Pain in the ankle
General
There can be many different causes of ankle pain.
Traumatic injuries, Broken bones, Sprains but also Nerve damage can be possible causes of pain in joints.
In addition, the varies as well Localization of the pain.
We differentiate between different joints on the foot, which can be affected by pain. These include that upper and lower ankle, the articulated connections between the individual foot bones (Calcaneocuboid, talonavicular, Chopart, tarsometatarsal, intertasal joints) as well as the articulated connections on the toe bones (Metatarsophalangeal and interphalangeal joints).
The following article looks at the most common causes of ankle pain, their symptoms, and appropriate therapy.
Ankle pain
These pains are those that are localized at the transition from the lower leg to the foot. It is also known colloquially as ankle pain.
The pain can come from the bony structures that make up the upper and lower ankle joints.
However, they can also be caused by the ligaments or the soft tissues that stabilize the ankle.
These are muscle and tendon pain.
Read more on this topic at: Pain in the ankle
Illustration causes of ankle pain
Foot pain
- Achilles tendonitis /
Achilles tendon rupture - Broken bones - toes,
Metatarsus, tarsus
(here outer ankle fracture) - Ligament stretch / torn ligament
at the ankle - Lower and upper heel spurs
Calcaneus spur - Hammer toe and claw toe
(Deformities of the toe bones)
Digitus malleus - Plantar warts
Verrucae plantares - Hallux valgus -
(Deviation of the big toe
in the base joint) - Hallux rigidus -
(Joint wear of the
Metatarsophalangeal joint) - Inflamed nails / nail fungus
- Osteoarthritis / arthritis -
degenerative change of
Joints / inflammation of the joints
You can find an overview of all Dr-Gumpert images at: medical illustrations
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Athletes (joggers, soccer players, etc.) are particularly often affected by diseases of the foot. In some cases, the cause of the foot discomfort cannot be identified at first.
Therefore, the treatment of the foot (e.g. Achilles tendonitis, heel spurs, etc.) requires a lot of experience.
I focus on a wide variety of foot diseases.
The aim of every treatment is treatment without surgery with a complete recovery of performance.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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causes
Injuries are often the cause of the pain that can be suffered, especially from excessive exercise and inadequate training.
Common injuries affect the Ligamentous apparatus of the ankle.
1. The supination trauma
The extremely painful supination trauma should be mentioned here. This is a violent overstretching of the outer ligament apparatus of the ankle.
In almost all cases this is the so-called Talofibular anterior ligament (anterior talofibular ligament) injured.
They are rarer Calcaneofibular ligament and talofibular posterius affected.
The injuries range from one simple overstretching up to one Rupture (Torn ligament).
The injury can be external as swelling or Hematoma being visible.
The pressure on the ankle is also painful and the mobility of the joint is limited.
In diagnostics, imaging methods such as the one are used X-ray examinationto make a safe diagnosis.
Supination trauma is very common, especially in athletes, and can usually be resolved conservatively calming and decongestant measures to treat.
A Physiotherapy or physiotherapy is recommended.
In addition, in patients with extensive physical rest, a Thrombosis prophylaxis With Heparin carried out.
In some cases, however, a surgical intervention be needed to restore the ligamentous apparatus.
2. The ankle arthrosis
In most cases there is one arthrosis of the ankle joint is a long-term consequence of a previous injury.
Osteoarthritis in general Signs of wearthat can affect any joint in general.
Osteoarthritis can also have other causes. These include:
- Sedentary lifestyle,
- Misalignments after torn ligaments,
- Misalignments of the leg axis,
- Injuries to the bones involved in the joint,
- an overload of the joints due to obesity or exercise,
- Osteoporosis.
The wear and tear leads to a increased stress on the bones, because the articular cartilage continues to wear and tear and its shock-absorbing effect is lost.
Outwardly can Swelling be visible.
Arthrosis is painless in some cases. Often however exercise-related pain, Joint deformations and grinding noises on the articular surfaces.
It comes to one increasing restricted mobility and one Relieving posture.
Osteoarthritis is then diagnosed with the help of imaging tests, such as the roentgen, CT or MRI of the foot, diagnosed.
There are now various therapeutic approaches that can be used for treatment.
First find conservative or minimally invasive procedures Application.
Ultimately, however, there are also a number of operational interventions for the treatment of advanced osteoarthritis.
3. The ankle arthritis / inflammation of the ankle
Ankle arthritis is one of the inflammatory joint disease.
Unlike osteoarthritis, arthritis shows clear signs of inflammation, as a swelling, Redness, overheat and Joint effusion.
Arthritis can bacterial or non-bacterial be conditional.
The non-bacterial arthritis is also divided into one rheumatoid and post-infectious arthritis.
There is also a form of arthritis, which is associated with metabolic diseases (e.g. gout) is socialized.
However, rheumatoid arthritis of the ankle is the most common. It affects women, for example three times more often as men and is the result of a degenerative process.
It comes to one excessive immunological reaction of the body against the body's own tissue, such as the articular cartilage, resulting in inflammation.
The arthritis then manifests itself in severe pain and the typical ones already mentioned above Signs of inflammation.
Here, too, there are conservative measures for treatment. First of all, be Immunosuppressants and Rheumatoid drugs used for anti-inflammatory purposes.
physiotherapy can counteract the restriction of movement.
In very advanced arthritis is a surgical intervention but inevitable.
Such an intervention is, for example Synovectomy, which involves the inflamed tissue of the joint athroscopic away. The knee joint is opened surgically.
At Bacterial contamination is additionally with Antibiotics treated.
In extreme cases and with extreme damage to the joint, a Joint prosthesis to be thought about.
4. The ankle fracture
Synonym: Malleolar fracture
Severe ankle pain can of course also indicate a fracture be.
The ankle fracture is the most common fracture of the lower extremity in adults.
Such a break usually occurs with a "contortion"Or a"Twist“Of the foot.
The doctor carries out a safe diagnosis X-ray examination by.
Furthermore, different ankle fractures are considered regarding their exact localization distinguished.
It can still be too Concomitant injuries to the ligamentous apparatus and others Soft tissues come, which secure the joint.
Such accompanying injuries can also be very painful.
The severity and type of the bone fracture ultimately determine the course of therapy.
In the case of slight bone fractures without dislocation of the bone parts minimally invasive procedures can be applied to those under anesthesia the bone parts straightened and then with percutaneous (under the skin) attached drilling wires are stabilized. Finally the break is cast in plaster.
In severe bone fractures with dislocation of the bone parts, a surgery may become unavoidable.
It is important here, at least the joint six weeks After the operation to spare and not to strain, in order to ensure a good healing.
As a rule, the materials that are inserted into the bone to stabilize the fracture remain (e.g. Screws), for a year in the joint.
Pain in other joints of the foot
Of course, ankle pain isn't just in the upper or lower ankle localized, but can also have their origin elsewhere.
Common causes of other ankle pain are discussed below.
1. The tarsus osteoarthritis
The tarsal osteoarthritis is an osteoarthritis in the area of the tarsus at the so-called Lisfrank joint.
The Lisfrank joint, too Tarsometatarsal joint called, is the articulated connection between the metatarsal bones and the tarsus.
Typical for tarsus osteoarthritis are strong pain in the area of the back of the foot.
In addition, rolling the foot is very painful.
The cause of tarsus osteoarthritis is often idiopathic. This means that the disease cannot be traced back to an identifiable cause.
However, also can Fractures or Trauma be the cause of tarsus osteoarthritis.
Upon examination, patients report pain when touching the Lisfrank joint.
In some cases are Swelling visible on the back of the foot.
Such swellings arise mainly in the presence of Osteophytes.
These are called osteophytes New bone formationwhich are called appostitional. This means that here new bone layers are superimposed on existing ones.
Osteophytes form in the frame degenerative bone disease out.
When examining the mobility of the joints, no abnormal findings are to be expected, since the mobility in the Lisfrank joint is not very high anyway.
However, rolling the foot is painful. Using imaging techniques like the roentgen and CT, on the other hand, you can see typical signs of osteoarthritis, such as a Joint space narrowing, detect.
Locally applied ones are used for treatment Anti-inflammatory drugs, which can also be taken orally.
Anti-inflammatory drugs have one anti-inflammatory effect.
In addition, that Wearing orthopedic shoes lead to a relief of the symptoms.
A surgery however, it is rarely indicated. In this case a Joint stiffening (Arthrodesis) carried out.
2. The acute gout attack (Uric arthritis)
Gout is a disorder of the purine metabolism in which uric acid accumulates and is less excreted. A lot of uric acid accumulates in the blood, which then accumulates in the form of crystals, so-called urates, especially in joints and joint capsules ).
The affected joint hurts mostly at night.
However, the complaints sound after hours or days so that some time passes before the next attack of gout.
In the initial stage, the affected joint is in X-ray image also inconspicuous.
In the late stages, however, show significant joint deformities, Pain, Swelling and Redness.
On average, men get sick more often than women.
A pronounced alcohol abuse such as unhealthy eating habits favor a gout attack.
For therapy one uses first Anti-inflammatory drugswhich have an analgesic and anti-inflammatory effect.
It also prevents the cytostatic Colchicine a further acidification of the joint interior.
Where is the pain?
External ankle pain
Pain on the outside of the foot or ankle is often caused by excessive strain in sports or accidents in everyday life. Usually the outer ligaments of the ankle are affected, which can be stretched, pulled or torn due to an ankle trauma. An ankle fracture can also occur, usually affecting the upper ankle.
Furthermore, the cause of pain in the outside of the ankle can be caused by joint wear (arthrosis) or inflammatory diseases of the joint such as arthritis, but also with old injuries to the ligaments or bones, as well as congenital malpositions of the ankle or ligaments.
A torn ligament or a stretching of the ligaments often results in extensive pain, as there is often accompanying massive swelling and bruising in and around the joint, which press on the injured ligaments.
It is characteristic of external ankle pain that it increases with movement and strain. There may also be instability in the joint, which leads to more frequent twisting of the joint, making the ligament worse.
The so-called Os trigonum syndrome can be another trigger for pain in the outer ankle. The os trigonum (Triangular leg) is a small bone at the rear end of the ankle bone, which is surrounded by various ligaments and when these are heavily used, irritation occurs, which can lead to persistent pain in the outside of the ankle.
A specialist in orthopedics and trauma surgery should be consulted at an early stage, who will be able to use targeted examinations, X-ray diagnostics or magnetic resonance imaging (MRI) Can reliably make the diagnosis in order to prevent consequential damage, such as the development of joint wear or misalignments.
Depending on the cause, treatment ranges from rest and cooling, to immobilizing the ankle with a plaster cast or splint, to surgical measures.
Learn more at: Pain in the outer ankle
Inner ankle pain
Here, too, accidents or sports injuries are often the cause of pain, with stretching of the ligaments on the inside of the ankle joint much less frequently. Other causes could be a fracture of the ankle or the lower fibula. In addition to pain, symptoms include swelling, restricted mobility and instability of the joint. Here, too, it is essential to see a doctor, who can differentiate between damage to the ligaments and a break and decide on the right therapy.
Read more about this under Pain in the inner ankle
Pain in the morning and after getting up
Morning foot pain can be caused by heel spurs on the one hand, and joint wear on the other in the ankle (arthrosis).
As with osteoarthritis in other joints, it is common after longer periods of rest, often in the morning, to pain in the affected joint, so-called Starting painuntil the joint "warm“Ran. Joint wear in the ankle already affects younger patients; often as a result older injuries or one Trauma.
Typical symptoms are still a Pulling deep in the ankle, Relief postures, Misalignments and in Late-stage resting pain.
The diagnosis is carried out by the orthopedic surgeon targeted survey and imaging procedures posed.
In the therapy come pain reliever drugs, Physical therapy, orthopedic footwear and with very advanced wear operational measures to use.
Heel spur however, is often through a irritated plantar fascia due to persistent overload caused. The plantar fascia is the tendon that originates from the heel bone and is needed for walking. Because of the constant irritation ossified as a countermeasure of the body the attachment of this tendon plate. Morning pain and increasing pain on exertion are typical symptoms.
The therapy includes orthopedic insoles, Heel pad, cooling, stretch, perhaps pain reliever drugs and if there is no improvement, shock wave therapy for use.
The ligaments of the ankle
The Ankle is stabilized by the following ligaments: the tibia and fibula are supported by the Syndesmosis (firm connective tissue) connected. Outside on the ankle can be found:
- Ligamentum fibulotalare anterius (Connection between the tip of the ankle and the ankle body),
- the Fibulacalcaneal ligament (Connection between the tip of the ankle and the calcaneus)
- the Ligamentum fibulotalare posterius (Connection between the tip of the outer malleolus and the back of the ankle bone);
On the inner ankle is the ligamentum deltoideum (connection between the tip of the inner ankle and the talus).
At Ligament stretch/-strain is often the Ligamentous apparatus on the outside of the foot Affected, as an ankle trauma usually results in an inward rotation of the foot, whereby the inner edge of the foot is raised while the outer edge is lowered at the same time.
Possible Symptoms are extensive pain, severe swelling, a bruise and Restrictions on movement. Bony injuries can be excluded by x-rays. Magnetic resonance imaging (MRI) provides precise evidence of possible ligament injuries.
At a fresh injury should be the affected foot stored high and chilled become. Furthermore, with Painkillers, Immobilization with a splint or plaster of paris and or operational treated.
