Ankle Pain

This article was written, reviewed and contributed to by some of Australia’s leading experts in the field of pain and ankle pain. Our goal with this comprehensive article is to help you better understand what’s causing your ankle pain and answer any questions you may have.

If ankle pain is something you have been suffering with for a long time, then we hope we can provide you with some new information, which may help you on your road to recovery.

We have provided a simple to read, practical and actionable plan, backed by the latest medical research to treat your ankle pain (including things you can do from home) and help you get back feeling your best.

Continue reading as we guide you in understanding the different types of ankle pain and help you work out what type you may have.

What is Ankle Pain?

Ankle pain is a term used for describing conditions or problems around the talocrural (ankle) joint. Injuries to structures, such as ligaments, bones and tendons can lead to ankle pain. Examples of common ankle conditions include ankle sprains, tendonitis and fractures.

According to researchers from the University of Sydney, 45.5% of Australians have experienced ankle injuries and pain.[1] Additionally, 23.7% of people experience long-term symptoms with ankle pain.[1] The Australian Institute of Health and Welfare also noted that males between the ages of 15-34 were at the highest risk of being hospitalised due to ankle pain resulting from sports injuries.[2]

Pain is categorised as either acute, subacute or chronic ankle pain

Acute ankle pain: (0 days - 6 weeks)

Acute ankle pain is usually the result of a minor injury or fall. The most common ankle injury is the sprained ankle (rolled ankle). These sudden ankle injuries types of injuries usually recover within a few weeks after the appropriate treatment and require rest to heal.

Subacute ankle pain: (6 weeks - 3 months)

Sub-acute ankle pain is usually the result of more tissue damage and potentially more complications. These types of injuries are slower to heal than acute ankle injuries and may require more treatment.

Chronic ankle pain: (3 months +)

Chronic ankle pain is usually defined as pain that lasts longer than three months. There are many reasons for this, including major tissue damage, or other injuries that also affect the ankle (like knee pain). Chronic pain may also be because of other factors like general poor health, we know that adequate sleep, good nutrition and general well-being helps with the healing process.

What are the symptoms of ankle pain?

Ankle pain is often characterised by physical discomfort on the outside of the ankle. People may also experience swelling or bruising as a result of injury. Other ankle pain symptoms include numbness, instability or a lack of ability to bear weight on the ankle.

Common complaints of pain in the ankle

• Swelling around the ankle joint

• Associated Foot Pain

• Tenderness

• Clicking or giving way under weight

• Pain going up hills or stairs

• Bruising

• Instability of the ankle

• Difficulty moving the ankle or weight-bearing

People may experience

Pain areas: in the ankle, Achilles or arch of the foot

Sensory: pins and needles, numbness

Also common: limping, difficulty weight bearing

What causes ankle pain?

The most common causes of ankle pain include injury, arthritis and natural wear and tear issues. In the case of injury, the most common cause of ankle pain would be a rolled ankle. Arthritis and wear and tear usually occur in older patients.

According to the Mayo clinic, ankle pain is defined as “any pain that originates from the inside or outside of the ankle, or pain around the achilles tendon.”[3]

Ankle pain can result from a problem in one or several parts of the ankle, including:

• Muscles (strain)

• Ligaments (sprain)

• Nerves

• Bone injuries - the bones of the ankle include; calcaneus (heel), tibia and fibula (ankle joint), talus and the bones of the mid and forefoot.

Common reasons why people experience pain in the ankle

• Awkward landing of the foot after jumping

• Fall on a twisted ankle

• Walking on uneven surfaces

• Overweight or obesity

• Arthritic or inflammatory issues

• Overuse injury of the ankle.

This list only scratches the surface of potential causes of ankle pain. Usually, there are several factors that lead to ankle pain.

Common injuries that cause ankle pain

Ankle sprain

Probably the most common injury of the ankle, an ankle sprain is usually caused by a twisting or rolling of the foot, which can cause damage to the ligaments that create stability in the ankle. This causes pain and swelling around the ankle. Weight-bearing may also be difficult if you have this injury. This is different to a high ankle sprain, which affects the ligamanents between the shin bones, above the ankle.

Osteoarthritis

Osteoarthritis is the wearing down of the cartilage that covers the end of your bones to provide additional cushion. This results in pain and stiffness of the ankle joint. Osteoarthritis usually becomes more prominent as we age.

Retrocalcaneal bursitis

Retrocalcaneal bursitis is where the fluid-filled sacs on your ankles become inflamed and cause pain. This can happen due to overuse, wearing high-heeled or improper fitting shoes, and arthritis.

Flat feet

Otherwise known as pes planus, this is the loss of the natural arch between your heel and the ball of your foot. This causes an imbalance in the distribution of body weight around your feet. This is usually hereditary but can also happen due to muscle weakness.

Achilles Tendinopathy

High intensity with a sudden change in movements or repetitive stress can cause tiny tears in the achilles tendon. Overuse and long term damage can lead to Achilles tendinopathy.

Fractures

Ankle fractures do happen, but thankfully are quite rare. The bones around your ankle joint can break due to direct trauma or injury like landing and twisting, or in a motor vehicle accident.

Common conditions that cause ankle pain

Medical conditions can also present with ankle pain. It is essential to know if you also have these conditions:

• Rheumatoid Arthritis

• Scleroderma

• Infection

• Gout.

Sports that increase the risk of ankle pain

Ankle pain is a prevalent injury among athletes. High-intensity and contact sports can increase the risk of having ankle pain over time. Here is the list of the most common sports that result in ankle pain:

• Basketball

• Soccer

• Football

• Volleyball

• Running

• Netball

• Tennis

There are several causes of ankle pain, with many that overlap. Understanding what may be causing your ankle pain can help you diagnose the problem and most importantly, access the right treatment.

How is ankle pain diagnosed?

Having a complete assessment of your ankle is essential in determining the root cause of your ankle pain and getting the most appropriate treatment for your condition.

There are several options available when it comes to diagnosing the underlying cause of your ankle pain. One of the most common recommendations by Australian GP’s is a physiotherapist assessment.

Ankle pain is extremely common and something that physiotherapists see regularly. The process of diagnosing is straightforward.

Your assessment will start with a consultation (mini-interview) where your physiotherapist will ask you essential questions about your medical history and lifestyle to understand the history of your condition. Use this time to discuss all relevant information about your injury.

After establishing the background of your condition, your physiotherapist will perform specific physical tests and movement screens to determine the cause of your problem and rule out other conditions.

Your physiotherapist will then provide you with a tailored treatment plan based on your condition and your goals.

From here, you will receive the details of your treatment program; this will include:

• Timeline for recovery

• Number of treatment sessions

• List of exercises you need to do at home

• Strategies to manage the pain and to prevent worsening of the condition

• Advice and recommendations.

How is ankle pain treated?

Ankle pain can be frustrating and keep you from participating in sports as well as working effectively. It can limit your movement and affect your daily activities. Some ankle pain can progress to a chronic condition depending on the underlying cause.

There are several options when it comes to treating ankle pain. One of the more common treatment options that is referred to by Australian GP’s is physiotherapy.

Ankle pain is something that physiotherapists come across regularly, and the process of treating it is straightforward. Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.

A combination of manual therapy, pain modalities, and specific movement exercises will be given to you by your physiotherapist.

Your physiotherapist will focus on decreasing your pain, improving the stability of your ankle and increasing your overall balance and strength to help you maximise your recovery.

Depending on the severity of your condition, your physiotherapist will provide you with a combination of these treatments:

• Therapeutic Exercises - Specific exercises tailored to improve your ankle pain.

• Balance and Proprioception Training - Geared towards strengthening the ankle joint specifically.

• Manual Therapy - Hands-on physiotherapy, used to help reduce pain and increase range of motion in the ankle.

• Stretching Exercises - Stretching will help lengthen muscles and increase range of motion.

• Joint Mobilisation - Specific joint mobilisations are used to reduce stiffness in particular areas.

• Myofascial Release - A specific treatment technique aimed at reducing muscle tightness.

• Dry Needling - A technique used to help alleviate pain and reduce muscle tension.

• Heat Therapy / Cryotherapy - Used to reduce tension and pain in acute situations.

• Taping - Tape provides stability and comfort in the early phase of ankle pain.

A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes, and it is not uncommon for patients to feel the benefits in just one session.

Next step: Creating a treatment plan made for you

After your initial appointment, your physiotherapist will create a specific treatment plan according to your goals to help you get the most out of your recovery and get you back to doing the things that you loved.

Self-care strategies

If you are having ankle pain, here are the best things you can do and avoid.

Things to do:

• Rest

Listen to your body and rest. Watch out for the signs of inflammation, such as swelling and tenderness. Seek professional help and advice from your physiotherapist before engaging again in high-intensity activities.

If you are an athlete, it may be frustrating but sometimes a rest day is exactly what your body needs. Give your body time to heal. Alternatively, you can focus on upper body workouts without putting stress or weight on your ankles.

• Ice

Ice can help you relieve the pain and control inflammation. It is crucial to use an ice compress in the first 24 hours of your injury. Apply ice compress for 10 to 15 minutes every two hours for maximum benefits.

• Compression

Compress the ankle joint with an elastic bandage to control the swelling and limit the mobility of the ankle joint, preventing further damage to the inflamed ligaments.

• Elevation

Elevate your ankle joint above the level of your heart, especially when you sleep at night; 30 to 45 degrees of elevation is ideal.

• Use crutches when required

Assistive devices such as crutches can help you decrease the load on your foot and assist you in walking, preventing further damage to your ankles during the initial stage of the injury. This is only necessary with very swollen and painful injuries.

Things you should avoid:

• Avoid activities that worsen the pain

Take rest and consult a physiotherapist as soon as possible. Avoid weight-bearing activities or stressing your ankle and foot.

• Minimise walking or climbing stairs

Walking and climbing stairs rely on the stability of your feet and ankles. If you are having ankle pain, these activities can make it worse.

Do I need a specialist or surgery?

A complete tear of the ligaments in your ankle and severe fractures may require surgery to restore the stability and function.

Diagnostic imaging can be done, such as an X-ray, ultrasound, CT scan, or MRI to assess the structures of your ankle and rule out other conditions.

Whether your condition requires surgery or not, you will benefit from having physiotherapy to help you restore your mobility and function.

What is the recovery time / prognosis for ankle pain?

The time of recovery depends on the severity of the condition that’s causing your ankle pain. Mid to low-grade tears can heal in one to three weeks with proper rest and treatment. Physiotherapy can help in aiding faster recovery and improvement of your condition.

Important factors in your recovery post-treatment:

• Following your tailored treatment plan

• Resuming sports only when ready

• Listening to your body and rest when required

Other factors that may influence your recovery time:

• Injury type and severity

• Lifestyle factors

• Weight

• Previous injury history

• Age

It is not uncommon to feel immediate relief after your initial physiotherapy session. However, it is essential to commit to your program and be consistent to achieve full recovery from your injury.

Can pain in the ankle be prevented?

Preventing ankle pain is almost impossible to guarantee, but there are some things you can do to minimise this risk.

These tips for preventing ankle pain can also double as treatment options if you already have ankle pain.

• Maintain flexibility: Maintaining the flexibility of your muscles through stretching will help you keep the natural range of motion of your ankle joint. Flexible muscles mean they are more resilient to tears from the sudden stretch.

• Strengthen your muscles: Keeping your lower body muscles strong through regular exercise will prevent soft tissue injuries and allow your joints’ greater stability.

Your physiotherapist will provide you with optimised training exercises to keep your lower body strong and prevent injuries.

• Phase your activity: Allow proper rest periods during your workouts or when playing sports. Most ankle injuries are the result of cumulative stress due to overuse.

• Wear properly fitting shoes: Use shoes that properly fit you and protect you from injuries. Each person has different footwear needs depending on their anatomy.

• Maintain a healthy weight: Your foot and ankle joint gets most of the load from your body weight and are constantly under stress during weight-bearing activities. Managing your weight allows lesser stress on the structure of your ankle joints, decreasing the chance of having ankle pain.

Outlook and the main takeaways

If there is one thing to take away from this guide to ankle pain, it’s that there are many causes, types and severities of ankle pain. You are experiencing pain for a reason, the best thing to do is to listen to your body and do something about it. Book a time, and have your ankle pain assessed by a physiotherapist today.

Anatomy of the ankle

The ankle joint comprises three bones;the bones of your leg (tibia and fibula) and the ankle bone (talus). These bones are connected via strong ligaments that provide stability in the ankle joint.

Ligaments inside the ankle joint:

• Anterior talofibular ligament (ATFL)

• Calcaneofibular ligament (CFL)

• Posterior talofibular ligament (PTFL)

• Deltoid ligament complex

Major muscles of the ankle:

• Peroneal muscles (peroneus Longus and peroneus brevis)

• Calf muscles (gastrocnemius and soleus)

• Posterior Tibialis

• Anterior Tibialis

The achilles tendon also runs behind the ankle and connects the calf muscles to your foot. Any injury to these structures can cause ankle pain.