Ankle Pain: Causes and what to do

An ankle injury is, especially to athletes, all too painfully familiar. The pain often stems from stress taking place over a long period of time at a stretch or repeatedly. You can think of incorrect running movements or an acute injury, such as a twisting trauma to the ankle.

The ankle joint divides into an upper ankle joint and a lower ankle joint. The upper ankle joint is often referred to as the ankle and is formed by the two strong bones of the lower leg (the fibula and tibia) and the talus. The lower ankle joint is located further towards the toes and is a complex structure formed by several other tarsal bones. The upper ankle joint forms the medial and lateral ankle and is supported and held stable by weight-bearing ligaments. It allows the foot to roll and is therefore crucial for smooth gait function (the pattern/movement of walking). In addition, mechanical processes in the ankle joint (and throughout the foot) cushion the stress on the gait and support the entire body weight when standing and walking.

Ankle pain can have a variety of causes, but the most common is a sports injury. You can prevent this cause by exercising regularly and stabilizing appropriately during sports. Typically, an ankle injury occurs during sports such as volleyball, basketball, tennis, gymnastics, football and field hockey.
Most of these sports require frequent jumping, quick sequences of steps and abrupt starts and stops. Such movements put a lot of stress on the ankle joints. One false landing or misstep - and the ankle will twist painfully. But it can also happen in everyday life that the foot comes up awkwardly or the joint is accidentally twisted. The risk of twisting an ankle in everyday life or sports also depends on the stability of the ankle region. Although this can be optimized through regular training, it is also dependent on innate mobility, among other things. 

Some of the injuries and diseases listed here are also typical for other joints and cause similar complaints. 

Symptoms overview:

• Pulling or stabbing pain in the ankle
• Swelling and redness in the ankle area
• Pain when treading
• Movement restrictions of the ankle joint
• Relief posture

Symptoms may worsen with persistent discomfort or severe injury:

• Treading is no longer possible
• The joint becomes stiff

When twisting their ankle, athletes in particular, suffer a stretched or torn ligament. Both are apparent in the ankle joint by symptoms such as swelling of the ankle and pain in the area of the joint. In the case of severe overstretching or a torn ligament, the joint becomes unstable because it is no longer adequately supported by the ligaments. This makes walking and stepping difficult. In the case of a torn ligament, there is a sudden onset of pain, accompanied by severe swelling and a bruise (hematoma). A distinct popping sound is often also heard. Ligament strains and tears require medical attention.

When fractures occur around the ankle, the complexity depends on how many structures were damaged in the injury. Medical care is necessary for clarification, also to determine whether surgery is needed or not.

Sprain is a term that groups together numerous "mild" injuries that can cause very intense pain. Soft tissues such as ligaments, tendons and muscles as well as the bony structures can be affected in several levels of complexity. 

Osteoarthritis refers to a degenerative change in the internal joint structures. In particular, the healthy cartilage substance is reduced. The causes are manifold. It can be age-related and cause little discomfort, or it can be caused by anatomical conditions, past injuries and surgeries, or other causes. An important piece of information here is that a joint with arthritic changes (signs of wear and tear) can be completely painless, which means that wear and tear on a joint is not enough on its own to account for pain.

Depending on the underlying triggers, there are different treatment options for ankle pain. If you have osteoarthritis, the pain is like that of a chronic or acute ligament strain. If you have suffered an acute injury, you should first apply the R.I.C.E. rule (rest, ice, compression, elevation) and regularly cool and elevate the joint until the pain subsides and any swelling that has occurred has gone down. In addition, it may be useful to then support the joint with the help of an ankle support.
If the swelling and pain do not subside over a prolonged time period, a serious injury may be present. In this case, assessment and treatment must be done by a medical professional. If you are unsure of the cause of your pain, you should also see a doctor. 

An ankle brace protects and stabilizes the ankle joint during exercise and relieves pain that is caused or encouraged by overuse and injuries to the joint. A support is also helpful in relieving arthritis.

With the help of a tape, painful joints can be stabilized in such a way that the risk of injury is reduced. Even pre-existing pain in the foot or ankle joint can usually be positively influenced by applying tape. For correct application, it is best to ask a doctor for help.

As a preventative measure against ankle injuries and pain, compression can be useful during sports. Compression can help improve circulation, which increases performance during sports and protects muscles and joints from premature fatigue. It also helps regenerate muscles after exercise, which in turn prevents muscle and joint damage.

Dr. Michael Richter has been a state-certified physiotherapist since 1999 and works at the renowned “Rückenzentrum Am Michel” in Hamburg, Germany - an interdisciplinary center specializing in the treatment of people with acute and chronic musculoskeletal complaints.

He is an expert in manual therapy and exercise therapy and has been treating people with back and joint problems for 20 years. In addition to his enthusiasm for the manual treatment of patients, pain education is very close to Michael's heart and it has been his ambition for years to inform patients and colleagues with the best and scientifically sound facts on the subject of pain.

In addition to his practical work with patients, Michael was involved in teaching and research as a substitute professor in the field of physiotherapy at the Münster School of Health in Münster, Germany.