There can be many different causes for pain in the ankle. Traumatic injuries, broken bones, sprains but also nerve damage can be possible causes for pain in joints. In addition, the localization of the pain also varies. We distinguish between different joints in the foot, which can be affected by pain. These include the upper and lower ankle joint, the articulated connections between the individual bones of the foot (calcaneocuboid, talonavicular, Chopart’s, tarsometatarsal, intertasal joints) and the articulated connections at the toe bones (metatarsophalangeal and interphalangeal joints).
Pain of the ankle joints
This pain is localized at the transition from the lower leg to the foot. They are also colloquially known as ankle pain. The pain can come from the bony structures that form the upper and lower ankle joint. However, they can also be caused by the ligamentous apparatus or the soft tissue that stabilizes the ankle joint. These are muscle and tendon pains.
Causes
Injuries are often the cause of the pain that can be contracted, especially in the case of excessive sport and insufficient training. Common injuries affect the ligamentous apparatus of the ankle. The extremely painful supination trauma must be mentioned here.
This is a violent overstretching of the outer ligament apparatus of the ankle joint. In almost all cases, the so-called talofibular anterior ligament is injured. Less frequently, the calcaneofibular and posterior talofibular ligaments are affected.
The injuries range from simple overstretching to a rupture (torn ligament). The injury may be visible from the outside as a swelling or hematoma. Pressing on the ankle is also painful and the mobility of the joint is limited.
Diagnostic procedures such as x-rays are used to make a reliable diagnosis. Supination trauma is very common, especially in athletes, and can usually be treated conservatively by immobilising and decongesting measures. Physiotherapy or physiotherapy is recommended.
In addition, thrombosis prophylaxis with heparin is performed in patients with extensive physical immobilization. In some cases, however, surgical intervention to restore the ligamentous apparatus may be necessary. In most cases, arthrosis of the upper ankle joint is the late consequence of a previous injury.
Arthrosis is generally a sign of wear and tear that can generally affect any joint. However, other causes can also be at the root of arthrosis. These include: Wear and tear leads to increased stress on the bones, as the joint cartilage wears away more and more and thus loses its shock-absorbing effect.
Swelling may be visible externally. In some cases, arthroses are painless. Often, however, load-dependent pain, joint deformations and crunching noises at the joint surfaces are common.
The result is an increasing restriction of movement and a relieving posture. Arthrosis is then diagnosed with the help of imaging procedures such as x-rays, CT or MRI of the foot. There are now various therapeutic approaches that can be considered for treatment.
First, conservative or minimally invasive methods are used. Ultimately, however, there are also a number of surgical procedures for the treatment of advanced arthroses.
- Lack of exercise,
- Malpositions after torn ligaments,
- Misalignment of the leg axis,
- Injuries to the bones involved in the joint,
- An overloading of the joints due to overweight or sports,
- Osteoporosis.
Ankle joint arthritis is one of the inflammatory joint diseases.
Unlike arthrosis, arthritis shows clear signs of inflammation, such as swelling, redness, overheating and joint effusion. Arthritis can be caused by bacteria or non-bacteria. Non-bacterial arthritis is further divided into rheumatoid and post-infectious arthritis.
There is also a form of arthritis that is associated with metabolic diseases (e.g. gout). The most common form of arthritis is rheumatoid arthritis of the ankle joint. It affects women about three times more frequently than men and is the result of a degenerative process.This leads to an excessive immunological reaction of the body against the body’s own tissue, such as joint cartilage, resulting in inflammation.
The arthritis then manifests itself in severe pain and the typical signs of inflammation mentioned above. Here too, conservative treatment measures are available. First of all, immunosuppressive and rheumatic drugs are used to inhibit inflammation.
Physiotherapy can counteract the restriction of movement. In the case of very advanced arthritis, however, surgical intervention is unavoidable. Such an intervention is, for example, a synovectomy, in which the inflamed tissue of the joint is removed athroscopically.
The knee joint is thus surgically opened. In case of bacterial infestation, additional treatment with antibiotics is performed. In extreme cases and in case of extreme damage to the joint, a joint prosthesis can be considered.
Synonym: Malleolar fractureSevere pain in the ankle joint can of course also be an indication of a fracture. The ankle fracture is the most common fracture of the lower extremity in adults. Such a fracture is usually caused by a “dislocation” or “twisting” of the foot.
For a reliable diagnosis, the physician performs an X-ray examination. Furthermore, various ankle fractures are distinguished with regard to their exact localization. This can also lead to concomitant injuries to the ligamentous apparatus and other soft tissues that secure the joint.
Such accompanying injuries can also be very painful. The severity and type of fracture ultimately determines the course of therapy. For minor fractures without dislocation of bone parts, minimally invasive procedures can be used, in which the bone parts are straightened under anesthesia and then stabilized with drill wires attached percutaneously (under the skin).
Finally, a plaster cast is applied to the fracture. In the case of severe fractures with dislocation of the bone parts, surgery may be unavoidable under certain circumstances. In this case, it is important to protect the joint for at least six weeks after the operation and not to put any stress on it in order to ensure good healing.
As a rule, the materials that are introduced into the bones to stabilize the fracture (e.g. screws) remain in the joint for one year. Of course, ankle pain is not only localized in the upper or lower ankle joint, but can also have its origin elsewhere. The following section discusses common causes of other ankle pain.
1. tarsal arthrosisTarsal arthrosis is an arthrosis in the area of the tarsal at the so-called Lisfrank joint. The Lisfrank joint, also known as the tarsometatarsal joint, is the articular connection between the metatarsals and the tarsus. Strong pain in the area of the back of the foot is typical of tarsal arthrosis.
In addition, the rolling of the foot is very painful. The cause of tarsal arthrosis is often idiopathic. This means that the disease is not due to a recognizable cause.
However, fractures or trauma can also be the cause of tarsal arthritis. During the examination, patients report having pain when touching the Lisfrank joint. In some cases, swelling is visible on the back of the foot.
Such swellings occur mainly in the presence of osteophytes. These so-called osteophytes are new bone formations called appositional. This means that new layers of bone are deposited on top of existing ones.
Osteophytes form in the context of degenerative bone diseases. When examining the mobility of the joints, no conspicuous findings are to be expected, since the mobility in the Lisfrank joint is not very high anyway. However, the rolling of the foot is painful.
With the help of imaging procedures such as X-rays and CT, however, typical signs of osteoarthritis, such as a narrowing of the joint space, can be detected. For treatment, locally applied anti-inflammatory drugs are used, which can also be taken orally. Antiphlogistics have an anti-inflammatory effect.
In addition, wearing orthopedic shoes can lead to an alleviation of the symptoms. Surgery, however, is rarely indicated. In this case a joint stiffening (arthrodesis) is performed.
Gout is a disorder of the purine metabolism, in which increased uric acid is produced and reduced excretion.Thus, much uric acid accumulates in the blood, which then accumulates in the form of crystals, so-called urates, especially in joints and joint capsules. In 3⁄4 of the cases the metatarsophalangeal joint of the big toe is affected (Podagra, gr: podos=foot, agra=catch, pincers). The affected joint hurts mainly at night.
However, the symptoms subside after hours or days, so that some time passes until the next attack of gout. In the early stages, the affected joint is also inconspicuous in the X-ray image. In the late stage, however, clear joint deformities, pain, swelling and redness become apparent.
On average, men fall ill more frequently than women. Pronounced alcohol abuse and unhealthy eating habits promote a gout attack. Anti-inflammatory and pain-relieving anti-inflammatory drugs are initially used for therapy. In addition, the cytostatic drug colchicine prevents further acidification of the joint interior.
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