The ankles are crucial for both walking and standing, but unfortunately, they are also quite prone to injuries. In fact, one of the most frequently injured joints in the entire body is the ankle.
Ankle injuries should be examined by a qualified physician and treated promptly. Not taking an ankle injury seriously is a leading cause of complications in this joint.
The ankle consists of bones held together by tendons and ligaments. The ankle allows the foot to move up and down, side to side, and in circular rotation. This makes the ankle one of the most versatile joints in the body. However, its very versatility is also its downfall. Because the ankle can move in so many different directions, it is common to push it too far in one direction and cause injury.
Main Causes of Ankle Pain
Most ankle injuries consist of either ankle strain or an ankle sprain. Although these two words are used more or less interchangeably in common speech, to a health care professional they are not the same thing, although both are injuries caused by stretching.
1. Ankle Sprain
A sprain refers strictly to the stretching of ligaments beyond their comfort zones. A severe sprain can involve actual tearing of the ligament tissue. Ligaments are the anatomical structures that connect one bone to another. Sprains are very common in the ankle joint, but they can also occur in other joints including those of the knee, ankle, finger, or wrist.
A strain, on the other hand, is the stretching of either tendons or muscle tissue, or sometimes both. Again, in severe cases the strain may involve tearing of the tissues.
In the majority of cases, sprains will occur on the outside of the ankle (the inside is the direction facing the opposite ankle). The inner ankle is more resistant to this type of injury due to the presence of a very strong ligament there. If the inner ankle is subjected to intense stress, the ankle bane may break before the ligament tears. For this reason, inner ankle pain should be x-rayed to determine if there are any injuries to the bone tissue.
Other causes of ankle pain have nothing to do with strains and sprains. These causes include gout, Achilles tendonitis, and bursitis. Gout is a condition caused by a build up of uric acid inside a joint. Gout of the ankle actually begins in many cases with the joint in the big toe, but the condition can spread upward to the ankle and may even reach the knee.
Achilles tendinitis and bursitis are similar conditions that affect the back of the ankle where the strong Achilles tendon supports the joint. Beneath this tendon there are small sacs filled with fluid; these serve to cushion the joint when it is moved. The sacs are called bursas. Achilles tendinitis and bursitis, then, are conditions that affect these two structures located at the back of the foot.
The causes of Achilles tendinitis and bursitis are generally related to exercise and include such things as
- repetitive motion
- running, particularly for long distances
- sudden stress caused by quick and / or unexpected movements; this can actually cause the Achilles tendon to rupture or tear
However, some people have naturally tight calf muscles; this can also contribute to the condition, and suddenly changing footwear can cause tendons and / or bursas to become inflamed, particularly when the change is from high heeled shoes to flats. This is because long wear of high heeled (including even cowboy boots for men) can cause the tendon to shorten. Switching to flats will stretch it out suddenly, which may cause discomfort and inflammation.
Symptoms of Ankle Pain
Mild Strains and Sprains
The so-called “twisted ankle” might be either a strain or a sprain depending on whether it is ligaments on tendons that have been stretched beyond their normal limitations. When this happens, the patient may hear some indication that the ligament or tendon has been stretched or torn.
The noises that result from the injury can take the form of cracking noise, or it might sound more like a sharp pop or a snap. The noise will appear to come from the outside surface of the ankle rather than from deep inside the tissue.
If a strain or sprain is mild enough, there might not be any swelling. Alternatively, there might be a small amount of swelling in the ankle area. There will most likely be pain; patients rate their experiences in this regard as falling between mild and moderate, with some patients reporting little pain. With mild strains and sprains, the patient will most likely be able to place weight on the foot, but this may be accompanied by discomfort; it is usually accompanied by a slight limp.
Moderate Strains and Sprains
Moderate strains may also present themselves with some form of audible warning that a tendon or ligament has been injured. In general, what distinguishes a moderate injury from a mild one is the fact that in a moderate sprain or strain, the ligament or tendon has probably done more than stretched; it will have torn to some degree.
Moderate ankle injuries have additional symptoms that boil down to more severe versions of the symptoms discussed above for mild ankle injuries:
- Moderate strains and sprains cause patients more discomfort and more levels of pain that are rated in the moderate to severe category.
- Moderate strains and sprains are especially painful when the joint is moved.
- With moderate strains and sprains, walking will become difficult enough so that the patient probably prefers to use some form of assistive device such as crutches.
- Moderate strains and sprains lead to more swelling.
- In moderately severe ankle injuries, the joint will be tender to the touch.
- bruising around the ankle, foot, and toes, sometimes extending along the side of the leg. Not all moderate injuries are accompanied by bruising, however.
Severe Strains and Sprains
Severe strains and sprains indicate that the tendon or ligament has probably ruptured, which means it has completely torn through. Symptoms of severe strains and sprains include:
- intense or agonizing ankle pain
- limited motion, sometimes severely limited
- swelling (largely responsible for the limited motion)
- extreme tenderness
- complete inability to bear weight
- bruising around the ankle, foot, and toes, sometimes extending along the side of the leg. Not all severe injuries are accompanied by bruising, however.
Patients with severe ankle injuries will not be able to walk without the assistance of crutches or another assistive device.
If you suspect you may have gout, contact a doctor without delay. The warning signs or symptoms to watch out for include:
- sudden extreme pain for which there is no known physical cause (i.e., no injury)
- redness of the big toe and/or ankle joint
- swelling in the same locations
Achilles tendinitis and Bursitis
The main symptoms of Achilles tendinitis are:
- pain in the back of the heel
- pain in the lower half of the leg, particularly in the calf muscle
- pain that is worse in the morning but subsides as the day goes on
The main symptoms of bursitis include:
- pain similar to the profile for Achilles tendinitis
- inflammation at the back of the ankle
Treatments for Back of Ankle Pain
The RICE Method of Home Care
No matter the degree of severity associated with an injury, the initial treatment protocol is largely similar. As with many injuries to the extremities, along with sports injuries in general, treatment often starts with what has come to be called the “RICE” method. This is an excellent acronym to memorize, for it will tell you that with most soft tissue injuries to the foot or ankle, the best initial treatment consists of:
Applying the RICE method is not complex at all, although some basic guidelines should be followed. Rest should last at least two to three days, longer if the injury continues to be painful. Obviously, resting means not putting any weight on the ankle. Avoid walking, but if it is strictly necessary, have someone help you around the house. Lean on them and don’t put your injured ankle down. If you have crutches, this would be a good time to put them to use.
Ice should be applied either by plunging the ankle into a bucket of cold water laced with ice cubes, or by application of an ice pack or gel pack that has been stored in the freezer. Ice treatment is recommended for 15 – 20 minutes at a time, repeated at 2 to 3 hour intervals throughout the day.
Compression involves wrapping the ankle, typically in Ace bandages, to help reduce swelling. Be careful not to wrap too tightly. Not only will this be uncomfortable for the patient, it can lead to a loss of circulation in the toes. If the toes turn dark pink or become too whitish, that is a sign that the compression wrappings should be loosened.
Elevation is most effective when the injured part of the limb is lifted above the heart level of the patient. With ankle injuries, this generally means having the patient lie down on his back, and propping his leg up on several couch cushions or stout pillows. If the patient insists on sitting up even partially, the leg will need to be elevated further to raise it to the correct degree of elevation.
Severe injuries should be seen by a qualified health care professional as soon as possible. Warning signs of a severe injury are excruciating pain, obvious deformation of the ankle area of the foot, or an inability to place even the slightest amount of weight on the injured ankle.
Barring the need to see a doctor right away, the “RICE” method can be used for 48 hours. If after that time there is no significant improvement in pain or swelling, the patient should consult a doctor or other qualified health care professional.
In the case of gout the patient should ice and elevate the leg to obtain some relief, but a doctor should be consulted as soon as possible. Effective medications exist for the treatment of gout.
When Should a Doctor be Consulted?
For most kinds of ankle pain, the RICE method accompanied by anti-inflammatory medications such as ibuprofen or naproxen can be quite effective, particularly if the patient rests enough to allow the injuries to properly heal. However, there are warning signs that indicate the need for a qualified health care professional:
- Any kind of pain or swelling that suddenly appears and seems not to be caused by any kind of injury. Short of an injury, the ankle should function normally. If it does not, this is a cause for concern. If the area that is painful or swollen is also shiny looking, feels warmer than usual, or is discolored, these are also causes for concern.
- Pain that is accompanied by systemic problems such as fever and chills. This is usually an indication that something is wrong beyond a mere ankle injury.
- An audible snapping or popping sound in the instant the injury occurs. This may indicate that a ligament or tendon has torn. Additional warning signs in this case will be rapid swelling of the injured area accompanied by excruciating pain.
- A crooked or obviously deformed appearance of the ankle joint, back of the ankle, or calf muscle.
- A numb, blue, or cold foot. All of these can be signs of nerve injuries.
Treatment Options: At the Doctor’s
In the case of sprains and strains, severe pain or a failure to begin healing may indicate a bone injury. Therefore, your physician or podiatrist will probably want to x-ray your ankle so that he can either confirm a fracture or rule out the possibility. The reasons to require an x-ray include:
- severe pain that does not fade with RICE treatment
- continuing inability to put weight on the joint
- tenderness at specific points on surface of the ankle
- tenderness near the base of the patient’s little toe.
Gout will be treated with the proper medications.