Ankle Pain and Injuries

Sprains

Ankle sprains are among the most common causes of ankle pain. They typically result from stretching or tearing ligaments due to sudden twisting or rolling of the ankle. Stretching or tearing ligaments can lead to varying degrees of pain, swelling and instability, making sprains painful for athletes and individuals with an active lifestyle. Usually, ankle sprains will improve with a short rest period and a simple rehab program. Occasionally, people can have persistent pain after an ankle sprain or develop repeated ankle sprains, which may require further diagnosis and treatment.

Ankle Instability

When a person sustains multiple ankle sprains, whether from trauma or due to an underlying deformity, this may lead to a condition known as functional instability (FI). FI is where the ankle is unstable to the point that you watch your step very carefully, are wary on uneven ground, or even feel the need to wear ankle braces with daily activity for fear of experiencing another sprain. This condition may also be associated with cartilage injury in the ankle joint itself.

Osteochondral defects (OCDs)

Osteochondral defects (OCDs) are abnormalities that involve both the cartilage and underlying bone in a joint. The surfaces of our bones are coated in cartilage, which is responsible for the smooth, gliding motion of the joint. Trauma, wear and tear and arthritis can cause pieces of cartilage to become loose or dented, causing ankle pain.

Arthritis

Arthritis can affect the ankle joint or the joint below the ankle (called the subtalar joint) and cause pain and stiffness. Around 80-90% of arthritis around the ankle is post-traumatic, meaning it is due to a prior injury. Less commonly, rheumatoid arthritis or another inflammatory arthropathy (autoimmune disorder) can cause ankle arthritis. Arthritic ankle pain is often characterized by stiffness, decreased range of motion and swelling around the joint.

Tendonitis

Tendonitis in the ankle occurs when the tendons around the joint become inflamed. It can result from overuse, injury, or an underlying foot deformity, causing the tendons to overwork or tear. Tendonitis often leads to pain and swelling around the ankle and can be uncomfortable during weight-bearing activities or sports.

Fractures (Broken bones)

Fractured or broken bones in the ankle can be a source of acute pain. These injuries can occur due to falls, accidents or direct trauma to the ankle. Pain intensity depends on the fracture's type and location, with some fractures causing severe discomfort and limited mobility. An ankle fracture can mean a break at the end of your tibia, fibula, or both, commonly occurring with a ligament injury.

Bone bruises

Bone bruises are often a result of traumatic injury and can be very painful. These deep bruises can result in prolonged discomfort, especially when walking or putting weight on the affected ankle.

Less common causes of ankle pain

• Gout: A form of arthritis, gout is caused by the buildup of uric acid crystals in the joints, leading to sudden and intense pain in the ankle or toes.
• Bone infection: Infections within the bone, such as osteomyelitis, can lead to localized pain and swelling.
• Tarsal tunnel syndrome: Tarsal tunnel syndrome is similar to carpal tunnel syndrome but affects the ankle, resulting in nerve-related pain, usually radiating to the bottom of the foot.
• Peroneal nerve injury (Foot drop): Nerve compression or damage high up the leg or in the back can cause ankle pain and weakness.
• Tumors: Ankle tumors are rare but can cause persistent pain, particularly when they pressure surrounding structures. Benign soft tissue tumors, like ganglion cysts, can cause ankle pain and difficulty with shoes.

Support and stability

For mild ankle pain, supportive measures can make a significant difference. Utilizing ankle braces or wraps can help stabilize the joint, reduce strain and promote healing. Supportive footwear is also essential in maintaining proper alignment and minimizing discomfort.

Physical therapy

Physical therapy plays a pivotal role in rehabilitation. Tailored exercises and stretches are designed to improve ankle strength, flexibility and range of motion. Physical therapy not only aids in pain relief but also helps prevent future issues.

Medications

Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can provide temporary relief from pain and inflammation. Sometimes, healthcare providers may recommend prescription medications for more severe conditions, such as autoimmune-related arthritis.

Surgery

When conservative treatments fail to alleviate the pain or when severe structural damage exists, surgical interventions become a consideration. The choice of ankle surgery depends on the specific condition, its severity and the patient's overall health. Orthopedic surgeons will carefully assess each case and consider the most suitable surgical approach to ensure the best possible outcome of ankle pain relief and improved joint function.

Common surgical procedures include:

• Arthrodesis (ankle fusion): This surgical procedure involves fusing the ankle joint by removing the cartilage and joining the bones. The procedure alleviates pain by eliminating motion in the ankle joint.
• Arthroplasty (ankle replacement): Ankle arthroplasty focuses on replacing the damaged joint. The surgeon may replace damaged joint surfaces with artificial implants to maintain the ankle's range of motion and pain relief.
• Fracture repair: Ankle fractures may require surgical repair. Depending on the type and location of the fracture, the surgeon may use screws, plates or pins to realign and stabilize the bones. Sometimes, ligament repair is required at the time of surgery.
• Tendon or ligament surgery: Surgical procedures can repair damaged tendons or ligaments surrounding the ankle, often due to injury. These operations aim to restore the ankle's function and stability and alleviate pain.
• Deformity correction: If an underlying deformity (such as flat feet or high arches) is part of the problem, the surgeon may correct this deformity by performing an osteotomy, which realigns or shifts the ankle bones or a tendon transfer.
• Arthroscopy: Ankle arthroscopy is a procedure where a small camera is placed inside the joint, allowing the surgeon to evaluate cartilage injuries and treat them through small incisions. Sometimes, this means removing loose cartilage or adherent scar tissue, stimulating healing of prior injuries, or, more rarely, replacing damaged cartilage with healthy tissue from a donor source. Often, ankle arthroscopy is performed at the same time as another operation.