Ankle Pain: What you need to know

Overview of ankle pain

Ankle pain refers to any discomfort or injury below the level of the ankle joint. It can be caused by sprains or falls, as well as medical conditions such as rheumatoid arthritis or even gout.

Symptoms of ankle pain

You may be experiencing,

Common causes of ankle pain

An ankle injury can involve various degrees of damage, to various ankle collateral ligaments and associated bones. Now, an ankle sprain is a common ankle injury, about 85% of ankle injuries are ankle sprains, however, ankle pain does not have to mean ankle sprain.

There are also acute and chronic injuries which can happen to the larger and smaller tendons around the ankle. There can be different degrees of joint damage; from impingement syndrome to osteoarthritis caused by different mechanisms of injury.

Besides mechanical factors, joint damage may also be due to inflammatory arthritis such as rheumatism or gout. Uncommon conditions, such as septic arthritis, bone or soft tissue tumours osteonecrosis. All of those can cause ankle pain. You can even have referred pain from somewhere outside the ankle area, including the neural vasculature.

Some of the most common causes of ankle injuries are;

As mentioned previously, the vast majority of ankle injuries are some version of an ankle sprain. The research suggests that these injuries are treatable, however, usually are not managed well in the long term. The biggest predictive factor of an ankle injury is having previously sprained it! Sufficient rehab and exercises are necessary to prevent further ankle injuries.

In the event of a serious ankle injury, there is a chance that you may have suffered a major ligament tear or even an avulsion fracture. This is where the ligament can completely tear off the bone. In this case, you will have severe pain and a lot of swelling. Please visit your GP immediately to get appropriate treatment.

Top 5 ankle injuries

Most commonly, physiotherapists will see patients with these ankle injuries;

  1. Ankle sprains

  2. Arthritis

  3. Gout

  4. Tendonitis

  5. Overuse injuries

Some of the sports and activities that lead to ankle injuries include;

Running

Running is a sport that will increase the strength and stability of the ankle, however, more is not always better. Running ankle injuries are most common with overtraining and fatigue. Speak to your coach or physiotherapist about ensuring that you aren’t training too hard! Your body needs rest and recovery to improve!

Netball

Netball is commonplace for ankle sprains. Changes of directions and the fast pace of the sport all contribute to the likelihood of injury. A lot of netballers will wear ankle braces to reduce the chances of rolling.

Gymnastics / dancing

Both gymnastics and dancing require greater than normal ankle mobility. Having to perform at extreme ranges of motion can make the ankle susceptible to injury. Stretching and recovery are both essential for gymnasts and dancers.

Tennis

Tennis is quite similar to netball in that it is a fast-paced sport with a lot of direction changes. Ankle sprains are prevalent in tennis, with most tennis players professionally using tape or braces to help prevent injury.

Ankle pain treatment

Self-treatment

The best thing to do in an acute ankle injury is to manage the pain and swelling. Some basic treatment methods are; rest, ice, compression, elevation, but seek medical attention immediately if you spot the following symptoms;

  1. severe pain, swelling or deformity

  2. open wounds

  3. signs of infection, such as redness or heat in the area

  4. inability to bear any weight on the foot

It is important to take care of your ankle, previous injuries can lead to complications later in life.

Gentle exercises

Whilst ‘rest’ is usually prescribed early on in ankle injury, it is important to keep sufficient movement in the joint. Gentle rotations and bending movements can help, you may also find that walking helps maintain a good range of motion as well.

Use heat and / or cold

Ice packs can be used if there is excessive swelling or pain acutely, for more chronic or ongoing pain, a heat pack can provide some good pain relief.

Avoid painful movements and exercises

You don’t want to overdo it when dealing with an ankle injury, activities such as running or playing sport should be avoided until you have been advised by a physiotherapist otherwise. You do not want to cause any further damage!

Stretching

Stretching your calves and achilles muscles can help manage pain, lean up against a wall, keep your heel on the ground and stretch the back of your leg out. Hold each stretch for at least 30 seconds for the best results.

Pain medication

Your pharmacist or GP can advise you on the appropriate pain medication if you need it. Generally, it is better to avoid pain medication if you can.

Seeking medical care

If you have severe pain or any concerns, it is best to speak to your GP as soon as possible. They will be able to advise you on the best course of action to manage your injury.

Make an appointment with a physio if

In most cases, ankle injuries can be appropriately managed by your local physiotherapist. You do not need a referral to see a physio and can make an appointment when you require.

Ankle injuries can be a source of discomfort and can limit your ability to go about your daily life. Simple tasks such as walking, climbing stairs and driving can be uncomfortable.

A physiotherapist will perform an initial assessment, firstly by asking you questions regarding the injury. This is described as a subjective assessment. The more information that you can provide your physiotherapist, the better! Including, but not limited to, aggravating factors, daily pain patterns and your medical history. Once your physio has collected enough information, they will move on to an objective assessment. Here they will focus on your movement and exercise capability.

Treatment of ankle injuries will include;

It will be up to your physiotherapist to guide you in the rehabilitation of your ankle injury. You may need to have time away from sports to allow sufficient healing and recovery

Frequently asked questions

What is the fastest way to relieve ankle pain?

Begin by following the simple steps to reduce inflammation:

Following 24-48 hours of this approach, you need to begin a rehabilitation program. A physiotherapist can guide you on how best to approach this.

How do I know if I’ve torn a ligament in my ankle?

Typically, following a bad ankle roll, you will hear a loud pop or crack noise. This will be followed by instantaneous swelling and quite significant pain. You can generally tell the severity of an ankle tear by the colour and amount of bruising. The more significant the bruising, the worse the injury.

Is walking good for ankle pain?

Under most circumstances, yes! If you have suffered a severe injury, then you may need to wear a boot or brace to allow healing and recovery. However, in most cases, walking will help reduce swelling and prevent stiffening of the ankle joint. Be sure to manage your pain appropriately and don’t overdo things!

Anatomy of the ankle

The human ankle is an intricate mechanism. The entire lower limb is interconnected but especially so at the foot and ankle. When we talk about the ankle joint, we are usually describing the talocrural joint. This connects the tibia and fibula to the foot (talus)

Working in conjunction with the foot, the ankle joint is responsible for bearing your body weight and adapting to any kind of terrain when you are walking. It is a synovial joint surrounded by a network of ligaments, tendons, muscles, nerves and blood vessels.

The ankle joint primarily functions as a hinge joint, allowing bending forward (plantarflexion) and back (dorsiflexion).

The ankle is supported by a collection of ligaments medially and laterally. The medial ligaments are unbelievably strong and rigid, making them unlikely to be the cause of injury or pain. The lateral ligaments usually come under test with a conventional ankle sprain. These ligaments are the;

The primary movements of the ankle joint are plantarflexion and dorsiflexion.

Plantarflexion is controlled by the posterior compartment of muscles;

Dorsiflexion is controlled by the posterior compartment of muscles;

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