Ankle Pain
The ankle is one of the most commonly injured joints of the body. Held together by ligaments and tendons, the ankle allows the foot a wide range of motion. Because of the ankle's crucial role in walking and standing, ankle injuries should be taken seriously and treated properly.
Causes
There are several causes of ankle pain.
Strains and Sprains
Strains and sprains are the most common ankle injuries. A strain is the stretching or tearing of a muscle or tendon. A sprain is the stretching or tearing of ligaments. Ligaments connect bone to bone. Sprains occur at a joint, such as the ankle, knee, wrist, or finger.
Twisting your ankle may cause stretching or tearing of the ligaments and tendons. With a strain or sprain you may hear or feel a snap, pop, or crack at the time of injury. This most often occurs on the outside of the ankle. Mild strains or sprains may cause mild to moderate pain and little or no swelling. The ankle can support weight, but usually a limp is apparent. Moderate sprains hurt more when you move, and swelling and tenderness increase. Walking is hard, and often crutches are needed for a few days.
A sprain is generally severe when the ligament and tendons are stretched or completely torn (ruptured). Severe sprains are accompanied by intense pain, swelling and tenderness, limited motion, and inability to walk or bear weight on the ankle. Moderate and severe sprains may cause bruising in the foot and toes, around the ankle, and up the side of the leg.
Most sprains are on the outside of the ankle. Because of the strength of the ligament on the inner ankle, often bone will give way before the ligament does. Pain on the inner ankle may be a fracture and should be x-rayed in most cases.
The Rest, Ice, Compress, and Elevate (RICE) method is the right first treatment for these injuries. A severe injury should be seen by a doctor. Unless the ankle is obviously deformed, very painful, or unable to bear any weight, a sprained ankle can be treated safely at home for the first 24 hours using the RICE method and avoiding weight on the sprain. With a mild or moderate sprain, swelling should stop within 24 hours and the ankle should begin to improve (although not be healed) within 48 hours. If it doesn't, see a doctor. An x-ray should be obtained after an injury to rule out a fracture if any of these signs or symptoms are present: inability to bear any weight on the ankle right after the injury, point tenderness on the inner or lateral bony protuberances at the ankle (medial and lateral maleolus), and point tenderness at the base of the fifth (little) toe.
Achilles Tendinitis and Bursitis
Achilles tendinitis and bursitis at the back of the ankle are very much alike. The Achilles tendon is a large, strong band that attaches the calf muscle to the heel. Underneath the Achilles tendon are bursas that may also become inflamed. Bursas are fluid-filled sacs that cushion movement within a joint.
Symptoms of Achilles tendinitis include pain in the lower calf and back of the heel that is worse when you wake up in the morning and generally gets better as the ankle is "warmed up" with use. Occasionally, with an improper warm-up or sudden movement, the Achilles tendon can tear or even rupture. Any deformity in the calf should be seen by a doctor right away. Bursitis usually causes inflammation of a bursa at the back of the ankle, along with pain similar to that of tendinitis.
Common causes of tendinitis and bursitis in the ankle include tight calf muscles, overuse, sudden stress from a quick movement, and repeated motion, such as running. But you don't have to be athletic to have either problem. Shoes are often the culprit. Switching from high heels or cowboy boots to flat shoes, or wearing shoes that fit poorly or provide inadequate support and cushioning, can also inflame tendons and bursas.
Gout
Gout often begins in the big toe, but it may move to the ankle and knee. If When uric acid (a waste product) builds up in the joint , it causes the symptoms of gout. Symptoms of gout may show up in many joints although the big toe if frequently involved first. Symptoms may include:
If you have symptoms of gout, call your doctor as soon as possible. There are medications that effectively treat gout. Elevate your leg and apply ice.
Self-Care Steps for Ankle Pain
As with other joint injuries, the first step in treatment for most ankle injuries is the RICE method and anti-inflammatory medications.
Other steps in self-care include the following:
You can usually treat a sprain or strain at home. You should see your doctor if the injured part looks deformed. Call your doctor if the pain keeps you from using the injured part.
Use the injured ankle as little as possible until the swelling stops.
Use crutches if it hurts to stand or walk.
If the swelling lasts for more than 3 days, soak the injured ankle in cold water (45 to 60F) for 1 minute, then soak in warm water (100 to 105F) for 2 to 3 minutes. Repeat this cycle for 15 to 20 minutes. Stop if you see more swelling.
As the swelling and pain decrease, do gentle exercises that strengthen and stretch your ankle.
If you have tendinitis or bursitis, decrease activity for 1 to 2 weeks or until fairly pain-free. Apply heat to the area before stretching and ice when you have finished. If there is no improvement in 10 to 14 days, call your doctor.
If you have gout, try raising your legs and applying ice. Call your doctor for prescription medications.
Range-of-motion exercise: Sit with your leg extended; keep it still while you move your foot to print the alphabet in the air with your big toe
Decision Guide for Ankle PainSymptoms/Signs | Action |
|---|
Swelling, pain, and possible bruising from sudden twist or force | Use self-care |
Pain at back of ankle -- begins slowly and may be worse when you wake up | Use self-care |
Ankle pain and swelling that comes on suddenly and is not related to injury; may appear discolored (reddish blue), shiny, or feel warm to the touch | See provider |
Ankle pain associated with swelling, fever, and chills | See provider |
Sudden intense pain, with rapid onset of swelling; felt or heard "snap" or "pop" at time of injury | See provider |
Unable to bear weight, stand, or walk; deformed or crooked appearance | Seek help now |
Signs of possible nerve damage -- foot is numb, cold, or blue | Seek help now |
