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Ankle pain

Definition

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.

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.

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 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 100 °F.
• 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.