Ankle Injuries

Ankle Pain – Causes, Symptoms and Treatment

Unsure what has caused your ankle pain?

Ankle pain can be caused by many things – it can present from playing sport, walking, landing incorrectly and can even happen for no apparent reason.

So what are causes of ankle pain?

Causes of Ankle pain can be due to many different reasons, the most common being a result of bone, muscle or soft tissue damage to the structures that support the foot and ankle joint.  The pain can be caused by an injury (sprain of the ligaments or tendons, a fracture or instability) or can be caused by a medical condition (Lupus, Gout, Scleroderma, rheumatoid arthritis, osteo and many others).

What does the ankle joint consist of?

The ankle joint itself consists of 8 ligaments, 6 tendons and 4 bones which unfortunately means alot of injuries can occur.

Ligaments of the ankle can be broken down into lateral ankle ligaments, medial ankle ligaments and inferior ligaments.

The lateral ligaments on the ankle are:

  • Anterior Talo-fibular Ligament (ATFL) –  This ligament is the most commonly injured ligament of the ankle and runs from the front of the Talus bone to the Fibula bone which is the outside long bone of the leg.
  • Calcaneofibular-fibular ligament (CFL) –   This ligament is the 2nd most commonly injured/ sprained ligament in the ankle and runs from the Calcaneus (heel bone) to the Fibula Bone.
  • Posterior TaloFibular Ligament (PTFL) –  This one is the least commonly sprained or injured ligament of the lateral ankle due to its position. It starts at the back of the talus and runs to the fibula bone connective of the posterior side.

Medial ligaments of the ankle are:

  •  Deltoid ligament – This ligament is a thick fan like structure that supports the entire inner side of your ankles.  This ligament connects the navicula,  a small ship-like structure of the inner foot to the tibia, calcaneus and the talus bone.  This ligament is a lot harder to cause damage to due to its structure and positioning. Injuries of the deltoid ligament generally happen in conjunction with either a high impact eversion sprain (inward twisting of the ankle) or in conjunction with a  fracture of the tibia or tendon damage to the tibialis posterior ligament.

Inferior ligaments are:

  • Anterior inferior tibiofibular ligament which connects the tibia and fibula together at the front of the ankle joint
  •  Posterior inferior tibiofibular ligament which connects the tibia and the fibula together at the back of the ankle joint.
  • The transverse ligament

These 3 ligaments tend to get injured at the same time which is called a syndesmosis injury – this usually occurs in some sport injuries and may require a lot of cutting- normally seen in footy, soccer, rugby and basketball players.

The last ligament in this category is the:

  • Interosseous ligament –  This ligament runs the entire length of tibial and fibular from the ankle right up to the knee.

All of these injuries of the ankle can be associated with swelling, stiffness, redness and warmth in the area involved. The pain is often described as an intense dull ache that occurs upon weight bearing and movement of the ankle.

Tendons:

Tendons are a strong fibrous connective tissue which attaches the muscle to the bone. Tendons are designed to be able to take a high amount of force through it, however with certain movement the tendon can become overused, torn or ruptured.

As we discussed before the ankle joint is a complex structure and  we can know that the ankle comprises 6 tendons.

This includes:

  • Tibialis Posterior
  • Peroneal Longus
  • Peroneal Brevis
  • Tibialis Anterior
  • Extensor digitorum longus
  • Extensor Hallucis longus

All of these tendons of the ankle help with stability and congruence of joint.

When an inversion sprain occurs it is not uncommon for one or more of these tendons to also be affected. Most commonly the Peroneal longus and brevis will sustain injury due to the location- being located on the lateral (outside) of the ankle.

Tendons can also get injury from chronic overuse and this most commonly happens with the tibialis posterior and the Peroneal tendons. If there trauma, overuse or other injury to the tendon or ligaments of the ankle can result in acute pain, swelling, bruising, reduced stability and proprioception (awareness of your body in space) as well as not rehabilitating properly lead to chronic ankle instability or arthritis.

Lastly we have the four bones of the ankle joint these are:

  • Tibia- Located on the inside of the leg and runs the entirety of the leg, form part of the knee joint as well. This bone takes 80% of your weight transfer through the lower leg  when walking.
  • Fibula- Located on the outside of the leg and runs the length of the leg.This bone takes the remaining 20% of weight transferring of the lower leg
  • Talus- this bone helps to connect the foot and leg together. It sits on top of the calcaneus (heel bone) and below the tibia and fibula. This bone helps to create a rocking motion through the ankle for proper foot biomechanics. If there is an injury or damage to this bone it can lead to restriction and altered gait patterns occurring.
  • Calcaneus – this is the heel bone of the foot. This bone connects with the talus and foot bones. The calcaneus is important for normal foot functioning and to propelling off the rear foot through to the midfoot for normal gait patterns when walking, running or playing sport.

Although not as common as ankle sprains or tendinopathies, ankle fractures can still occur, usually through acute injury to the ankle, and usually resulting in severe pain and difficulty or an inability to bear weight.

What is the most common injury to the ankle?

Ankle sprains, or rolling your ankle is the most common explanation for ankle pain and makes up roughly 85% of the ankle injuries.  Majority of ankle sprains that occur result from a lateral ankle sprain which happens due to rolling your foot too far outwards.  This movement causes increased stretch being placed through the tendons and ligaments of the ankle and can result in different levels of sprains. There are grade 1 sprains right through to grade 3 sprains.  There can be tears of the entire ligament or tendon and even result in a fracture as well.

The remaining 15% is due to fractures, tibialis posterior dysfunction, tarsal tunnel syndrome, other pathology and medical conditions such as osteoarthritis, rheumatoid arthritis, gout or lupus.

What are symptoms of ankle pain?

Ankle pain can be debilitating. It can stop individuals from living their daily life.

Symptoms include:

  • pain
  • Swelling
  • Bruising
  • redness
  • numbness or tingling
  • Instability
  • Chronic instability if untreated
  • Reduced range of motion through the ankle joint.

How to treat ankle pain?

You have ankle pain but are not sure what to do or what has caused it?

It is best to seek podiatric advice in regards to the grading of your ankle pain or cause of the ankle issue. Podiatrists will be able to do a full comprehensive assessment of your foot and ankle to identify the structures that are injured or have been overused that is causing your ankle pain. They will also be able to advise and send you for imaging if needed, offload your ankle through the use of ankle strapping, supports or a cam-walker depending on severity of your ankle injury, prescribe a customised strength and conditioning program where they will focus on improving range of movement, strength of surrounding structures (above and below) and balance to prevent recurrence of the injury or overloading from happening.

If you sustain an acute ankle sprain or injury it is recommended to elevate and compress the area as soon as possible to further reduce swelling and bruising and further trauma from happening, as well as taking anti-inflammatory and panadol to help.

Further treatment may involve immobilisation of the ankle depending on the injury and pain levels this can include anything from a cam walker through to ankle brace or strapping to support the ankle and get you moving better.

Other treatment for chronic ankle instability may be orthotics in conjunction with strength and conditioning as well as footwear advice.

When to see a podiatrist?

It is best to see a podiatrist as soon as the ankle injury or pain starts to ensure a correct diagnosis, proper treatment and to prevent long term injury and instability from occurring.

If you have any concerns in regards to an ankle or foot pain  give us a call on 9553 0044 or book online here. Your Podiatrist will be able to give you the best advice to ensure you give your feet the very best care they deserve.

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