What You Should Know about Ankle Pain

Ankle pain and swelling can have a number of different etiologies or causes.  Intra-articular problems within the joint can include traumatic arthritis, degenerative arthritis, rheumatoid arthritis, gout, osteochondral lesions, fractures, and painful os trigonum to name a few.  Extra-articular sources of ankle pain may include, but are not limited to ligament sprains and tears, tendon tears, synovitis, tendinitis, sinus tarsi pain, and accessory muscles.

Ankle pain may arise suddenly in the case of a trauma or injury.  Twisting your ankle may cause an ankle fracture or an ankle sprain.  Repetitive use or activities may cause inflammation and tendinitis.  Abnormal gait or foot alignment may cause excessive strain on ligaments and muscles causing pain and potentially deformities.  Some pains are more insidious in nature with no specific injury or event to incite the pain.

Work up of the pain starts with a taking a good history about the pain.  Identifying an injury or timing of the pain is helpful.  A physical exam can identify locations of the pain and areas of swelling and inflammation.  An ankle sprain may show hypermobility or instability compared to the other side.  People may even complain of their ankle rolling or giving out on them.

Range of motion may be limited especially in cases of arthritis.  An acute gouty flare or infection may result in severe pain with attempted range of motion.  Swelling and/or redness may accompany the pain as well.

Radiographs of the ankle used to identify problems like fractures and arthritis.  Bone and cartilage tumors may also be identified in xrays.  MRIs are particularly helpful in identifying soft tissue pathology involving tendons, ligaments, and muscles.

Many pathologies of the ankle can initially be treated with rest, NSAIDS, Tylenol, ice, and physical therapy.  Bracing is often very helpful to allow return to activity and management of pain.  More extreme conditions may even need rigid immobilization in a cast or a camboot.

For certain ankle disorders, surgical intervention may be inevitable.

Written by  Dr. Brimacombe, MD 

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