If you’re suffering from chronic ankle pain that lasts and lasts, there are a few conditions that could be leading to pain. We talk about the six most common causes here, along with treatment options that can help you relieve your pain.
Causes of chronic ankle pain
The ankle comprises the ankle joint itself, but many also consider the top of the foot and the lower part of the leg part of the ankle. There could be a few reasons why you’re suffering from pain in this area. Chronic ankle pain is most often caused by:
- Damage after a previous injury, sprain, strain, twist, or blow
- Osteoarthritis and rheumatoid arthritis
- Tarsal tunnel syndrome
Many of these conditions create inflammation in the ankle that then leads to pain.
Chronic ankle pain after strain or injury
One of the more common causes of pain stems from a previous injury. As Dynamic Chiropractic explains, this can happen for a number of reasons:
- “Lack of appropriate and early immobilization in severe cases
- Lack of appropriately prescribed mobility and strengthening exercises
- Development of scar tissue
- Development of late hypermobility
- Secondary, continuing aggravation due to unrecognized or untreated hyperpronation
- Too much immobilization”
It’s for these reasons that seeing a general practitioner or physical therapist after an injury is so important. They can ensure your ankle heals properly, with strengthening exercises to reduce scar tissue and instability.
Any joint in the body is susceptible to arthritis. The ankle joint is no different. In fact, almost 50% of people in their 60s and 70s have arthritis-related foot pain. Almost 90% of people who suffer from rheumatoid arthritis will experience pain in the foot or ankles. Finally, an injury can lead to pain further on as well. An injured joint may be seven times more likely to become arthritic.
There are two major types of arthritis: osteoarthritis and rheumatoid arthritis.
- Osteoarthritis typically affects older people. Onset is gradual, with progressively worsening pain. Your ankle may feel stiff, especially after long periods of inactivity.
- Rheumatoid arthritis, on the other hand, is characterized by swollen and red joints. Your joints may become deformed or have outgrowths.
Learn more about arthritis in the feet here.
Tendonitis is characterized by inflammation along the tendons in the ankle. This can occur specifically when patients fail to properly care for an injury or sprain. As a report from the American Academy of Orthopaedic Surgeons noted, “Approximately 40 percent of those who suffer an ankle sprain will experience chronic ankle pain, even after being treated for their initial injury.”
Major symptoms of tendonitis include:
- Ankle pain that lasts far longer than would be expected, or doesn’t respond to treatment
- Swelling and tenderness along the outside of the ankle, known as chronic lateral ankle pain
- Pain that travels down the ankle into the foot
Many people experience gout in the joint of the big toe, but some may suffer from it in the ankle joint. Symptoms of this condition are fairly obvious–sudden and severe pain, redness, and swelling in the joint. If you suffer from gout, there are a few treatments that can help, including diet modifications and medications.
Tarsal tunnel syndrome
Ankle pain can also occur when there’s nerve compression in the ankle, known as tarsal tunnel syndrome. This condition can, again, occur from an earlier injury. It can also be caused by certain diseases–like arthritis or diabetes–and the natural shape of the foot. Symptoms of this condition include:
- Burning pain in the sole of your foot
- Pain that worsens during exercise or even when standing
- Tingling or numbness near the bottom of your foot
- Pain at night
- Pins-and-needles sensations
- Decreased sensitivity
Finally, if you’re experiencing chronic pain in the ankles, you could be suffering from synovitis. This type of pain refers to inflammation in the synovial membrane. It’s caused by fluid collecting in your joint. You’ll likely experience pain when your joint moves, as well as swelling.
Diagnosing ankle pain
Some patients may be able to point to one specific accident or injury that led to their pain. For many, however, the cause of their pain may be a mystery. It could be due to an injury you had ten years ago or it could be from a chronic condition you’re now suffering from.
The first step of any diagnosis is examining the pain itself. Before you contact your doctor, consider how, how often, and where you feel your pain. First, ask yourself what your pain feels like:
- Is it sharp, stabbing pain or is it constantly achy?
- Does it get better or worse with exercise?
- Is there any redness, warmth, tingling, bruising, stiffness, or other sensations along with pain?
- Does your pain increase in certain shoes or while barefoot?
- Are there any exercises that exacerbate your pain?
Next consider where you feel your pain. For example, you may feel your pain as:
- Chronic lateral ankle pain, that is pain felt on the outer side of the ankle
- Severe instability of the ankle joint
- Pain in your ankles and across your feet
- Pain in both ankles or only one
These descriptions can help provide deeper insight into what’s causing your pain. Pain in only one ankle, for instance, could point to damage or a previous injury. Or, widespread pain and inflammation in both ankles may be linked to rheumatoid arthritis.
Once your doctor knows how your pain is feeling, they can diagnose the cause of your pain with a physical examination and imaging tests, as needed.
How to treat chronic ankle pain
If you suffer from ankle pain, there are treatments to find relief. Which option you use will depend on the cause of your pain, as well as how long you’ve experienced pain. Chronic ankle pain treatments include:
- Ankle cast or brace
- Physical therapy
- Ankle joint injections
RICE refers to the process to follow after a minor injury or sprain. It stands for Rest, Ice, Compression, and Elevation. After visiting a doctor to rule out other serious damage, you can apply these principles to help care for minor ankle injuries. Talk to your doctor about the appropriate amount of time to rest your ankle, as staying off of it for too long can lead to instability and getting back on it too quickly can prevent it from healing.
Ankle cast or brace
Depending on the cause of your pain, your doctor may also recommend a cast or brace. Casts can help your joint heal after an injury. For cases of arthritis or other chronic pain, a brace can help you enjoy exercises or physical therapy while on the path to recovery. Doctors typically recommend bracing over taping. In this case, investing in a good quality ankle brace is always a good idea.
For pain or an injury that doesn’t resolve with rest, your doctor may prescribe physical therapy. Therapy exercises can help you:
- Strengthen the muscles around the ankle joint
- Restore or improve your range of motion
- Increase your joint perception
- Reduce pain and swelling
A highly-qualified physical therapist will give you a structured program to follow that includes both in-clinic and at-home exercises to do. Physical therapy can also be used in conjunction with other measures like injections or medications.
Medication can help reduce acute bouts of pain, especially during or after physical therapy appointments. While medication can be a helpful aid, it often can’t resolve the underlying condition causing you pain. Because of this, it’s always recommended to use medications along with other therapies.
With an ankle joint injection, patients receive an injection of anti-inflammatory agents (such as steroids) and an anesthetic pain reliever directly into the ankle joint and surrounding soft tissue. This can help reduce pain and inflammation, allowing patients to move around more freely or engage in physical therapy. It also represents another minimally-invasive option for pain relief before more invasive surgery is considered.
You can learn more about ankle joint injections here, or watch a video of a similarly-performed knee joint injection below.
Surgery is a last-line treatment for ankle pain. As the American Orthopaedic Foot & Ankle Society explains:
“If your condition requires it, or if conservative treatment doesn’t bring relief, your doctor may recommend surgery. Many surgical procedures can be done on an outpatient basis. Some procedures use arthroscopic techniques; other require open surgery. Rehabilitation may take six to 10 weeks to ensure proper healing.”
These treatment options may remove loose fragments causing inflammation or cleaning out the joint itself. Further surgical repair or reconstruction may also be necessary after a severe injury.
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