Ankle pain

Ankle pain: When suddenly the ankle hurts

Our ankle joint lies between the lower leg and the foot. While the ankle joint plays an important role in the mobility of the foot, it contributes significantly to our gait and stance.  

We distinguish between an upper and a lower ankle joint, although the two joints cooperate closely to allow for the wide range of movements of the foot. While the upper ankle joint facilitates extension and flexion of the ankle joint, the lower joint is primarily responsible for inward and outward rotation.  

It is the interaction of various bones, ligaments and muscles that makes the ankle joint capable of performing its various tasks. From this it also follows that different disorders of this interplay can affect the function of the joint and lead to pain.  

Primarily, traumatic events and inflammatory processes stand out among the many causes of ankle joint pain. Several different mechanisms of injury can cause damage to the bones as well as to tendons, ligaments, or the cartilage of the joint. Also, inflammations around the ankle joint cause pain and swelling in patients.

First clues to potential causes: When is pain experienced?

Ankle pain is a symptom of a disorder in the area of the ankle joint and can be caused by many different factors. In this context, the severity and the timing of the pain onset are important clues.  

Ankle pain after an accident

In case of traumatic events leading to ankle joint pain, the pain usually occurs right after the accident. After a short interval, the swelling of the joint usually sets in, too. Pain will then increase upon loading of the ankle joint.  

One of the most common accident mechanisms is twisting of the ankle joint outward. This can stretch or even tear ligaments. Less frequently, the ankle may also break.

Ankle pain with osteoarthritis

Since the ankle joint is heavily loaded when walking, standing and by various other physical activities, osteoarthritis can develop. It is a wear and tear of the joint with loss of the protective articular cartilage.  

The patients typically describe pain at the beginning of a load. After a while, the pain tends to decrease slightly and then gets worse again with prolonged exertion.  

Recurrent inflammatory reactions can also be seen in ankle joint osteoarthritis. Caused by an increase in stress, swelling of the ankle joint usually persists for several days and may also be warm to the touch. Through rest, the inflammatory reaction can resolve itself and the pain improves.  

Ankle pain associated with systemic diseases

Systemic inflammatory diseases like rheumatoid arthritis can also become evident in the area of the ankle joint and lead to pain. Rheumatic diseases also proceed in episodes and patients complain of recurrent inflammatory reactions in the joints. A symmetrical distribution affecting several joints is typical of this disease, so that both ankle joints are simultaneously affected, for example.

Ankle pain due to deformities

If ankle pain mainly occurs during exercise, such as jogging or after a longer walk, different malpositions of the leg axis or the arch of the foot are possible causes.  

Pain usually evolves slowly and only occurs after prolonged exposure to unequal stress on the ankle joint.  

When to seek medical attention for ankle pain?

Basically, any form of ankle pain that is present for a longer period of time and results in limitations for the patient should be seen by a doctor. A detailed diagnosis is possible in this way, allowing the cause to be identified and, if necessary, a treatment to be introduced.  

If ankle pain is the result of an accident, such as a twisted ankle or a fall, then a doctor should be seen as soon as possible to rule out the possibility of a fracture. Ignoring the symptoms in such a case and placing further strain on the ankle can potentially cause even more damage.

Swollen ankle joint: What measures can help? 

Ankle pain is often accompanied by swelling. Although therapy should be directed against the underlying cause, there are several measures that can be taken to relieve the swelling of the joint.   

The first step should be to rest the joint and to limit or completely stop weight-bearing. Furthermore, patients should keep their foot elevated so that the ankle joint is positioned above the level of the heart. One way to do this is to place the foot on an elevated pillow while the patient is lying down. This helps the blood to flow back from the foot to the heart.  

Cooling the ankle also can provide relief to patients and help reduce swelling. This can be very efficient when inflammatory processes are the cause of the ankle pain.

Inflammation of the ankle joint

In case of an inflammation, the body responds to a stimulus with various measures. In medical practice, five major symptoms of inflammation are distinguished. They include pain, swelling, redness, warmth and functional restrictions. All of these symptoms can also appear in the area of the ankle joint when there is an inflammation.  

Different triggers lead to inflammation. Above all, this includes osteoarthritis, that means wear and tear of the joint. In this case, the inflammatory reactions recur and then subside again in between. The acute phase is then referred to as activated arthrosis. This is enhanced, for example, through increased stress on the ankle joint.  

Rheumatic diseases also typically lead to inflammation. Usually, the joint cartilage is falsely attacked by the patient's own defense mechanism, even tendons and ligaments can be affected. This immune response leads to inflammation, for example in the ankle joint.  

In a similar way to a rheumatic joint disease, a so-called reactive arthritis can be yet another cause of inflammation in the ankle joint area. It is an inflammation of the joint resulting from an infection of another part of the body, for example the intestine. This may involve the unwanted attack of various joints by the immune system, resulting in an inflammatory response.    

Diagnosis of ankle pain

Normally, an orthopedist or surgeon is consulted for ankle pain. They will first obtain a detailed patient history, asking questions about the extent, occurrence and progression of the pain. A physical examination of the ankle region follows, and the foot and lower leg should also be examined.  

After the physical examination, different imaging procedures can be employed. First of all, X-ray images of the ankle joint are usually made, with the joint being examined in two planes. This allows bony structures to be visualized very well.  

Then, to be able to display tendons, ligaments and muscles as well, an MRI examination or ultrasound can be performed, for instance. Further diagnostic measures or consultations with other medical specialists may be required, depending on the results of the examination and the disease.

Therapy and treatment of ankle pain

Therapy of ankle pain should always focus on the cause. Here, we distinguish between conservative and surgical measures, and conservative treatment possibilities should be fully exhausted first before considering surgery.  

To treat ankle pain, general measures can provide relief for many patients. Among them are rest, elevation of the joint or cooling.  

Moreover, in conservative therapy, various bandages and braces are very often used to stabilize the joint. Many patients also benefit from physiotherapy. Also certain medications can be prescribed, which have analgesic or anti-inflammatory effects.  

Surgical intervention should only be attempted when conservative therapy has failed or has been exhausted.  

According to the disorder, an operation can either be carried out through an open incision in the skin, which allows visualization of the respective structures, or in a minimally invasive way by an ankle arthroscopy.  

This involves introducing a so-called endoscope into the joint space through a small incision in the skin. A camera along with a light source can be used to examine structures and operate on them using a variety of instruments.   

As a rule, ankle pain should always be treated after extensive diagnostics and in consideration of the patients' individual situation.   

Where can I find doctors & clinics for ankle pain?

Ankle pain may severely limit patients in their everyday life and create considerable distress. For this reason, the treatment should always be performed by experienced specialists in the field of orthopedics, foot surgery or pain therapy.  

We have thoroughly reviewed all of the doctors listed here and consider them to be extremely competent. All of them are experts in their field and have extensive experience in diagnosing and treating ankle pain. Schedule your first appointment quickly and easily and see their expertise for yourself.