The ankle joint is a complex joint consisting of three articulating bones and various muscles, tendons, and ligaments. Our ankles are beautifully made, with all of these structures working together to provide movement and stability needed for getting along our daily lives. The ankle joint takes on high loads and stress and is thus prone to injury. Pain in your ankle can occur suddenly like an ankle sprain when you twist your ankle or fall, or it can develop over time.
The most common causes of ankle pain are outlined in sections based on the location of your pain.
Ankle Pain from Sprains
A “twisted” ankle is one of the most common ankle injuries, especially among people who participate in sport. However, any incident where your ankle steps or lands awkwardly can cause an ankle sprain, which is an injury to one or more of the ligaments. The majority of ankle sprains occur to the outer part of the ankle.
With an acute ankle sprain, you will typically have immediate pain. Your ankle will slowly start to swell, and you may notice bruising around your ankle. With a more severe injury, there may be a popping or tearing sound at the time of injury. You may or may not be able to walk on the injured foot.
Ankle sprains are graded according to the severity of the injury:
- Grade 1 injuries are minor tears or stretching of the ligaments where minimal ligament tissue is damaged. With a grade 1 injury, you may have mild pain, swelling and bruising and be able to put some weight on your ankle.
- Grade 2 injuries are partial tears or stretching but the ligament is still intact. With a grade 2 injury, you will have moderate pain, swelling and bruising, and struggle to step on your ankle. Your ankle might feel unstable as well.
- Grade 3 injuries are complete tears of the ligaments. You will not be able to step onto your foot. More severe injuries can also cause damage to the tendons, nerves and blood vessels around the ankle.
When a ligament is injured in any way, it rarely ever regains its full elasticity and strength. The highest risk for spraining your ankle is when you have had a previous ankle sprain. Therefore, early and proper rehabilitation following an ankle injury is so vital. Physiotherapy for an ankle sprain is tailored to your history, your symptoms, and the severity of the injury.
Mild sprains naturally recover well within two weeks with basic treatment. Treatment will be based on the RICE principles of Rest, Ice, Compression and Elevation. We may suggest that you use a crutch to reduce the load on your ankle. To manage pain and swelling, we can apply ultrasound, gentle massage and taping. We will teach you early, pain-free, active ankle movements to restore ankle mobility. As soon as your symptoms allow, we will guide you through a progressive rehabilitation program. Most rehabilitation programs can be continued at home.
More severe injuries naturally take longer to heal, ranging from 6 to 12 weeks. During the initial phase of healing, physiotherapy can help manage pain, swelling and bruising, and we can teach you how to protect and rest your ankle as needed. You will need to commit to a progressive rehabilitation program starting with early gentle movement exercises, and building up to loading exercises, balance training and other functional training. During your recovery, we can still apply other treatment techniques to manage any symptoms, encourage blood circulation, improve joint mobility and stabilise your ankle joint. We may decide to use ultrasound, taping, massage, manual therapy, electrotherapy and dry needling. Just Physio will guide you on your journey of recovery until you reach your optimal level of function again.
Ankle Pain from Fractures
Most ankle fractures need to be managed with a cast or with surgical repair. Most people will start with their physiotherapy program the day after their injury or surgery in the hospital. Here, we will teach you exercises you can do to keep the other leg muscles strong, as well as how to use your crutches. Following up with your physiotherapist for early rehabilitation following an ankle fracture is crucial to allow early and optimal recovery.
As your fractures heal, we adapt your exercise program accordingly. When a part of your body is immobilised for a while in a cast or moon boot, the joints become stiff, muscles become weak and your balance will also be affected. Your physiotherapist will assist in treating the stiffness, weakness, and functional deficits.
Ankle Impingement Syndromes
Due to the complexity of the ankle joint and the various structures comprising it, sometimes these structures get pinched in-between one another. Although it is uncommon, impingement can occur at the front or back of the ankle joint. If you have had an ankle before, there may be bony outgrowths or scarring around your ankle that reduces the space for structures to move. This can cause pain and discomfort and will ultimately limit the mobility of your ankle.
Previous or repeated ankle trauma are risk factors for ankle impingement, as well as inflammation, scarring, or joint hypermobility. It is seen more in athletes requiring extreme ranges of ankle movements, such as soccer players, long-distance runners, swimmers, gymnasts, and ballet dancers. Pain from impingement can occur suddenly or develop gradually over time until it limits some of your daily activities. There may be swelling along your ankle joint line and when you try to move your ankle, it may feel blocked.
Treatment of ankle impingement should always start with physiotherapy. Our treatment will focus on freeing some joint space to allow for more mobility and reduced pain during daily living. We may encourage a period of rest and advise you on ways to adapt your activities to avoid aggravating your symptoms. We will assess and advise you on your shoe types. For pain and swelling, we may apply ultrasound, electrotherapy, taping, massage, and/or dry needling. To encourage joint health and mobility, we may perform manual joint techniques. We will also guide you through specific therapeutic exercises.
Tendonitis is when there is irritation of one of the tendons around the ankle. It is usually an acute injury causing inflammation with pain, swelling and trouble moving your ankle. The pain will come on with activity and be less when you stop and rest. However, severe inflammation will make the pain more constant and your ankle can become red, hot and swollen. Tendonitis can become a chronic problem, which is called tendinopathy. Tendinopathy will not cause typical inflammatory symptoms but rather stiffness. Pain from tendinopathy will come on with activity but get better as you continue being active, only to return once you cool down again. Most commonly, the tendons on the outer aspect of the ankle are affected.
Tendonitis/tendinopathy is commonly seen in running athletes, dancers, ice skaters, and sportspeople who have to jump or change direction quickly. Repetitive movement and trauma to the tendon can cause further damage such as minor tears or the tendon slipping out of its place. This will affect your ankle stability and thus your balance.
Tightness in your calf muscles, poor training techniques, poor foot posture or movements, or improper footwear can predispose you to tendinitis/tendinopathy. Other factors that may contribute to the development of this condition include previous ankle sprains or fractures and repetitive or long durations of activity. Oftentimes, people with ankle injuries who return to their activities or sport too early or without the proper rehabilitation place themselves at risk of developing tendinitis/tendinopathy.
The main aim of our treatment will be to relieve your pain, restore the mobility of your ankle and help you return to your daily life without any complications. For acute tendonitis, you may need to take anti-inflammatory medication. We may decide to use ultrasound, massage, taping, electrotherapy, dry needling, and joint mobilisation in our treatment for your pain and inflammation. We can also advise you on orthoses or braces if needed. Important for your recovery will be a progressive stretching, strengthening, and functional training program, which we will guide you through.
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