Additional Causes For Severe Ankle Pain
Injuries to the ankle due to various fractures, sprains, or Achilles tendon ruptures can cause severe ankle pain. Ankle injuries are is among the most common reasons people visit the emergency room.
- Avulsion fracture: A ligament or tendon tears away from its attachment on the bone, taking a fragment of bone with it.
- Fibula fracture: The fibula is the smaller of the two bones in the lower leg. A break just above the ankle can cause severe ankle pain.
- Stress fracture: This is a crack or severe bruising in the small bones of the ankle, due to overuse and/or weakening from a loss of minerals.
Front Of Ankle Pain Causes & Best Treatment Options
Front of ankle pain is an affliction or discomfort in the ankle. It can result from an injury to the ankle or other medical conditions of the front of the ankle.
According to the National University of Health Sciences , the most common cause is a sprain in the ankle. It is the primary factor behind 85 % of ankle injuries. An ankle sprain takes about 7 to 14 days to recover, but a severe injury might take a few months to heal properly.
If youre having pain in front of your ankle and are worried about the causes, confirmed diagnosis, treatment, and home remedies for it, youre at the right place.
Diagnosis Of Tendonitis Of The Ankle Or Foot
Foot or ankle tendonitis is diagnosed under the care of your primary care provider, podiatrist, orthopedist or sports medicine physician. The physician will do a full physical exam and take your medical history.
Your physician may order an x-ray or MRI to determine if the injury is more severe. Fractures, tendon ruptures and calcifications require alternative treatments.
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How Is Posterior Ankle Impingement Caused
Pain felt to the rear of the ankle is the result of compression of the soft tissue or bone when plantar flexion occurs, where the foot and ankle are angled away from the body. Impingement can be a consequence of ineffective rehabilitation following an injury and may also be due to bone spurs and arthritis.
Who Can Help My Foot Or Ankle Pain
There are trained healthcare professionals who specialise in diagnosing and treating problems affecting the foot and lower leg.
A podiatrist
Podiatrists are trained foot specialists, they used to be called chiropodists. They can offer you:
- advice on padding, dressings, specialist insoles, splints and supports
- advice about footwear and exercise
- small non-surgical procedures
- advice on medication
Different areas have different rules for who can be referred to an NHS podiatrist. Some only refer people if they have rheumatoid arthritis, diabetes, or peripheral arterial disease. Other authorities may have broader terms.
If you visit a podiatrist privately you will need to pay for your appointments and any treatment. However, they can refer you for some services, such as scans or x-rays, on the NHS.
You can find a private podiatrist by visiting:
A physiotherapist
Physiotherapists are trained to use movement, exercise, manual therapy, and advice to help get your foot and ankle moving again. They will show you exercises to practice at home to support your recovery.
In some areas you can self-refer to an NHS physiotherapist. Otherwise, your doctor will request an appointment for you.
You can see a physiotherapist privately, though you would have to pay for your treatment. To find a registered private physiotherapist visit the Chartered Society of Physiotherapy.
An orthotist
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Other Severe Ankle Pain Causes
Other conditions can eventually lead to severe ankle pain.
- Ankle impingement: This involves a bony growth at the front of the ankle bone where it meets the shinbone. It restricts the ankle’s range of motion and causes pain.
- Metabolic disorders: This may involve a buildup of mineral crystals within the joints, often in the big toe or the ankle. This causes intense pain and some swelling. The buildup may be caused by either uric acid crystals in people with gout or calcium pyrophosphate dihydrate crystals in those with pseudogout.
Preventive Measures For Ankle Impingement Syndrome
Prevention is always better than cure. It is imperative to take preventive measures in order to minimize the risk of injury, infection, or disease.
- Strengthen your muscles: by exercising and maintaining your diet.
- Maintain your weight: ensure that your ankle is not bearing extra weight to prevent front of the ankle joint pain.
- Rest: do not push yourself too hard if you are tired. Taking rest is very important, and you must not ignore it! Dont overuse the affected ankle joint.
- Wear proper footwear: do not wear shoes that increase the risk of injury or sprain in the ankle.
- Warm yourself up: stretching and warming can reduce the risk of muscle and ligament stretching. Stretching up your calf muscles can help relieve chronic ankle pain and foot pain.
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What Is Dorsiflexion Of The Foot
Dorsiflexion is the backward bending and contracting of your hand or foot. This is the extension of your foot at the ankle and your hand at the wrist. Dorsiflexion occurs in your ankle when you draw your toes back toward your shins. You contract the shinbones and flex the ankle joint when you dorsiflex your foot.
When Should I See A Healthcare Professional About Foot Or Ankle Pain
Some foot pain can become more than a short-term problem. If you cannot treat the pain yourself or you have a condition that could affect the joints or soft tissue, it may need further investigation.
You should speak to your doctor or a footcare specialist if:
- your pain does not improve in the first few days
- your pain is getting worse
- it is still causing problems after two weeks of self-care
- you have sores that are not healing
- your skin has changed colour especially if its turned dark blue or black
- your foot has changed shape or is really swollen
- you have a high temperature or feel hot and shivery
- it is red, warm, or swollen as you may have an infection
- the problem keeps coming back or lasts longer than three months
- you have an inflammatory condition, such as rheumatoid arthritis or scleroderma
- you have diabetes
- you are taking steroids, biologics or other drugs that affect your immune system.
Your doctor may want to refer you to a specialist in foot care, such as a podiatrist, physiotherapist, or an orthotist, for a diagnosis and treatment.
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What Controls Plantar Flexion
Plantar flexion seems like a simple act, but it requires an entire group of muscles and tendons in the leg and foot.
Most muscles are centered on the tibia and the fibula, which is a thinner bone that supports the tibia. Muscles also attach to the ankle and various bones in the foot.
Gastrocnemius
The gastrocnemius is a muscle that forms half of what is commonly called the calf muscle. It starts at the back of the knee and attaches to the Achilles tendon at the heel.
The gastrocnemius is one of the muscles that does most of the work in plantar flexion.
Soleus
This is a broad and strong muscle that also starts behind the knee and runs beneath the gastrocnemius. It merges into the gastrocnemius to create the Achilles tendon at the heel.
The soleus muscle is responsible for pushing away from the ground. It is vitally important for any movement involving plantar flexion.
Plantaris
The plantaris muscle starts behind the knee, just above the gastrocnemius. The plantaris tendon runs below both the soleus and gastrocnemius muscles to connect directly with the heel bone.
This muscle works with the Achilles tendon to flex both the ankle and knee joints, allowing a person to stand on their toes or point their foot in plantar flexion.
Flexor hallucis longus
This is one of the three deep muscles of the leg. It starts along the back of the fibula and goes through the ankle, running along the sole of the foot to attach to the big toe.
Flexor digitorum longus
Tibialis posterior
What Can The Athlete Do
- Rest and apply the PRICE principles of protection, rest, ice, compression, and elevation, until there is no pain. Apply ice or cold therapy for the first two days. Cold can be applied for 15 minutes every couple of hours, reducing the frequency as pain allows.
- After an initial, acute inflammation has settled down, applying heat and using a heat retainer-type ankle support may be more beneficial. Put padding into the shoe if it is pressing on the tendon at the front of the ankle, aggravating the injury.
- When pain allows exercises to stretch and strengthen the tibialis anterior muscle can begin, particularly resisted eccentric inversion. The aim is to gradually increase the load through the tendon so it can cope with normal training.
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When Should I Call My Doctor About Ankle Pain
- Ankle pain is severe or doesnt go away after two to three days of at-home treatment.
- Pain and swelling come on suddenly.
- The area is red or warm to the touch, or you have a fever, which could be a sign of infection.
- You cant put weight on your ankle.
A note from Cleveland Clinic
Ankle pain is a symptom of many injuries and conditions. Swelling, stiffness and pain can make walking difficult or impossible. Most ankle injuries get better with treatments you can do at home, such as elevating your foot and getting plenty of rest. Ankle pain doesnt usually require surgery. If the pain is severe, you have a lot of swelling or the pain doesnt go away after a few days, see your provider. Several noninvasive treatments can help you get back on your feet.
Last reviewed by a Cleveland Clinic medical professional on 12/26/2020.
References
Why Does My Ankle Hurt On The Top
There are numerous causes of ankle pain like arthritis , anterior ankle impingement , or sudden injury or trauma of the ankle.
References:
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How Are Foot Or Ankle Problems Diagnosed
A healthcare professional will usually make their diagnosis after examining your feet. They will look for signs of swelling and any structural changes that could be causing the pain. You may also be asked to walk about, to see whether the problem affects your movement and posture.
Most of the time they can make a diagnosis without scans, x-rays or blood tests, unless they think your pain is being caused by a condition, such as arthritis.
Types Of Tendonitis Of The Foot Or Ankle
- Peroneal tendonitis pain and inflammation along the outer edge of the heel.
- Achilles tendonitis causes heel and calf pain, typically felt when walking or running, extending all the way up to the middle of the calf.
- Extensor tendonitis causes pain on the top of the foot, a very rare type of ankle tendonitis.
- Anterior tibial tendonitis causes pain on the front of your foot, typically felt when walking down stairs or on sloped surfaces.
- Posterior tibial tendonitis pain and inflammation on the inner portion of the ankle , can contribute to flat foot.
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How Can You Prevent Ankle Pain When Flexing Foot Up
Its important mentioning that ankle discomfort isnt always avoidable. Maintaining excellent health, on the other hand, can help to keep your bones, ligaments, and tendons robust.
In order to avoid injury-related ankle discomfort, you should:
- Maintain a healthy weight: Obesity puts unnecessary strain on your joints, particularly your ankles.
- Other muscles should be strengthened: To help support your ankles and lessen the chance of damage.
- Warm up properly: Before you begin your workout, stretch. When muscles and soft tissues are heated, they are less prone to be harmed.
How Is It Diagnosed
Your examination will begin with your personal health history and current symptoms. Your physical therapist will ask you when your symptoms began, where the location of your pain is, and what activities cause you pain. Your physical therapist will perform a physical examination to evaluate your ankle strength, range of motion, sensation, and structural stability as well as your balance. Your physical therapist also will perform special tests, such as gently moving your ankle to see if it causes symptoms.
To diagnose posterior ankle impingement in dancers, the exam may be specialized to that activity. For example, a physical therapist may ask a ballet dancer to demonstrate the âen pointeâ position, which involves standing on the tips of the toes.
To provide a definitive diagnosis, your therapist may collaborate with an orthopedist or other health care provider. The most accurate method to diagnose ankle impingement is by X-ray or magnetic resonance imaging , which can be ordered by the orthopedist.
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Ankle Sprain Or Strain
Sprains and strains are both types of soft tissue damage. Both can cause significant pain and discomfort, depending on severity.
A sprain is an overstretching or tearing of a ligament, which is a band of tough tissue that joins bones together. Sprains can range from partial to complete.
A strain is an injury to the muscle or tendon. Tendons are tough cords that attach muscle to bone. Strains can range from a small overstretch to a complete tear.
The ankles are a common area for sprains and strains, as they are a complex joint that endures a lot of daily movement.
Symptoms of an ankle sprain or strain include:
- a popping or snapping sound
- instability of the ankle joint
Gout is a form of arthritis that occurs due to a buildup of uric acid crystals in the body. Gout commonly affects the foot and ankle, especially a persons big toe.
Symptoms of gout include:
- pain that is usually worse at night or immediately after waking up
- swelling around the ankle
- warmth over the ankle joint
People with a family history of gout are more likely to have the condition. Other conditions that increase the risk of gout include diabetes, obesity, and high blood pressure. Taking medicines such as diuretics or niacin can also increase the risk.
A previous cut, trauma, or surgery can allow bacteria to enter the skin or joint around the ankle and cause an infection.
Symptoms of an ankle infection include:
- fatigue and feeling generally unwell
- trouble walking or bending the ankle
How To Get Moving
Within the first 24 to 48 hours of the onset of an ankle problem you should try to:
- reduce your activities but move as much as your symptoms allow
- put your ankle in an elevated position, when resting
- move your ankle gently for 10 to 20 seconds every hour when you’re awake
- avoid long periods on your feet
When using stairs it may help to:
- lead with your good leg when going upstairs to reduce the strain on your ankle
- lead with your problem leg when going downstairs to reduce the strain on your ankle
- use a handrail when going up and downstairs
After 48 hours:
- try to use your leg more – exercise really helps your ankle and can relieve pain
- do whatever you normally would and stay at, or return to work – this is important and is the best way to get better
It’s beneficial to do specific exercises that can help in your recovery. They may be challenging at the beginning so just do what you can and try to build it up over time.
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Causes Of Peroneal Tendonitis
Causes of peroneal tendonitis include:
- Repetitive running on sloped streets can cause peroneal tendonitis as your foot rolls outward, the friction increases between the tendon and the bone, and this over pronation can increase this tension between the tendon and the bone.
- Tight calf muscles increase the tension on the tendons and causes them to rub more which can cause peroneal tendonitis.
- People who have recurrent ankle sprains are more likely to develop peroneal tendonitis because the ankle is weaker around the injury.
What Causes Tibialis Anterior Tendonitis
Overuse is the main cause, but there are factors that can increase the chance of incurring tibialis anterior tendinopathy or tendonitis.
- Running up and down hills means the tibialis anterior muscle has to work harder. When running up a hill the muscle must lift the foot higher than normal.
- Running downhill means the tibialis anterior muscle is working eccentrically, which means it is lengthening at the same time as contracting, placing even greater loads through the muscle.
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Osteochondral Lesions Of The Talus
A sudden injury like a sprain can damage cartilage on your talus or cause fractures, blisters or sores in the bone underneath. You might notice a catch in your ankle, or it could lock up or still hurt months after a treated injury, which could be an OLT. Treatment depends on the type, but you may wear a cast to keep your ankle still and use crutches to keep your weight off it. Your physical therapist will add exercises slowly.