Ankle Pain: Information & Ankle Specialists

The ankle joint is subjected to heavy strain every day. With every step we take, our ankles bear about five to seven times our body weight per square centimeter. This means that the strain on the ankle joint is considerably greater than on any other joint in the body.

The ankle joint is subjected to particularly high pressure during certain sports activities.

Although the ankle joint has been challenged and constantly stressed throughout a person’s life, it is a fairly resilient joint. For example, osteoarthritis occurs less frequently in the ankle than in other joints, such as the knee or hip.

In everyday language, we use the term “ankle pain” to refer to any pain in the area between the lower leg and the foot. Strictly speaking, however, ankle pain refers only to pain in the upper ankle joint. This joint is the actual ankle.

From a medical and anatomical perspective, however, pain in the ankle joint is not limited to pain in the ankle. The lower ankle joint can also cause pain. Pain resulting from damage to ligaments and muscles is also classified as ankle joint pain.

The ankle joint is the joint connecting the foot to the lower leg and enables us to walk normally and upright. It consists of the upper and lower ankle joints.

The upper ankle joint (OSG for short) consists of three different bones. These are

• the talus,
• the fibula, which forms the outer ankle, and
• a portion of the tibia.

Tight ligaments located around the joint are essential for cushioning, support, and stability. They stabilize the joint. In the upper ankle joint, a distinction is made between the medial ligaments and the lateral ligaments.

The ankle joint is surrounded by a capsule. The upper ankle joint and its ligaments allow movement between the foot and the lower leg. This enables us to lift and lower the foot, roll it forward while walking, and push off when jumping.

Due to its complexity, the lower ankle joint (USG for short) is even more prone to injury than the upper ankle joint. As a result, it is also more frequently responsible for ankle pain. The lower ankle joint also consists of several bones. It is held in place by multiple ligaments.

When standing on an incline or walking on very uneven ground, the lower ankle joint stabilizes our gait. Since stability automatically decreases as the foot is lowered, this often results in

• twisting of the ankle,
• strains and tears in ligaments, as well as
• fractures of the lower ankle bones or
• damage to the cartilage.

This can result in significant ankle pain. Cartilage damage can also lead to further injuries to the ankle joint.

Due to the complex anatomical structure of the ankle joint, there are a variety of different causes of ankle pain.

Ankle pain is usually the result of

• accidents,
• excessive strain, or
• old injuries to ligaments and bones.

Congenital ligament weakness or misalignments can also cause ankle pain.

Ankle pain caused by ligament damage

If the medial or lateral ligaments are chronically overloaded or injured by a tear or strain, they cause pain.

People who suffer from congenital ligament weakness are more prone to twisting their ankles and do so more frequently.

Ankle pain caused by a bone fracture

Fractures in the upper ankle joint can cause severe ankle pain. An ankle fracture is usually accompanied by a ligament sprain, strain, or tear.

Ankle pain caused by osteoarthritis

Osteoarthritis is a general term for all forms of joint wear and tear. Osteoarthritis can also occur in the ankle joint and cause severe pain and associated limitations in movement.

Osteoarthritis of the ankle is less common than osteoarthritis of the hip or knee. Nevertheless, osteoarthritis of the upper ankle is considered a widespread condition.

In osteoarthritis, the protective layer of cartilage in the ankle joint gradually wears away. As a result, the joint’s load-bearing capacity decreases, and affected patients complain of very severe ankle pain.

Athletic individuals are more frequently affected. In particular, sports involving rapid changes in direction and jumping place significant stress on the ankle joint. Over the long term, this can lead to significant wear and tear in the ankle joint. High-risk sports include, for example,

• skateboarding,
• handball,
• volleyball,
• soccer,
• basketball, and
• hockey.

In addition to overuse from sports activities, ankle osteoarthritis can have the following causes:

• Improper weight-bearing following ligament injuries,
• misalignment following torn ligaments,
• cartilage injuries following a torn ligament,
• Stress due to excess weight, and
• misalignment of the leg axis.

However, previous injuries are a more common cause.

Ankle pain varies depending on the cause and location. Bones, ligaments, and muscles can all be responsible for ankle pain.

Injuries at the junction of bones and ligaments tend to be perceived as localized pain. If the medial or lateral ligaments are torn or partially torn, the pain is more diffuse and spreads across the foot.

Torn or strained ligaments are accompanied by severe swelling or bruising. These put pressure on the surrounding tissue, causing severe pain in the ankle.

During the healing process, scarring of the tissue may sometimes occur. This, too, can lead to pain in the ankle and to joint restrictions. Joint restrictions significantly limit the mobility of the ankle.

Pulling pain in the ankle often occurs, especially in certain foot positions or under specific types of stress.

The pain usually subsides with

• pressure or stress,
• when palpating, or
• walking, standing, and running

.

Pain results from a medical condition or injury. To treat the pain effectively in the long term, it is therefore essential to identify and treat its underlying cause. Taking pain relievers without addressing the underlying condition can worsen symptoms and limitations over time.

Untreated instability also increases stress on the cartilage and can lead to osteoarthritis. Therefore, you should consult a doctor early on so that they can initiate treatment tailored to the specific cause.

After taking your medical history, the doctor will examine your ankle. During the physical examination, the doctor will palpate the area to check for tender points by applying pressure and to assess stability.

Further diagnosis is typically made using X-rays of the foot. X-rays or magnetic resonance imaging (MRI) are well-suited for diagnosing bone or ligament injuries. This allows for the detection of injuries to

• ligaments,
• bones,
• cartilage, and
• muscles

and their structure can be clearly visualized.

Treatment is typically performed by specialists in trauma surgery or orthopedics.

Treatment for ankle pain depends on the diagnosis—that is, on the cause of the ankle pain.

In the case of a torn ligament, wearing a splint is usually prescribed.

A cast is often necessary for a fracture of the upper ankle joint. Surgery may also be indicated, depending on the type of injury.

For sprains and strains, immobilization and weight-bearing relief using a splint are usually sufficient. The ankle should be rested, and swelling should be reduced by elevating the foot. Complete immobilization is not necessary—or even recommended—in some cases.

If torn ligaments do not heal despite the use of a splint, ankle surgery may be necessary. The goal is either to repair the existing ligaments or to replace them. Surgery may also be necessary for ankle osteoarthritis.

Arthroscopy is frequently used in ankle surgeries. This is a minimally invasive procedure that does not require a large skin incision. Instead, just a few small incisions are sufficient.

Arthroscopy can be used, for example, to detect and remove bone fragments that have broken off during a fracture.

Physical therapy is also often an important part of medical treatment and the healing process. Physical therapy helps stabilize the affected joints and provide long-term relief from ankle pain.

Especially in sports such as

• hockey,
• soccer,
• basketball, etc.,

there is a risk of sustaining injuries that can subsequently cause pain in the ankle. Therefore, wearing the right footwear is particularly important for athletes in these sports.

Warm-up and stretching exercises before physical activity also help minimize the risk of injury. Even if you’re already experiencing ankle pain, stretching exercises may help in some cases and also serve as a preventive measure.

Depending on the sport, medical history, and risk of injury, supportive wraps may also be beneficial during sports.

The ankle receives additional support during sports through taping or by wearing special orthoses. However, taping and support stockings are not intended to relieve the load on healthy, resilient, and fully functional ligaments.

Physical therapy plays a significant role in preventing ankle pain. It allows those affected to regain the necessary stability by strengthening the muscles. This helps prevent injuries, such as repeated ankle sprains.

To prevent ligament injuries, regular strengthening of the muscles along the shinbone is recommended. If the person suffers from misalignments or improper weight distribution while walking, appropriate physical therapy can help resolve these issues.