be accompanied by pain and inability to perform a range of motion.

Joint instability – Joint instability in the ankle develops when the injured part of the ankle heals in a stretched position. This causes the ankle to move in unusual positions and sometimes, it can be hypermobile.

Nerve compression or dysfunction – The nerves of the ankles can be affected when the ankle is twisted during accidents. Also, excessive swelling may put pressure on the cutaneous nerves in the ankle.

6Diagnosis

Ankle pain can be diagnosed by many diagnostic tests such as physical examination, history taking, imaging tests and laboratory tests.

Physical assessment – The physical assessment ankle pain involves the doctor looking at the affected ankle and touching them to look for areas of tenderness, pain, and swelling.

Medical history – The doctor will assess the medical history of the patient through questions about the symptoms, the severity of the symptoms and the nature of work or activity that may put a strain on the ankle joint.

Imaging tests – Imaging tests can help diagnose ankle problems. This may also show fractures and other abnormalities.

The most commonly used imaging test is the X-ray, which can show fractures, the condition of the joint space, and the presence of bone spurs. Another imaging test is the computed tomography scan or CT scan, which creates 3D cross-sectional images of the internal part of the ankle. This can show the soft tissues such as ligaments, muscles and the cartilage.

A magnetic resonance imaging (MRI) can also provide photos of the internal structures of the soft tissues, bones, and some areas where there is inflammation. Lastly, the bone scan, which requires the injection of radioactive material, will show the condition of the bones to detect fractures and bone growths.

Laboratory tests – If the condition is caused by arthritis, bone tests and joint fluid analysis may be required for examination.

7Treatment

If the ankle pain is caused by an injury, there are ways to provide immediate at-home treatment and relief for ankle pain. This is called the RICE method, which includes:

Rest – Do not put weight on the ankle and try to move as little as possible. You can use walking aids if you feel better.

Ice – Put a cold compress on the ankle for about 20 minutes at a time. Repeat this procedure three times a day.

Compression – For injured ankles, wrap the ankles with an elastic bandage. However, do not wrap the ankles too tightly to still provide circulation to the injured area.

Elevation – Elevate the affected leg and keep the ankle raised above the heart level.

Medications

The common medicines used to treat ankle pain are nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, analgesics and over-the-counter pain relievers. Make sure these are still prescribed by licensed doctors to prevent complications and adverse side effects.

Devices

Walking with a painful ankle is difficult and uncomfortable. Using crutches and walkers are helpful until the pain subsides. The doctor may also recommend using bandages or sports tape to support the ankle.

Therapy

Once the pain and inflammation subside, therapy us needed to restore the ankle’s range of motion, stability, flexibility, and strength.

Surgery

In more severe cases, surgery is needed. Usually, surgery is needed to reconstruct a ligament and repair a ligament that won’t work. In rare cases, surgery can be used in severe fractures where screws are needed to keep the bones intact and to prevent further damage to the area affected.

8Prevention

The following are preventive measures to prevent ankle pain and injury:

  • Be careful and watch your step when walking or running, particularly on surfaces with uneven levels
  • Warm up before any exercise or sports activities
  • Use an ankle support or brace on your previously injured or weak ankle.
  • Do not use high-heeled shoes if you’re not used to them
  • Do not play sports if you’re not well-conditioned
  • Maintain good muscle flexibility and muscle strength
  • Use shoes that are ideal for various activities
  • Practice balance and stability exercises
  • Maintain a healthy weight or lose weight if you’re overweight or obese
  • Eat a healthy and well-balanced diet
  • Exercise regularly
  • Do stretch exercises