Ankle Pain – Discover the Common Causes and the Right Treatment Option for You
The ankle is a complex network of ligaments, bones, cartilage, tendon and muscles. It forms the base of your foot and bears the entire bodyweight enabling you to move around. Like other body parts, ankle is also prone to various injuries causing pain. We will learn about this symptom and how it can be treated through different strategies.
The pain in ankle refers to any pain or discomfort inside or outside the ankle. It can be due to an injury such as sprain or a medical condition including arthritis. Where mild pain can be treated at home, other types of ankle pain needs surgery and time to resolve while some others are chronic.
As per National University of Health Sciences, a sprain in the ankle is one of the most common reasons of ankle pain accounting for about 85 percent of all the injuries. A sprain or injury occurs when the ligaments (tissues connecting the bones) tear or overstretched.
Causes of ankle pain
The most common cause of ankle pain is sprain which are mostly lateral sprain occurring when your foot falls, walking on uneven surface, during a sport such as basketball or tennis where you need rapid change in direction. A sprained ankle will swell or bruise for about a couple of weeks, however, depending on the injury the healing might take few months.
Other common causes include:
When tendons, the muscle attachments to the bone, become inflamed or irritated, it is called as tendonitis. There are several types of tendonitis including perineal tendonitis, brevis tendonitis, posterior tibial tendonitis and Achilles tendonitis.
Arthritis refers to painful inflammation and stiffness of the joints. There are several types of arthritis including osteoarthritis, rheumatoid arthritis and posttraumatic arthritis. The most common culprit is the osteoarthritis in which the cartilage in the ankle joint steadily deteriorates. This condition usually occurs with age.
Another reason for ankle pain is the fracture or break in the ankle bone. These include bones such as Tibia and Fibula (the lower leg bones) and Talus (the foot bone).
Ankle pain can also occur from a less severe form of injury such as bruise. These often cause severe swelling and pain just like in a fracture.
Some other rare causes include:
- Gout, a type of inflammatory arthritis occurring due to uric acid crystal formation
- Bone infection (osteomyelitis)
- Tarsal Tunnel Syndrome or compression of the tibial nerve, the nerve that orginiates from the sciatic nerve (the biggest nerve in the human body)
- Non-cancerous tumor of the ankle and foot
- Blocked blood vessels
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How ankle pain is diagnosed?
The bone specialist or an orthopedist generally diagnoses the condition by examining the ankle physically, checking the medical history and conducting x-rays. The doctor may ask questions related to location of pain, duration, intensity besides other symptoms such as fatigue, numbness or fever. Other cases might require blood and imaging tests.
Depending on case to case, the doctor would conduct a range of physical examination of the ankle. After checking the bruising, swelling or deformity he may like to perform some tests related to ankle including:
- Ottawa Ankle Rules – The doctor checks whether you can bear the weight or not. This test is performed to rule out any fracture. It can be followed by x-ray.
- Talar Tilt test – The doctor will hold the heel of your ankle and turns inside and outside gently to check for laxity or pain.
- Squeeze test – During this procedure the doctor compresses your lower leg bones and check for pain above the ankle joint.
The doctor may order anti-cyclic citrullinated peptide (anti-CCP) level test in case of rheumatoid arthritis. A WBC count can also be ordered in case of bone infection.
An x-ray is mostly used to check ankle pain and different it from sprain or fracture. The imaging test can also tell about the signs of osteoarthritis or gout. More complex cases such as infection or tumor would need CT scan or MRI.
Treatment – Home remedies, medications and surgeries
The treatment will depend on case to case and from person to person and their medical history. These can be divided into various categories including:
There is one common treatment methodology for many varieties of ankle pain and it’s the RICE method. This is usually the first step towards treating ankle pain and can be performed at home:
- Rest – Move as little as possible and try to avoid putting weight on your ankle, especially for the first few days. Use crutches or cane if you really need to move around
- Ice – Put an ice bag on the ankle for about 20 minutes. This should be repeated in every 90 minutes, 3-5 times a day for 3 days.
- Compression – Wrap the injured ankle with compression bandage such as ACE wrap. Don’t wrap it tightly as it may numb the area or create tingling sensation or increase in pain in the area
- Elevation – Raise your ankle above the heart level whenever possible. Use pillows or some other support structure to do this.
This is commonly used for many cases of ankle pain including tendonitis and strain or after a surgical procedure. The therapists use different rehabilitation exercises to strengthen the ankle muscle, minimize stiffness, regain mobility and prevent many chronic problems related to ankle.
There are several medications doctor may prescribe depending on the type and intensity of pain including:
- Acetaminophen or ibuprofen pain relievers for sprains, arthritis and tendonitis.
- Opioids in case of severe pain such as caused by fracture
- For serious cases related to arthritis, cortisone is recommended. This type of steroid reduces inflammation and may be injected in some cases.
- Topical pain relievers
Depending on the type of pain and injury, one might need surgery to fix the problem. These surgical procedures can be any from below mentioned:
Arthroscopic Ankle Debridement
This is performed in the early stages of ankle pain related to arthritis. This procedure removes any inflamed tissue, bony growths, foreign material or dead tissue from the area around the joint. The surgeon will use a small camera (arthroscope) into the joints for visually examining and cleaning out the area.
In this procedure, ankle bones are fused together in order to prevent the joint from moving, hence minimizing pain.
This surgery involves total replacement of ankle. In this procedure, the surgeon removes the damaged bone and cartilage and place an ankle implant on the site.
When to See a Doctor
If you are suffering from ankle pain, tried various home remedies and pain relievers but in vain or really unsure of the cause of problem, then you must consult your doctor. Check if you are able to walk properly, able to bend the ankle, there are no signs of infection or if pain persists longer than a few days.
If the condition is left untreated, it can also cause deformity, so make sure you seek medical attention if the problem persists for longer time.