All About Ankle Pain

Ankle Pain                                           

Ankle pain is often due to an ankle sprain. A sprain is an injury to ligaments, which connect bones to one another. In most cases of ankle sprain, the ankle is twisted inward, causing tiny tears in the ligaments. This makes the ankle somewhat unstable. The tearing leads to swelling and bruising, making it difficult to bear weight on the joint.

Once an ankle is sprained, the injury may take a few weeks to many months to fully heal. Often, the injured ankle remains a little weaker and less stable than the uninjured one. A proper recovery program can prevent this problem.

Other structures in the ankle that can be damaged and cause pain are tendons (which join muscles to bone), cartilage (which cushions joints), and blood vessels. Adjacent areas can cause pain to be referred to (felt in) the ankle -- these include the foot, lower leg, knee, and even hip.

Common Causes
In addition to ankle sprains and other injuries, ankle pain can be caused by arthritis, gout, pseudogout, and infection.

Gout occurs when you produce too much uric acid (a waste product in the body). The extra uric acid gets deposited and forms crystals in joints, rather than being excreted in the urine.

Pseudogout is similar to gout. In this condition, calcium deposits in one or more of your joints, causing pain, redness, and swelling.
The types of arthritis that can cause ankle pain include:

  • Osteoarthritis
  • Rheumatoid arthritis
  • Chronic gouty arthritis
  • Psoriatic arthritis
  • Septic arthritis

Home Care

  • If you feel pain in your ankle, rest it for several days. Try NOT to move the affected area.
  • If your ankle is unstable, support it, especially during standing or walking. ACE bandages work well. If this does not provide enough support, you may need to be fit for a brace. Crutches or a cane can help take the weight off a sore or unsteady ankle.
  • For swelling, keep your foot elevated above the level of the heart, even while sleeping. Ice the area right away. Apply ice for 10-15 minutes every hour for the first day. Then, every 3-4 hours for 2 more days.
  • Try acetaminophen or ibuprofen for pain and swelling.

Even after the pain subsides, you will need to keep pressure off of it for up to 10 days for a mild sprain and up to 5 weeks for a more severe sprain.

Once you have healed adequately, you can start exercises to strengthen your ankle and avoid injury in the future. Do not begin these exercises until a health care professional tells you it is safe to start. One exercise, for example, involves balancing on your healing foot and hopping.

For arthritis of the ankle, take medication exactly as prescribed. When the pain and swelling start to decrease, gently begin to exercise the joint again. Swimming is good, followed by stretching. Walking can be added later. Exercises can be done several times a day; but DO NOT overdo it. Pain is a message from your body to stop.

Call your health care provider if:
Go to the hospital or call 911 if:

  • You have severe pain when NOT bearing weight.
  • You suspect a broken bone.
  • The joint appears deformed.
  • There is an audible popping sound and immediate difficulty using the joint.

Call your doctor if:

  • Swelling does not go down within 2-3 days.
  • You have symptoms of infection -- the area becomes red, more painful, or warm, or you have a fever over 100°F.
  • The pain does not go away after several weeks.

What to expect at your health care provider's office

Your doctor will perform a physical examination, including a detailed examination of the ankles, and ask questions such as:

  • Does the pain shift from joint to joint?
  • Is the pain the same in both ankles?
  • Did the pain begin suddenly and severely?
  • Did the pain begin slowly and mildly and then get worse?
  • Did the pain resolve spontaneously in less than 6 weeks?
  • Does the ankle feel warm to the touch?
  • Does the ankle hurt when you are not bearing weight on it?

Diagnostic tests that may be performed include the following:

  • X-ray of the ankle and possibly the foot
  • Aspiration of synovial fluid (fluid from the joint space) and synovial fluid analysis

Nonsteroidal anti-inflammatory medications (NSAIDs), special foot gear, or braces may be prescribed. Surgery is occasionally necessary.

Prevention

  • Lose weight if you are overweight. Extra pounds put strain on your ankles.
  • Warm-up before exercising. Stretch the muscles and tendons that anchor the ankle.
  • Avoid sports and activities for which you are not properly conditioned.
  • Make sure that shoes fit you properly. Avoid high-heeled shoes.
  • If you are prone to ankle pain or twisting your ankle during certain activities, use ankle support braces. These include air-casts, ACE bandages, or lace-up ankle supports.

Sprained Ankle

sprained ankle occurs following a sudden sideways or twisting movement of the foot. An ankle sprain can occur during athletic events or during everyday activities. All it takes is an awkward step or an uneven surface to cause an ankle sprain--that is why sprained ankles are among the most common orthopedic injuries. Orthopedic doctors see patients for ankle sprains very often, and it is the most common foot and ankle injury.

How does an ankle sprain occur?
A sprained ankle usually occurs when a person lands from jumping or running on to an uneven surface. For example, sprained ankles are often seen when basketball players come down from a jump and land on another player's foot. Ankle sprains also occur with more routine daily activities such as stepping off a curb or slipping on ice.

What happens inside the ankle when it is sprained?
An ankle sprain is an injury to the ligament in the ankle. The ligaments are structures that control excessive movement of the joint. When an ankle sprain happens, the ligament is stretched too far, and is either partially or completely torn.

There are two broad categories of ankle sprain:

Inversion Ankle Sprains
The most common type of ankle sprain occurs when the foot is inverted, falling inward. When this type of ankle sprain happens, the outer, or lateral, ligaments are stretched too far. There are three ligaments that attach to the outer side of the ankle. About 90% of ankle sprains are inversion injuries. Pain is always on the outside of the ankle, and there is usually no pain on the inside of the ankle joint.

Eversion Ankle Sprains
The other type of sprained ankle is called an eversion injury, where the foot is twisted outwards. When this occurs, the inner ligament, called the deltoid ligament, is stretched too far. Patients will have pain on the inner side of the ankle.

What are the symptoms of an ankle sprain?
Common symptoms associated with an ankle sprain are pain with swelling and bruising. The degree of symptoms tends to correlate well with the extent of the damage to these ligaments.

Grade I Ankle Sprain:
Grade I ankle sprains cause stretching of the ligament. The symptoms tend to be limited to pain and swelling. Most patients can walk without crutches, but may not be able to jog or jump.

Grade II Ankle Sprain:
A grade II ankle sprain is more severe partial tearing of the ligament. There is usually more significant swelling and bruising caused by bleeding under the skin. Patients usually have pain with walking, but can take a few steps.

Grade III Ankle Sprain:
Grade III ankle sprains are complete tears of the ligaments. The ankle is usually quite painful, and walking can be difficult. Patients may complain of instability, or a giving-way sensation in the ankle joint.

As said before, pain and swelling are the most common symptoms of an ankle sprain. Patients often notice bruising over the area of injury. This bruising will move down the foot towards the toes in the days after the ankle sprain--the reason for this is gravity pulling the blood downwards in the foot.

Do I need to see the doctor if I have an ankle sprain?
If you do have significant symptoms following a sprained ankle, you should seek medical attention. Signs that should raise concern include:

  • Inability to walk on the ankle
  • Significant swelling
  • Symptoms that do not improve quickly or persist beyond a few days
  • Pain in the foot or above the ankle

Differentiating between a sprained ankle and an ankle fracture can be difficult, and sometimes an x-ray is needed. While moderate pain and swelling are common symptoms following a simple sprained ankle, symptoms such as inability to place weight on the leg, numbness of the toes, or pain that is difficult to manage should raise concern. If you think you may have done more than sustained a sprained ankle, you should seek medical attention.

What is a 'high ankle sprain'?
A high ankle sprain is a particular type of injury to the ligaments around the ankle. In a high ankle sprain, the ligaments above the joint are also injured. These ligaments, called the syndesmosis ligaments, can also be injured, and may necessitate a longer course of rehabilitation.

What is the treatment of a sprained ankle?
Treatment of sprained ankles is important because returning to normal activities in a timely manner is important for most patients.