Common Causes of Ankle Pain
Ankle pain is a common condition that can affect people of all ages and activity levels. It may arise from a variety of factors, including injury, overuse, or underlying health conditions. Understanding the causes of ankle pain is essential for appropriate treatment and prevention. Below are some of the primary causes of ankle that we see at the Injury Hub.
Sprains and Strains
Ankle sprains are among the most frequent causes of ankle pain and is the most common injury we see at the Injury Hub. It affects all ages but especially in individuals engaging in physical activities. A sprain occurs when the ligaments that support the ankle are stretched or torn, usually due to an inversion injury (rolling, twisting, or turning the ankle in an awkward way). Most patients complain of pain on the outside of the ankle and if the injury is bad enough it can also affect the inside of the ankle of well. A strain, on the other hand, refers to an injury of the muscles or tendons in the ankle caused by overstretching or overuse. Both injuries can lead to swelling, bruising, and sharp pain, making walking difficult.
Fractures
We have seen it time and time again whereby an individual has rolled their ankle, been to A&E and the X-ray showed there was no fracture just soft tissue bruising. When this type of injury occurs, there is generally one main ligament known as the anterior talo fibula ligament that can suffer overstretching, partial tearing or complete tearing and in a lot of patients where it tears it pulls some of the adjacent bone away known as an “Avulsion fracture” these can be very subtle and when there is overlying swelling it can be difficult for an X-ray to pick up. These subtle bone fractures are generally picked up on ultrasound and makes a big difference to the individuals management of the condition. There are many other bones in the ankle that can fracture. At the Injury Hub if we suspect or can see bone injuries via ultrasound we know when to advise on appropriate orthopaedic boots. When major orthopaedic fractures are suspected, we will refer to A&E or orthopaedic colleagues for possible surgical intervention.
“Check out our video on ANKLE FRACTURE TIP…what visual clues may determine whether your ankle is fractured or not”
Tendonitis/Tendinopathy/Tedinosis
These are three terms often used to describe pathological tendons. Tendonitis is an older term which is used to signify an inflamed tendon. But when looking at tendons on imaging such as ultrasound and MRI, quite often an inflamed tendon has associated micro tears or degenerative changes alongside the inflammation. The all-encompassing name is tendinopathy. The term “Tendinosis” is used when the condition is chronic and has been ongoing for more than 3 months. Tendons connect muscles to bones. In the ankle, three tendons are often affected: the Achilles tendon and the peroneal tendons. Achilles tendonitis/tendinopathy typically results from overuse or excessive strain, especially in runners or athletes who increase their activity level too quickly. Most patients with an achilles issue will feel soreness at the base of their heel bone, as this is where the achilles inserts. In other individuals the pain is felt in the mid portion of the achilles with a thickening or associated swelling. We always advise our patients to have an ultrasound scan of their achilles, as it’s the one tendon you don’t want to rupture. If partial tears are caught early, we will advise on booting the ankle with a heel lift for several weeks. With the right rehabilitation exercises 99% of the time, it’s a successful outcome. The other two main tendons are the peroneal tendons that run around the outside of the ankle. These can be injured by repetitive ankle motion, poor foot mechanics and in some cases, tears can occur when an individual roll their ankle. Again, its paramount the tendons are scanned with ultrasound in order to acquire the right diagnosis so a tailored treatment approach can be obtained.
Arthritis
Arthritis in the ankle, such as osteoarthritis or rheumatoid arthritis, can lead to chronic ankle pain. Osteoarthritis occurs when the cartilage in the ankle joint wears down over time, leading to pain, swelling, and limited range of motion. Rheumatoid arthritis, an autoimmune condition, can cause inflammation in the joints, including the ankle, leading to stiffness, tenderness, and swelling. Both conditions can worsen over time, making it difficult to walk or engage in physical activities. At the Injury Hub we provide a thorough, structural hands on approach when treating the arthritic ankle and foot. Manipulation and articulation of the joints and bones is key to getting individual bones moving. When the osteoarthritis is advanced and chronic, we offer pain killing injections such as cortico-steroid and lubricating, hyaluronic acid injections to help nourish lubricate the degenerate cartilage.
Plantar Fasciitis
Although plantar fasciitis primarily affects the bottom of the foot, the inflammation of the plantar fascia can cause pain that radiates to the ankle. This condition is often seen in individuals who spend long periods standing, walking, or running, as well as those with flat feet or improper footwear. The pain is typically worse in the morning or after prolonged rest and is normally located in the heel or along the bottom of the foot. This can take many weeks, months, even years to heal in some individuals. The key to managing the condition properly is to get an ultrasound scan of the sole of the foot. Is there a tear present? Does this need booting? Is the plantar fascia just inflamed? Is the plantar fascia chronic and thickened? Would it respond to needling, shockwave, ice, stretching, night splints? Is it even a plantar fascia issue? Could it be fat Pad Syndrome or Bursitis or a heel fracture. These tissues are all located in the same area and can cause significant pain.
Bursitis
Bursae are small, fluid-filled sacs that act as cushions between bones, tendons, and muscles. Bursitis occurs when these sacs become inflamed, often due to repetitive movement or prolonged pressure on the joint. In the ankle, bursitis can cause localised pain, swelling, and tenderness. It is commonly seen in individuals who engage in activities that involve repetitive ankle motions, such as running or dancing. It can also occur just by wearing tight shoes especially when the pack portion of the shoe rubs up against the back of the ankle.
Gout
Gout is a type of inflammatory arthritis caused by the buildup of uric acid crystals in the joints. While it typically affects the big toe, gout can also occur in the ankle, leading to sudden and intense pain, redness, swelling, and warmth in the joint. Gout flare-ups often occur at night and can be triggered by factors such as diet, dehydration, or certain medications.
Nerve Compression or Injury
Nerve-related issues, especially when compressed in the lower back often manifest along the outside of the ankle. Patients tend to say the outside of their ankle is numb, pins & needles or just that they feel an altered sensation. There are more local nerve conditions such as tarsal tunnel syndrome, which can cause ankle pain. This condition occurs when the tibial nerve, which runs along the inside of the ankle and foot, becomes compressed or irritated. Nerve compression can lead to a burning sensation, tingling, or numbness in the ankle and foot. In some cases, nerve injuries from trauma or repetitive stress may also contribute to chronic ankle pain. We have even seen patients suffering pain and tingling due to wearing socks that are too tight, causing compression of the superficial peroneal nerve.
Infection
Though rare, infections can cause ankle pain. Septic arthritis occurs when bacteria or other infectious agents invade the ankle joint, leading to severe pain, swelling, and redness. Infections may arise from wounds, surgery, or the spread of bacteria through the bloodstream. Immediate medical treatment is essential to prevent further complications.
Injury Hub is here to help.
Ankle pain can arise from a wide range of causes, ranging from acute injuries like sprains and fractures to chronic conditions such as arthritis or tendinopathy. Understanding the underlying cause of the pain is crucial for proper diagnosis and treatment. If your ankle pain persists or worsens, we would be happy to see you at the Injury Hub where we can scan and diagnose your problem straight away preventing long-term damage and ensure appropriate management.