Reasons for Ankle Pain
Mayo Clinic describes some major reasons for Ankle Pain as
Injury to any of the ankle bones, ligaments or tendons and several types of arthritis can cause ankle pain.
Common causes of ankle pain include:
Achilles tendinitis is defined as Inflammation in the tendon of the calf muscle, where it attaches to the heel bone. Achilles tendonitis causes pain and stiffness at the back of the leg, near the heel. Achilles tendonitis can be caused by overuse of the Achilles tendon, overly tight calf muscles or Achilles tendons, excess uphill running, a sudden increase in the intensity of training or the type of shoes worn to run, or wearing high heels at work and then switching to a lower-heeled workout shoe. Achilles tendonitis causes pain, tenderness, and often swelling over the Achilles tendon. There is pain on rising up on the toes and pain with stretching of the tendon. The range of motion of the ankle may be limited. Treatment includes applying ice packs to the Achilles tendon, raising the lower leg, and taking an anti-inflammatory medication. In some severe cases of Achilles tendonitis, a cast may be needed for several weeks. A heel lift insert may also be used in shoes to prevent future overstretching of the Achilles tendon. Exerting rapid stress on the Achilles tendon when it is inflamed can result in rupture of the tendon.
Achilles tendon rupture defined as The most common initial symptom of Achilles tendon rupture is a sudden snap at the lower calf, intense pain, and inability to point the foot downward.Prior tendon inflammation or irritation can predispose one to Achilles rupture.Immediately after an Achilles tendon rupture, walking will be difficult and one is unable to stand on their toes. In addition, the patient will complain of pain with ankle movement.Bruising and swelling around the lower calf into the ankle and foot may occur.Achilles tendon rupture most commonly occurs in middle age (ages 30-50), and may be associated with repeated strain and inflammation.Achilles tendon rupture has been reported with the use of corticosteroids, taken either by mouth or after injection near the tendon area.The fluoroquinolone antibiotics (such as ciprofloxacin [Cipro], levofloxacin [Levaquin]) are associated with Achilles tendon rupture, especially patients with previous tendinitis.Achilles tendon rupture repaired with surgery may have a re-rupture rate of up to 5%. Those treated without surgery have a re-rupture rate as high as 40%.
Avulsion fracture defined as the detachment of a bone fragment that results from the pulling away of a ligament, tendon, or joint capsule from its point of attachment on a bone — called also sprain fracture
Broken Foot defined as Broken foot: Disruption of one or more of the 26 bones in the foot. Foot fractures account for 10% of all the broken bones in the body. Symptoms of a broken foot include pain, swelling, bruising, and tenderness. Bones of the foot can be broken because of a sudden injury, such as jumping from a height or a heavy object falling and landing on the foot. Foot fractures can also develop gradually over time, such as the result of the constant stress of walking or running. Treatment depends upon the location and severity of the break and may include immobilization, avoidance of weight bearing, medications for pain control, and, in some cases, surgery. Also known as a fracture, break, or crack of the foot.
Bursitis (joint inflammation) defined as inflammation or irritation of a bursa sac. You have these sacs all over your body. They’re filled with fluid that helps ease rubbing and friction between tissues like bone, muscle, tendons, and skin. Bursitis is common around major joints like your shoulder, elbow, hip, or knee.
A common form of inflammatory arthritis that is very painful. It usually affects one joint at a time (often the big toe joint). There are times when symptoms get worse, known as flares, and times when there are no symptoms, known as remission. Repeated bouts of gout can lead to gouty arthritis, a worsening form of arthritis. There is no cure for gout, but you can effectively treat and manage the condition with medication and self-management strategies.
Osteoarthritis (disease causing the breakdown of joints) defined as the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work. Signs of OA are Pain or aching, Stiffness, Decreased range of motion (or flexibility) and Swelling
Osteochondritis dissecans defined as A condition in which a fragment of bone in a joint is deprived of blood and separates from the rest of the bone, causing soreness and making the joint give way. Diagnosis is made via X-ray. Treatment usually involves casting, although if the fragment has detached completely, arthroscopic surgery may be necessary. Abbreviated OCD and OD.
Plantar fasciitis is defined as Inflammation of the plantar fascia, the bowstring-like tissue that stretches from the heel bone to the base of the toes. Plantar fasciitis can be due to calcaneal spurs, which typically cause localized tenderness and pain that is made worse by stepping down on the heel. Plantar fasciitis may be related to physical activity overload, abnormal foot mechanics, or may be due to underlying diseases that cause arthritis, such as Reiter disease, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Treatment is designed to decrease inflammation and avoid reinjury. Icing reduces pain and inflammation. Anti-inflammatory agents, such as ibuprofen and injections of cortisone, can help. Infrequently, surgery is done on chronically inflamed spurs. A donut-shaped shoe insert can take pressure off a calcaneal spur and lessen plantar fasciitis.
Pseudogout is defined as a type of inflammation of joints (arthritis) that is caused by deposits of crystals, called calcium pyrophosphate, in and around the joints. Pseudogout literally means “false gout.” It derives its name from its similarity to gout. Pseudogout has many similarities to true gout, which also can cause arthritis. However, the crystal that incites the inflammation of gout is monosodium urate. The crystals that cause pseudogout and gout each have distinct appearances when joint fluid containing them is viewed under a microscope. This makes it possible to precisely identify the cause of the joint inflammation when joint fluid is available. Pseudogout has been reported to occasionally coexist with gout. This means that the two types of crystals can sometimes be found in the same joint fluid. Researchers have also noted that the cartilage of patients who had both forms of crystals in their joint fluid was often visibly calcified, as seen on X-ray images.
Psoriatic arthritis defined as a chronic autoimmune disease characterized by a form of inflammation of the skin (psoriasis) and joints (inflammatory arthritis). Psoriasis is a common skin condition affecting 2% of the Caucasian population in the United States. Signs and symptoms include patchy, raised, red areas of skin inflammation with scaling. Psoriasis often affects the tips of the elbows and knees, the scalp and ears, the navel, and around the genital areas or anus. Approximately 15%-25% of patients who have psoriasis also develop an associated inflammation of their joints. Patients who have inflammatory arthritis and psoriasis are diagnosed as having psoriatic arthritis.The onset of psoriatic arthritis generally occurs in the fourth and fifth decades of life. Males and females are affected equally. The skin disease (psoriasis) and the joint disease (arthritis) often appear separately. In fact, the skin disease precedes the arthritis in nearly 80% of people. However, the arthritis may precede the psoriasis in up to 15% of patients. In some patients, the diagnosis of psoriatic arthritis can be difficult if the arthritis precedes psoriasis by many years. In fact, some patients have had arthritis for over 20 years before psoriasis eventually appears! Conversely, patients can have psoriasis for over 20 years prior to the development of arthritis, leading to the ultimate diagnosis of psoriatic arthritis. Psoriatic arthritis is a systemic rheumatic disease that also can cause inflammation in body tissues away from the joints other than the skin, such as in the eyes, heart, lungs, and kidneys. Psoriatic arthritis shares many symptoms with several other arthritic conditions, such as ankylosing spondylitis, reactive arthritis, and arthritis associated with Crohn’s disease and ulcerative colitis. All of these health conditions can cause inflammation in the spine and other joints, and the eyes, skin, mouth, and various organs. In view of their similarities and tendency to cause inflammation of the spine, these health conditions are collectively referred to as “spondyloarthropathies.”
Reactive arthritis defined as A chronic form of arthritis featuring the following three conditions: (1) inflamed joints; (2) inflammation of the eyes (conjunctivitis); and (3) inflammation of the genital, urinary or gastrointestinal system. Reactive arthritis is the preferred name for what was called Reiter’s syndrome since it is thought to involve the immune system which is “reacting” to the presence of a bacterial infection in the genital, urinary, or gastrointestinal system. Accordingly, certain people’s immune systems are genetically primed to react aberrantly when these areas are exposed to certain bacteria. The aberrant reaction of the immune system leads to inflammation in the joints, eyes, and genital, urinary or gastrointestinal system.
Rheumatoid arthritis (inflammatory joint disease) defined as an autoimmune and inflammatory disease, which means that your immune system attacks healthy cells in your body by mistake, causing inflammation (painful swelling) in the affected parts of the body. RA mainly attacks the joints, usually many joints at once. RA commonly affects joints in the hands, wrists, and knees. In a joint with RA, the lining of the joint becomes inflamed, causing damage to joint tissue. This tissue damage can cause long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness).RA can also affect other tissues throughout the body and cause problems in organs such as the lungs, heart, and eyes.
Septic arthritis defined as septic, or infectious, arthritis is infection of one or more joints by microorganisms. Normally, the joint is lubricated with a small amount of fluid that is referred to as synovial fluid or joint fluid. The normal joint fluid is sterile and, if removed and cultured in the laboratory, no microbes will be detected. With this form of arthritis, microbes are identifiable in an affected joint’s fluid. Most commonly, infectious arthritis affects a single joint, but occasionally more joints are involved. The joints affected vary somewhat depending on the microbe causing the infection and the predisposing risk factors of the patient affected. Septic arthritis is also called infectious arthritis.
Sprained ankle is defined as a common musculoskeletal injury in which the ligaments of the ankle partially or completely tear due to sudden stretching. This typically occurs when the ankle is suddenly “twisted” in a sports activity or by stepping off an uneven surface. The pain is initially severe and can be associated with a “popping” sensation. Immediate swelling over the area of injury often occurs as the injured blood vessels leak fluid into the local tissue. Partial tears retain some ankle stability, whereas complete tears lose stability because the strapping ligaments no longer brace the ankle joint.Initial treatment is with ice, rest, and limiting the amount of walking and weight bearing on the injured ankle. The leg can be elevated to reduce swelling, and crutches are often recommended to avoid further trauma to the injured ligaments. Antiinflammatory medications can be given to reduce local inflammation. Severe injuries are placed in immobilization casts. Surgery may be needed for complete tears. Physical therapy programs are part of the rehabilitation process, incorporating strengthening exercises of the lower leg muscles.
Tarsal tunnel syndrome defined as A type of compression neuropathy (nerve disease due to compression of the nerve) in the ankle and foot. Tarsal tunnel syndrome (TTS) is similar to the better-known carpal tunnel syndrome (CTS) caused by compression and irritation of the median nerve within the carpal tunnel, a bony canal in the palm side of the wrist that provides passage for the median nerve to the hand. The irritation of the median nerve is specifically due to pressure from the transverse carpal ligament. Anatomy similar to that of the wrist and hand exists in the ankle and foot. Tarsal is a word from Latin which means ankle. The tarsal tunnel refers to the canal formed between the medial malleolus (part of the ankle bone, this is the bump on the inside of the ankle) and the flexor retinaculum (a band of ligaments that stretches across the foot). Inside the tarsal tunnel are the nerves, arteries, and tendons that provide movement and flexibility to the foot. The sensory nerve in the ankle, the tibial nerve, passes through the tarsal tunnel and can be compressed and irritated causing numbness and tingling of the foot and toes as this nerve provides sensation to the bottom of the foot. Tarsal tunnel syndrome has also been called posterior tibial neuralgia. This condition is far less common than carpal tunnel syndrome (CTS). Both CTS and TTS are usually due to trauma from repetitive work involving the wrist and ankle, respectively. Other factors predisposing to TTS include obesity, pregnancy, hypothyroidism, arthritis, and diabetes, flat feet or fallen arches, an enlarged or abnormal structure lie a cysts or a bone spur, or swelling secondary to ankle sprain. The symptoms of TTS include a shooting pain in the foot, numbness, burning and tingling of the bottom of the foot and toes, a “pins and needles” feeling at night, feelings of weakness in the ankle and incoordination. The diagnosis of TTS is suspected based on symptoms, supported by signs on comprehensive physical examination, imaging (X-ray, CT or MRI scans), and nerve conduction testing. The treatment of TTS depends on the severity of symptoms and the underlying cause. Early TTS is usually treated by modification of activities, a removable ankle brace and anti-inflammatory medicines. Caught early, TTS is reversible. If numbness and pain continue in the foot and toes, a cortisone injection into the tarsal tunnel can help. Surgery is only indicated if other treatments have failed. In advanced TTS, particularly with profound weakness and muscle atrophy (wasting), surgery is done to avoid permanent nerve damage. The surgical procedure is called a tarsal tunnel release. It relieves the pressure exerted on the nerve within the tarsal tunnel. This surgical procedure is performed via a small incision using conventional surgery or a fiberoptic scope (endoscopic tarsal tunnel repair).
Stress fractures are defined as A fracture caused by repetitive stress, as may occur in sports, strenuous exercise, or heavy physical labor. Stress fractures are especially common in the metatarsal bones of foot, particularly in runners. Osteoporosis increases the possibility of stress fractures. Treatment is by rest, disuse, and sometimes splinting or casting to prevent reinjury during healing.