Ankle pain

Answer 1

Definition

Ankle pain involves any discomfort in one or both ankles.

Alternative Names

Pain - ankle

Considerations

Ankle pain is often due to an ankle sprain. A sprain is an injury to the ligaments, which connect bones to one another. In most cases of ankle sprain, the ankle is twisted inward, causing small tears in the ligaments. This makes the ankle unstable. The tearing leads to swelling and bruising, making it difficult to bear weight on the joint.

Once an ankle is sprained, the injury may take a few weeks to many months to fully heal. Often, the injured ankle remains a little weaker and less stable than the uninjured one. A proper recovery program can prevent this problem.

Other structures in the ankle that can be damaged and cause pain are tendons (which join muscles to bone), cartilage (which cushions joints), and blood vessels. Adjacent areas can cause pain to be felt in (referred to) the ankle -- these include the foot, lower leg, knee, and even hip.

Common Causes

In addition to ankle sprains and other injuries, ankle pain can be caused by Arthritis, gout, pseudogout, and infection.

Gout occurs when you produce too much uric acid (a waste product in the body). The extra uric acid gets deposited and forms crystals in joints, rather than being excreted in the urine.

Pseudogout is similar to gout. In this condition, calcium deposits in one or more of your joints, causing pain, redness, and swelling.

The types of arthritis that can cause ankle pain include:

• Chronic gouty arthritis
• Osteoarthritis
• Psoriatic arthritis
• Rheumatoid arthritis
• Septic arthritis

Home Care

• If you feel pain in your ankle, rest it for several days. Try NOT to move the affected area.
• If your ankle is unstable, support it, especially during standing or walking. ACE bandages work well. If this does not provide enough support, you may need to be fit for a brace. Crutches or a cane can help take the weight off a sore or unsteady ankle.
• For swelling, keep your foot elevated above the level of the heart, even while sleeping. Ice the area right away. Apply ice for 10-15 minutes every hour for the first day. Then, every 3-4 hours for 2 more days.
• Try acetaminophen or ibuprofen for pain and swelling.

Even after the pain subsides, you will need to keep pressure off of it for up to 10 days for a mild sprain and up to 5 weeks for a more severe sprain.

Once you have healed adequately, you can start exercises to strengthen your ankle and avoid injury in the future. Do not begin these exercises until a health care professional tells you it is safe to start. One exercise, for example, involves balancing on your healing foot and hopping.

For arthritis of the ankle, take medication exactly as prescribed. When the pain and swelling start to decrease, gently begin to exercise the joint again. Swimming is good, followed by stretching. Walking can be added later. Exercises can be done several times a day; but DO NOT overdo it. Pain is a message from your body to stop.

Call your health care provider if

Go to the hospital or call 911 if:

• You have severe pain when NOT bearing weight.
• You suspect a broken bone (the joint appears deformed and you cannot put any weight on the leg).
• There is an audible popping sound and immediate difficulty using the joint.

Call your doctor if:

• Swelling does not go down within 2-3 days.
• You have symptoms of infection -- the area becomes red, more painful, or warm, or you have a fever over 100F.
• The pain does not go away after several weeks.

What to expect at your health care provider's office

Your doctor will perform a physical examination, including a detailed examination of the ankles, and ask questions such as:

• Does the pain shift from joint to joint?
• Is the pain the same in both ankles?
• Did the pain begin suddenly and severely?
• Did the pain begin slowly and mildly and then get worse?
• Did the pain resolve spontaneously in less than 6 weeks?
• Does the ankle feel warm to the touch?
• Does the ankle hurt when you are not bearing weight on it?

Diagnostic tests that may be performed include the following:

• X-ray of the ankle and possibly the foot
• Aspiration of synovial fluid (fluid from the joint space) and synovial fluid analysis

Nonsteroidal anti-inflammatory medications (NSAIDs), special foot gear, or braces may be prescribed. Surgery is occasionally necessary.

Prevention

• Lose weight if you are overweight. Extra pounds put strain on your ankles.
• Warm-up before exercising. Stretch the muscles and tendons that anchor the ankle.
• Avoid sports and activities for which you are not properly conditioned.
• Make sure that shoes fit you properly. Avoid high-heeled shoes.
• If you are prone to ankle pain or twisting your ankle during certain activities, use ankle support braces. These include air-casts, ACE bandages, or lace-up ankle supports.

References

Chorley JN. Ankle sprain discharge instructions from the emergency department. Pediatr Emerg Care. 2005; 21(8): 498-501.

Van Rijn RM, van Os AG, Bernsen R, Luijsterburg PA, Koes BW, Bierma_Zeinstra SM. What is the clinical course of acute ankle sprains? A systematic literature review. Am J Med. 2008;121:324-331.e6.

Osborne MD. Chronic ankle instability. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 77.

Ivins D. Acute ankle sprain: an update. Am Fam Physician. 2006;74:1714-1720.

Answer 2

Definition

Ankle pain involves any discomfort in one or both ankles.

Alternative Names

Pain - ankle; Sprain - ankle; Ankle sprain

Common Causes

Ankle pain is often due to an ankle sprain.

• An ankle sprain is an injury to the ligaments, which connect bones to one another.
• In most cases, the ankle is twisted inward, causing small tears in the ligaments. The tearing leads to swelling and bruising, making it difficult to bear weight on the joint.

In addition to ankle sprains, ankle pain can be caused by:

• Damage or swelling of tendons (which join muscles to bone) or cartilage (which cushions joints)
• Infection in the ankle joint
• Osteoarthritis, gout,rheumatoid arthritis, Reiter syndrome, and other types of arthritis

Problems in areas near the ankle that can cause you to feel pain in the ankle include:

• Blockage of blood vessels in the leg
• Heel pain or injuries
• Nerve injuries (such as tarsal tunnel syndrome or sciatica)

Home Care

To treat an ankle sprain:

• Rest your ankle for several days. Try NOT to put much weight on your ankle.
• Put on an ACE bandage. You also can buy a brace that supports your ankle.
• Use crutches or a cane to help take the weight off a sore or unsteady ankle.
• Keep your foot raised above the level of your heart. When you are sitting or sleeping, place two pillows under your ankle.
• Ice the area right away. Apply ice for 10-15 minutes every hour for the first day. Then, apply ice every 3-4 hours for 2 more days.
• Try acetaminophen or ibuprofen for pain and swelling.

As the swelling and pain improve, you will need to keep extra stress off your ankle for up to 10 days for a milder sprain and 2 to 5 weeks for a more severe sprain.

The injury may take a few weeks to many months to fully heal. Once the pain and swelling are mostly gone, the injured ankle will still be a little weaker and less stable than the uninjured ankle.

You will need to start exercises to strengthen your ankle and avoid injury in the future. Do not begin these exercises until a health care professional tells you it is safe to start.

For arthritis and other ankle problems, follw the treatment your doctor recommended.

Call your health care provider if

Go to the hospital if:

• You have severe pain even when you are NOT bearing weight.
• You suspect a broken bone (the joint looks deformed and you cannot put any weight on the leg).
• You can hear a popping sound and have immediate trouble using the joint.

Call your doctor if:

• Swelling does not go down within 2 - 3 days
• You have symptoms of infection -- the area becomes red, more painful, or warm, or you have a fever over 100 A°F
• The pain does not go away after several weeks
• Other joints are also involved
• You have a history of arthritis and are having new symptoms

What to expect at your health care provider's office

Your doctor will perform a physical examination, including a detailed examination of the ankles, and will ask questions such as:

• Does the pain shift from joint to joint?
• Is the pain the same in both ankles?
• Did the pain begin suddenly and severely?
• Did the pain begin slowly and mildly and then get worse?
• Did the pain get better by itself in less than 6 weeks?
• Does the ankle feel warm to the touch?
• Does the ankle hurt when you are not bearing weight on it?
• Do you have any abnormal sensation in your foot?

Diagnostic tests that may be performed include the following:

• Aspiration of synovial fluid (fluid from the joint space) and synovial fluid analysis
• X-ray of the ankle and possibly the foot

Nonsteroidal anti-inflammatory medications (NSAIDs), special foot gear, or braces may be prescribed. Surgery is sometimes needed.

Prevention

• Lose weight if you are overweight. Extra pounds put strain on your ankles.
• Warm up before exercising. Stretch the muscles and tendons that support the ankle.
• Avoid sports and activities for which you are not properly conditioned.
• Make sure that shoes fit you properly. Avoid high-heeled shoes.
• If you are prone to ankle pain or twisting your ankle during certain activities, use ankle support braces. These include air casts, ACE bandages, or lace-up ankle supports.
• Work on your balance and do agility exercises.

References

Koenig MD. Ligament injuries. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:section C.

Baer Gs, Keene JS. Tendon injuries of the foot and ankle. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:section D.

Brodsky JW, Bruck N. Stress fractures of the foot and ankle. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:section E.

Hirose CB, Clanton TO, Wood RM. Etiology of injury to the foot and ankle. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier;2009:section J.

Abu-Laban RV, Ho K. Ankle and foot. In: Marx JA, Hockberger Rs, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 55.

Osborne MD. Chronic ankle instability. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 77.

Price Md, Chiodo CP. Foot and ankle pain. In: Firestein GS, Budd RC, Harris ED Jr, et al, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 43.

Reviewed By

Review Date: 02/19/2011

Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.