If you’ve had ankle joint pain, you’ll know that it bothers you with every step you take. Your ankle might be small in comparison with the rest of your leg, but having a sore ankle can really bring your life to a standstill. No more running or going for long walks or standing in the queue in the shops. Maybe you have a swollen ankle joint or maybe it makes painful ‘clicking’ sounds or feels really stiff. Either way, it is enough to make your whole leg and foot feel useless.

There are many causes of ankle pain. It could be due to an injury or simply happen out of the blue. But, to be able to effectively treat your pain, you’ll have to know what is causing it. Luckily, that is something we specialize in. Read on if you want to understand your ankle joint pain better.

Your ankle, together with your foot is one of the most complex and hard-working parts of your body. It consists of 28 bones and 33 small joints, all held together by a network of soft tissue made up of muscles, tendons, ligaments, nerves, and blood vessels. So, how do you know which part is your ankle and which part is your foot? Don’t they do pretty much the same thing?

The ankle joint is also called the tibiotalar joint and it is the junction between your lower leg and your foot. Basically, the area around that knob of bone that sticks out at the side of your ankle.

Bones

Three different bones make up your ankle joint. The tibia (shin bone) and fibula in your lower leg forms a hinge joint with the talus (ankle bone) just above your calcaneus (heel bone). The joint space is called the ankle mortise and the whole joint is covered by a layer of tissue, called the joint capsule.

Ligaments

Ligaments are tough layers of connective tissue that connects bones to each other. They provide stability to the ankle and foot. The ankle ligaments are called:

• Medial (deltoid) ligaments (found at the inside of your ankle): Tibiocalcaneal ligament, tibionavicular ligament, anterior and posterior tibiotalar ligaments.
• Lateral ligaments (found at the outside of your ankle): Calcaneofibular ligament, anterior and posterior talofibular ligaments. The anterior talofibular ligament is the weakest of the three lateral ligaments and thus the most frequently injured in ankle injuries.

Muscles and tendons:

The muscles around your ankle can be divided into three groups:

• Posterior muscles (At the back of the ankle): The gastrocnemius and soleus muscles are the strongest, primary muscles in this group. Smaller muscles in this group includes: Tibialis posterior, flexor hallucis longus, flexor digitorum longus and plantaris. Together, they give you the ability to point your toes (plantarflexion and toe flexion), or push off the ground to launch you into the air.
• Anterior muscle group (front of the ankle): This group consists of the tibialis anterior, extensor digitorum longus and extensor hallucis longus. The tibialis anterior muscle, is the primary muscle that gives you the ability to lift your foot and toes upward and inward (dorsiflexion and inversion). These muscles control your decent down when running down a hill.
• Lateral muscle group (outside of the ankle): The peroneus longus and peroneus brevis muscles function together to give you an outward movement of your ankle (eversion). These work overtime when balancing the foot a you tightrope walk over a pole.

It is important to understand that all these muscles actually come from higher up in your leg. They stretch from close to your knee all the way down to your ankle and foot. Some of them attach onto your toes. So, they produce both ankle and toe movement.

Each of these muscles end in a tendon, which is the part that anchors the muscle onto the bone. A tendon is made of stronger collagen fibres, so they are not as flexible as muscles. These tendons cross your ankle joint to help keep the alignment and stability during forceful landings.

Nerves and bloodvessels

There is a whole network of arteries, veins and and nerves in your ankle and foot. We tend to forget about them, but they can just as easily be part of what is causing your ankle joint pain.

Nerves stimulate the right muscles at the right time, allowing you to move your foot and gives you the ability to feel different sensations on your skin. Important nerves in and around your ankle are: the tibial nerve and the common peroneal nerve.

Blood and oxygen travels through your arteries and veins to ensure that your feet have good circulation.

• Supports your body’s weight when you stand or step on your leg
• Helps you to balance on one leg
• Provides stability to prevent your foot from rolling in or out
• Helps your foot to adapt when walking on an uneven surface
• Absorbs the shock of the impact of walking or running
• Compensates for malalignment of your hip or knee
• Supports the arch of your foot
• Acts as a hinge to help propel your body forward when you walk, run jump
• Allows you to point your toes or stand on your toes
• Allows you to lift your foot up when you climb up a step
• Turns your foot out or in when you want to turn around

In conclusion, your ankle joint has a two-fold job, which is stability and mobility. It needs to be the strong and stable connection point between your leg and foot, but it should also be flexible enough to allow your foot to be moved in different directions.

Forceful, traumatic type of injuries can force a bone to break or a muscle or ligament to tear, or both. These type of injuries are always accompanied by inflammation, swelling, bruising and ankle joint pain, depending on the severity and type of injury.

Ankle ligament sprain or tear

Falling, stepping in a hole in the grass or jumping and landing the wrong way are all different ways for you to sprain your ankle ligaments. Usually, the weaker lateral ligaments, on the outside of your ankle, are the ones to get injured.

Ankle joint fracture

Any of the bones that form your ankle joint can fracture. Usually, it happens with high speed falls, landings or accidents like a car crash. A severe ankle sprain can even lead to the ligament tearing and breaking a piece of the bone off with it, which is called an avulsion fracture. It is important to make sure that the ankle joint space, called the ankle mortise, isn’t injured as well, as it can cause you significant pain and problems.

Muscle strain or tear

An ankle muscle or tendon can be strained or torn if it is either overstretched or overworked. With a muscle injury, you will specifically have pain and weakness when you try to use the affected muscle.

Repetitive overuse of your ankle can lead to pain due to excessive friction, pressure or overstretching of the joint or structures around it. These type of injuries usually lead to inflammation that comes and goes and ankle joint pain that feels worse when you move and better when you rest.

Tendonitis

A tendon will become inflamed, thickened and less flexible with time, if it is overused repeatedly. The tendon loses its ability to recoil and absorb force. It won’t be able to do the amount of work that it should be when you want to exercise. That is why it will cause soreness and stiffness of your ankle that sometimes feel worse the next day. Peroneal tendonitis is a well known example of this condition.

Ankle impingement

When the ankle joint is compressed or repeatedly forced into the end of it’s range, it can cause impingement (pinching) of soft tissue structures like ligaments or tendons close by.

Sinus tarsii syndrome (ankle joint instability)

Both ligaments and muscles provide the ankle joint with stability, which can be influenced after an injury. If there wasn’t a sufficient chance of recovery for the ligament or muscle, the ankle joint becomes unstable. Now, when you put pressure on your ankle joint, like when you run or jump, it leads to pain and swelling.

Tarsal tunnel syndrome

The tibial nerve is part of your sciatic nerve that runs down from your lower back, into your leg and foot. It runs past your ankle joint on the inside and can be injured by repeated compression. This leads to the nerve becoming irritated and inflamed, leading to symptoms like burning, tingling and numbness in your foot.

Flat feet

If the arch of your foot tends to push flat when you stand or put weight on your leg, it changes the alignment of your ankle directly. It puts more pressure on the ankle joint and can lead to pain and problems in the rest of your leg as well.

Inflammation is part of any healing process in your body and usually it settles within a few days or weeks. However, there are certain conditions that continually stimulate inflammation in your tissues, which will lead to a swollen, red-hot and sore ankle.

Gout

High levels of uric acid, can cause gout almost anywhere in your body, including your ankle joint. It forms sharp uric acid crystals inside the joint, which in turn leads to pain, redness and swelling of the ankle.

Lupus

Lupus is a auto-immune disease which causes your body’s immune system to attack itself. In other words, there will be continuous cycles of inflammation in your tissues and organs and joints. Lupus can affect your ankle joints directly or can simply lead to swollen ankles due to kidney failure.

It is normal for our bodies to deteriorate with age, but unfortunately certain conditions like arthritis speeds up this process. It can affect any joint in your body leading to changes in the cartilage, bones and joint space. This greatly affects the movement in your joints and leads to pain and stiffness. There are hundreds of different types of arthritis, but the following types are the main ones that affect the ankle joint:

Osteoarthritis

The cartilage in the ankle joint gradually wears away and becomes frayed and rough. The protective joint space decreases and can result in bone rubbing on bone and the formation of bone spurs (osteophytes).

Rheumathoid arthritis

Rheumatoid arthritis is also classified as an auto-immune disease. It causes your own immune cells to attack the synovium covering the joint, leading to swelling of the ankle joint. Over time, bone, cartilage, ligaments and tendons get damaged as well, leading to serious joint deformity, stiffness and pain.

Posttraumatic arthritis

Posttraumatic arthritis can develop after an injury to the foot or ankle. Ankle dislocations and fractures, particularly those that damage the joint surface, are the most common injuries that lead to posttraumatic arthritis. Like osteoarthritis, posttraumatic arthritis causes the cartilage between the joints to wear away. It can develop many years after the initial injury

• Diabetes: Decreases the circulation in your feet, increases the chances of inflammation and hinders your ability to heal.
• Weight: Increased body weight increases the load that is placed on your leg, ankle and foot.
• Poor bone density: Conditions like osteoporosis decrease the density and strength of your bone structure, which could put you at risk of breaking a bone in your ankle.
• Hypermobility: The ligaments around your ankle joint allow more movement than what is safe for the joint.
• Badly fitting shoes: Wearing shoes that are either too tight, too flat or too high can easily lead to a sore ankle. The shoes you wear should keep your ankle and foot supported and neutral.
• High impact sport: Sports like gymnastics, ballet, athletics, soccer etc. that involve jumping, running and turning, will increase the impact and stress on your ankle joint.
• Old ankle injuries: Unfortunately, once you have injured your ankle in the past, your chances of re-injury increases as well, especially if you don’t work through a good rehabilitation programme.
• Previous surgery: Surgery and damage of the bone surfaces of the ankle joint can predispose you to developing arthritis in your ankle joint.

Mild – You can move your ankle in almost any direction before you feel pain

If you compare the movement in both of your feet and ankles, one might feel a bit more sore, but not really limited by it. Meaning, you only feel pain or stiffness at the end of the range of your movement. Furthermore, your ankle joint only becomes swollen at the end of the day or when you’ve stood in the queue for a long time. At this stage, inflammation in your ankle joint is still under control and your ankle might only become sore when you’ve been on your feet the whole morning.

Moderate – The pain gets bad when you stand on it

Now, you feel ankle joint pain more often. It is painful when you take those first few steps in the morning or when you climb up a few stairs. At this stage, the inflammation has caused enough swelling and pressure inside the ankle joint, that each time you step on it, it feels severely sore. Your ankle is swollen and stiff throughout the whole day, which limits the joint movement. At times the pain seems to be under control, especially when you do as little as possible. But, once you get up and walk again, it feels much worse. This is a tricky phase indeed because you will feel better when you don’t move your ankle and foot. Unfortunately, that is no way to live and if you don’t manage it the right way, it can easily become worse.

Severe – Your ankle looks angry red, swollen and feels sore all the time

Now, your pain is constant and excruciating. You can’t sleep and you the only way you can walk, is with a limp. The smallest movement of your foot is so sore that your whole leg feels weak from it. The condition of your ankle joint has deteriorated so much now, that it is constantly sore and stepping on it feels excruciating. Tight shoes feel uncomfortable, because the pressure is just too much. But nevermind the pressure, your foot won’t even fit into a shoe, because it is swollen and hot and red. You simply feel like lying in the bed with your foot up in the air all the time.

Our physiotherapists are experts at detecting and diagnosing what is causing your sore and swollen ankle joint. We have the necessary experience to differentiate between different types of ankle pain. Understanding the intricacy of the anatomy of your ankle and the biomechanics of ankle movements is important and we use this to look at the bigger picture. Different factors will contribute to each patient’s ankle joint pain. Therefore, we look at what you would like to achieve. Doing a full clinical assessment is the starting point.

During your physiotherapy evaluation, we’ll stretch and stress your ankle joint, test the strength of ankle and foot muscles and evaluate ligament and nerve integrity. Thorough evaluation makes our physiotherapists the best at diagnosing the cause of your ankle joint pain or swelling.

X- rays will show your ankle and foot bones as well as the integrity and alignment of joints between them. A general guideline is that you need x-rays if you cannot step and stand on your foot due to pain. Or if pressure on the bony points of your ankle are severely painful.

Your physiotherapist can refer you to get x-rays taken if necessary.

Diagnostic ultrasound can be used to show the condition of soft tissue like ligaments, tendons and nerves and the presence of fluid/swelling. But not able to see inside the ankle joint, but very sensitive to see all kinds of problems around the outside of your ankle joint and guide further investigation.

If you need an ultrasound, your physio will refer you.

An MRI scan can show all of the structures in your ankle, including soft tissue, bones and and nerves. However, an image like this is very expensive and you need a referral from a specialist to get one. If your physiotherapist suspects that you need an MRI, you will be referred to the right specialist.

Effective treatment of ankle joint pain needs to adress the underlying cause. Inflammation and swelling in the joint needs to subside, so that there is less pressure and pain. Muscles, tendons and ligaments need to recover to help with normal ankle movement and stability. The sooner you sort out exactly what is causing your sore and swollen ankle, the better. Certain treatments like medication might ease the pain, but it won’t prevent the pain from coming back. Usually there’s a deeper problem causing it.

You will feel frustrated that your ankle joint pain isn’t easing, but it could be a sign that you need to pay attention. There is a risk of more critical and possibly irreversible damage to your ankle joint if you keep on pushing through your pain. Resting might seem to help, so you start to use your leg and foot less. But now your muscles will become weaker, joints become stiff and you will start to compensate by using the wrong muscles at the wrong time. It’s a vicious cycle. And you wonder whether it is better to move or to rest. Just get it checked out by the experts, and you’ll know what to expect.

We provide effective treatment for ankle joint pain and stiffness. We understand that you want to have full use of your leg and foot so that you’re able to stand and cook, go for a walk with the dogs or run around with your grandkids. That is why we are here to guide you and tell you which movements you can do safely. As physiotherapists we will implement a very effective and structured plan of action that treats all the aspects of your sore and swollen ankle. Our ankle joint treatment will help to decrease inflammation and swelling in and around your ankle joint, in order to get your movement and strength back to normal.

The basic structure of our treatments:

1. Determine what is causing your ankle joint pain
2. Which structures is injured?
3. Protect it from further injury
4. Give it time to heal
5. Improve range of movement and strength
6. Re-evaluate to monitor progress

We will be looking at different aspects, like your ankle range of motion, strength and stability. Physiotherapy treatment can include: soft tissue massage, joint mobilisations, dry needling, strapping, laser therapy, nerve mobilisations and guiding you through a rehabilitation program of gradual strengthening and conditioning. It’s important that you commit to the treatment plan, as this improves your chances of successful long-term recovery.

Our treatment plan and how often we need to see you will depend on the severity of your condition and your current ankle joint pain. All people experience pain differently and is affected by it in different ways. Your treatment plan will be tailored to your individual goals, so that you’ll be able to get back to doing all the things you love. We can make a big difference in your pain and quality of life.

In the beginning you will see your physiotherapist twice a week, to start with your pain management and rehabilitation process. Thereafter we will make an appointment once a week to maintain the joint movement we have gained and to increase the intensity of your exercises. As you progress through your treatment, the time between each treatment can increase to once every few weeks. Remember, you only spend an hour at a time with your physiohterapist, so how fast you recover, will greatly be up to you. You will have better days and worse days during your treatment process, but luckily your physiotherapist will be able to guide you through any flare-ups.

It is very important for you to finish your treatment process and not to stop when you feel better. Otherwise your ankle joint pain could simply return or get worse. Also remember that even if your doctor has suggested surgery, you don’t have to wait until after your procedure to start physiotherapy treatment. Prehabilitation ensures that you are strong before surgery and can dramatically shorten your recovery after surgery.

• Your GP can prescribe anti-inflammatory or pain medication to help with relieving your symptoms. Keep in mind that these medications will give temporary relief to for a sore and swollen ankle joint. Continuous use of medication isn’t always the solution to your problem.
• A Cortisone injection can help to suppress inflammation, swelling and pain in your ankle joint. However, it will only provide temporary pain relief if the real problem isn’t adressed. Long-term use of cortisone has a bad effect on the integrity of your ankle joint and ligaments.
• Getting your ankle joint ‘aligned’ or ‘clicked’ in the hopes of improving stiffness or pain will not improve the condition of the joint or change your injury. It could even worsen or trigger an inflammatory response. First look at the bigger picture.
• A biokineticist will be able to help you in the final stages of your rehabilitation and get you back to training for your sport.
• Wearing an ankle brace or moonboot can be helpful after an injury, but you can become very dependent on it if you continue to wear it long-term. You should not think of this as the solution to your problem.
• Seeing a rheumatologist can be very helpful if your ankle joint pain is caused by arthritis or gout. A doctor like this will be able to help you manage the inflammation and flare-ups as well as slow down the progression with a tailored treatment plan specific to your needs.

If you have persistent ankle joint pain, it would be understandable if you’ve thought about surgery. You might be concerned because you don’t know what is causing your ankle joint to be swollen and sore. However, it is very important that you don’t jump to your own conclusions. Surgery should not be your first option when dealing with pain. Physiotherapy offers a non-surgical solution before you decide to go for surgery. Your physiotherapist will be able to give you more information about different surgical options and refer you to the right specialist if necessary.

Usually, ankle fractures will need surgery to be fixated back into place, but that will all depend on the type and severity of the fracture. Some fractures are treated non-surgically by immobilising the ankle in a cast or a moonboot. Your orthopaedic surgeon will be able to give you more information.

If you do get ankle surgery or even if you had ankle surgery already, it won’t be a quick fix to sort out your ankle joint pain. It takes months of disciplined rehabilitation to make the surgery worth while and reach your goals. We can help you through your rehabilitation process. Please remember that the stronger you go into your surgery, the easier your recovery will be. So you can start “prehabilitaion” before you even have the date of your procedure.

• Achilles Tendonitis: Pain at the back of your heel that feels better once you move or exercise, but feels worse again afterwards.
• Plantar Fasciitis: Burning, aching pain at the bottom of your foot or heel that feels worse when you walk far or stand for long. It feels specifically sore when you take the first few steps in the morning.
• Torn Achilles tendon: Sudden sharp pull at the back of your heel that leads to weakness when you walk and an inability to move your ankle or point your toes.
• Foot pain: Pain in any of your toes or around the ball of your foot.
• Referred sciatic nerve pain: Pain caused by compression or irritation of the sciatic nerve in your lower back. It can cause a burning, sharp pain all the way down to your ankle and foot.

• Swollen ankle
• Sore Ankle
• Ankle gout
• Pain in ankle
• Arthritis of ankle
• Stiff ankle