Pain in the ankle joint

The most common cause of problems and pain in the ankle area is twisting the foot to the outside (supination trauma).  This causes excess strain on the bone-ligament-capsule-system on the outside of the foot. During the twisting motion, the ligament structures are severely overstretched or tear. Concomitant injuries such as fractures can also occur.

The medial collateral ligament connects the medial malleolus with the talar bone and heel bone. Its design is much more complex than that of the lateral collateral ligament. It consists of an anterior, central and posterior section that stabilise the ankle joint and prevent twisting. In cases of medial collateral ligament ruptures, the medial collateral ligament tears partly or is fully ripped out of the upper ankle joint.

After a sprain, damage can occur in the area of the joint, such as chip fractures on the joint surface or fractures of the fibula, tibia or talar bone.

These injuries can subsequently affect other structures in the foot and lead to excessive mobility (hypermobility) or restricted movement. Severe pain in the ankle with swelling and bruising is usually the consequence. In cases of fractures where the bones have shifted, the ankle can be visibly deformed.

Not everyone’s ligaments can cope with the same amount of strain. Additionally, ligament instabilities can remain as a consequence of an injury that has not healed fully. The ligaments in the ankle joint take approximately 9 months to completely stabilise and strengthen again. Incomplete healing of the ligaments or misalignment of the foot triggered, for example, by adopting a relief posture in the recovery period makes it more likely for patients to twist their ankle again or be less sure-footed after an injury. This is particularly the case for sporting activities or walking on uneven ground.  

Chronic ligament instabilities could be prevented in a lot of cases, but more often than not, injuries to the ankle and ligaments of the foot remain untreated or insufficiently treated during the acute phase, i.e. immediately after the accident. Patients do not take their symptoms seriously, for example, or go to the doctor too late. As a result, every second person will experience problems not just in the foot, but also in other joints during their lifetime.

When left untreated, chronic instability of the upper and lower ankle joint is considered as a pre-osteoarthritic deformity, i.e. a risk factor for the development of osteoarthritis. In its final stage, complex treatment is generally required, such as orthopaedic footwear, joint replacement or stiffening surgery.

In a healthy state, joint cartilage facilitates the movement of the joints and provides a cushioning effect during walking. Osteoarthritis is a sign of wear and tear of these joint surfaces. But cartilage does not get damaged by age-related wear and tear alone. Insufficiently treated injuries resulting in osteoarthritis of the ankle joint as an after-effect are often to blame.

An injury can result in permanent inappropriate biomechanical stress to the foot. Over many years, this stress leads to wear and tear of the cartilage until the joint surfaces rub against each other and cause severe pain. The earlier a ligament instability or onset of osteoarthritis is detected, the more effectively action can be taken. The aim, however, is to take preventative measures to avoid damage to the cartilage.

Inflammation in the ankle can have various causes such as tendonitis, osteoarthritis of the ankle or rheumatism. Pain usually limits joint mobility.

Rheumatoid arthritis causes inflammation of the synovial membrane, resulting in the joint swelling due to liquid. Inflammatory substances and white blood cells accumulate and lead to excessive growth that spreads all the way into the cartilage.

Achillodynia is a pain syndrome caused by excess strain or inappropriate stress in the area of the Achilles tendon. Pain occurs as a result of acute irritation of the Achilles tendon and its synovium. It can manifest in a specific area or more wide-spread. If achillodynia does not subside, this can lead to degenerative changes.

When the Achilles tendon tears, a whip-like cracking sound is often heard, accompanied by piercing pain. Afterwards, the affected person is no longer able to stand on tip-toes. In order to avoid a loss of function, treatment should be administered as quickly as possible. In addition to surgery, conservative treatment is also an option. This is generally used for older patients with comorbidities.