Ankle Pain Causes of Acute and Chronic Pain, Treatment

What is ankle pain?

Ankle pain is any discomfort or soreness emanating from the ankle which may be related to the ankle structures or neighboring regions of the foot or lower leg. The most common causes of ankle pain are a sprained ankle, although there may be other causes such as a fracture, arthritis, or infection. Pain may be present in one or both ankles.The ankle connects the leg to the foot and the area around this region. The ankle joint is a hinge joint made up of bones, ligaments, tendons, muscles, nerves, and blood vessels. It is a very strong and stable joint which supports the body weight on standing. The up and down movement at the joint allows smooth movement while walking and running.

Inside the Ankle

Under the skin of the ankle lies the following structures :

• Bones of the ankle joint comprise of the talus (ankle bone), which fits in proximally in the socket formed by the lower end of the tibia (shin bone) and fibula (small bone of the lower leg) to form the talocrural joint. The up-and-down movement at this joint results in dorsiflexion and plantarflexion. The lower surface of the tibia and fibula form the tibiofibular joint. Distally, the talus sits on the calcaneus (heel bone) to form the subtalar joint. This joint allows inward and outward ankle movements known as inversion and eversion.
• Articular cartilage within the joint not only allows smooth movement of the joint but also acts as a buffer or shock absorber while carrying body weight during standing, walking, or running.
• Ligaments are tough fibrous bands of connective tissue that connect and hold the bones together. There are 2 main ligaments around the ankle joint which help to support this region. The lateral collateral ligament is made up of three separate ligaments and is most often sprained. The medial collateral ligament or the deltoid ligament is stronger and is less likely to be injured.
• Tendons are fibrous tissue that connects muscles to bones. The Achilles tendon joins the calf muscles to the calcaneus. It is the most important tendon involved in walking, running, or jumping, and allows a person to rise up on his toes. The other tendons of the foot are associated with various functions of the foot.
• Muscles of the lower leg and their tendons are responsible for movement of the ankle joint.
• Nerves supplying the ankle are the tibial nerve, which runs behind the medial malleolus, and other nerves on the front and outer edge of the ankle.
• Blood vessels include the main arteries supplying the ankle which are the dorsalis pedis artery in front of the ankle and the posterior tibial artery behind the medial malleolus.

Symptoms of Ankle Pain

The symptoms of ankle pain may come on suddenly (acute pain) or over a period of time (chronic pain). The pain may be mild or severe. It may be a sharp, shooting pain, or a dull, aching, throbbing pain. Ankle pain may be associated with various other symptoms.

Acute Ankle Pain

Acute pain is usually caused by injury and may be very severe. Accompanying symptoms includes :

• Restricted mobility of the ankle or foot.
• Inability to move the foot.
• Inability to stand or bear weight on the foot.
• Swelling.
• Signs of injury, such as bruises.

Chronic Ankle Pain

Chronic pain is usually due to overuse or disease. The pain develops more gradually over a period of time. The pain may flit from joint to joint. Accompanying symptoms may include :

• Joint stiffness.
• Swelling.
• Redness of the area.
• Warmth over the area.
• Restricted mobility of the ankle.
• Fever.
• Abnormal sensation in the foot such as tingling and numbness.
• Foot or ankle deformity.

Causes of Ankle Pain

Injury

Injuries can result in sprains, strains, or fractures. Ankle pain is often caused by sports injuries.

• Sprains – ligament tears are known as sprains. This is most often caused by sports injuries or the ankle being twisted inwards while walking on uneven ground.
• Strains – muscle or tendon pull or tear result in strains. Rupture of the Achilles tendon is a common cause of ankle pain.
• Fractures – broken ankle or foot mainly due to severe trauma or stress fractures from overuse and repetitive injuries.

There are other structures that may be inflamed as a result of injury. However, inflammation of these structures may also arise without any preceding injury.

• Tendinitis – inflammation of a tendon, such as Achilles tendinitis.
• Bursitis – inflammation of small fluid-filled pockets that reduces friction between the body structures. It can sometimes be infected.

Arthritis

Arthritis is inflammation of the joint lining and/or articular cartilage. There are many different types of arthritis that can cause ankle pain including :

• Rheumatoid arthritis
• Osteoarthritis
• Ankylosing spondylitis
• Reactive arthritis
• Gouty arthritis
• Psoriatic arthritis
• Septic arthritis

Infection

The main types of infection causing ankle pain may include cellulitis (tissue under the skin surface) and osteomyelitis (bone).

Risk of infection increases in case of :

• Break in the skin due to injury, animal bite, or ulceration.
• Diabetes.
• Immunocompromised state as in HIV/AIDS.
• Individuals on immunosuppressive drugs or cortisone.

Other Conditions

• Nerve compression – such as tarsal tunnel syndrome, where there is compression of the tibial nerve at the ankle as it passes through the tarsal tunnel under the flexor retinaculum.
• Peripheral neuropathy.
• Blockage of blood vessels in the leg.
• Heel pain, such as plantar fasciitis, may lead to ankle pain.
• Tumors.

Diagnosis of Ankle Pain

Apart from the history and physical examination, the diagnostic tests that may be recommended are :

• X-ray – to rule out fracture.
• MRI or CT scan – to detect ligament damage.
• Bone scan.
• Arthroscopy.
• Aspiration of synovial fluid (fluid in the joint space) for analysis.
• Nerve conduction tests.
• Blood tests.

Treatment of Ankle Pain

• Rest to the affected part by limiting walking and weight-bearing on the affected ankle.
• Immobilization of the bone by braces or a cast in case of fracture.
• Cold compress in case of acute injury.
• Hot compress in case of chronic injury and muscle pain.
• Elevation of the part.
• Drugs for pain relief, such as nonsteroidal anti-inflammatory drugs (NSAIDs).
• Achilles tendon rupture may need orthopedic surgical repair.
• Some fractures may need surgery.
• Treatment of any underlying condition, such as infection with drainage of pus and antibiotics.
• Physical therapy.