The ankle joint acts as a hinge between the foot and the lower leg. This joint is a complex structure that determines the range of motion of the foot in relation to the lower leg. It also has to bear significant force as it withstands the weight of the entire body except the feet. This force increases dramatically when a person walks or runs. Therefore the ankle joint is a hardworking structure and is prone to a host of injuries and diseases.
Parts of the Ankle Joint
The following are the main structures that form the ankle joint.
The surfaces of a variety of bones take part in the formation and movements of the ankle joint. The bones that contribute to the formation of the ankle joint include talus (also known as the ankle bone), tibia (also known as the shin bone), fibula and calcaneous (also known as the heel bone). The lower ends of tibia and fibula form a socket into which the talus fits. The resulting joint is known as the talocrural joint.
This joint is responsible for the up and down movements of the foot. Technically, these up and down movements of the foot are referred to as dorsiflexion and plantarflexion, respectively. The joint formed by the lower ends of the tibia and the fibula is known as the tibiofibular joint. At the distal end of the ankle, the talus sits on the calcaneous and forms the subtalar joint. The inward and outward movements of the foot are mediated at the subtalar joint.
Technically, these inward and outward movements of the foot are referred to as inversion and eversion, respectively.
The articular cartilages that form the contact surfaces of the bones that make up the ankle joint allow smooth movements of the foot. These cartilages also act as shock absorbers during the processes of standing, walking, running and jumping.
The bones that make up the ankle joint are held in place by strong bands of connective tissue known as ligaments. The two main ligaments of the ankle joint are the lateral collateral ligament and the medial collateral ligament. The lateral collateral ligaments is more prone to getting sprained than medial collateral ligament.
Muscles and Tendons
The movement of the bones at the ankle joint is mediated by the muscles of the lower leg. The muscles attach to the bone through wiry fibrous cords known as tendons. The most important tendon of the lower leg is the Achilles tendon, which attaches the calf muscle to the calcaneus. Activities such as walking, jumping and running are made possible through the action of the Achilles tenson.
Nerves and Blood Vessels
The ankle joint is supplied by the tibial and other nerves. The dorsalis pedis artery supplies the front of the ankle, whereas the posterior tibial artery runs behind the medial malleolus.
Why do the ankles pain?
Pain in the ankle can happen due to the involvement of any of the tissues that comprise the ankle joint and its surrounding region. The nature of ankle pain differs in different cases. Ankle pain may be felt as a discomfort or soreness in some cases. In other cases, the pain may be more severe and hinder all foot movements at the ankle joint. In addition, ankle pain may affect either one leg or both legs. Sprained ankle is the most common cause of ankle pain. Other causes include fracture of the bones that comprise the ankle joint, arthritis, and infections.
Also read more on joint pain in pregnancy.
Depending on the cause, ankle pain can be mild or severe in intensity. The nature of the pain itself may vary. In some cases, it is felt as a sharp, shooting pain. In other cases, a dull, throbbing ache may occur. Ankle pain can be categorized into acute and chronic pain.
Acute ankle pain has a sudden onset, whereas chronic pain usually develops over a longer period of time. Acute ankle pain is commonly caused by an injury, whereas chronic ankle pain usually develops due to a disease or overuse of the ankle joint.
Acute ankle pain may cause the following signs and symptoms:
- Swelling in the ankle
- Restricted foot movements at the ankle joint
- Bruises or other signs of injury at the ankle joint
- Inability to bear the body weight on the feet
- Stiffness of the ankle joint
- Impaired mobility at the ankle joint
- Deformity of the ankle joint (usually chronic cases)
- Abnormal tingling sensation or numbness in the ankle area
Causes of Ankle Pain
The following are some of the most likely causes of ankle pain.
Injuries resulting in sprains, strains, and fractures are some of the most common causes of ankle pain. Sprains refer to tears in ligaments. A sudden twist of the ankle (for example, while playing sports or walking on uneven surfaces) is usually the cause of ankle sprains. Tears or pulls in muscles and tendons are referred to as strains. One of the common causes of ankle pain is the rupture of Achilles tendon.
Fractures refer to broken bones. Fractures of the bones of the foot and the ankle (either due to repetitive stress or due to traumatic injury) are also common causes of ankle pain. In addition, inflammation of the tendons (also known as tendinitis) and the bursa (also known as bursitis) can also cause ankle pain.
Arthritis refers to an inflammation of the articular cartilage or the lining of the joints. Various types of arthritis that can cause ankle pain include rheumatoid arthritis, osteoarthritis, gout, ankylosing spondylitis, reactive arthritis, septic arthritis, and psoriatic arthritis.
Inflammation of bone (also known as osteomyelitis) and the tissue just under the surface of the skin (also termed cellulitis) can also cause ankle pain. Most of these ankle joint infections are bacterial in nature when a break in the surface tissue allows bacteria to enter joint space.
Ankle pain may also result from nerve compression, peripheral neuropathy, blockage of blood flow and tumors. In some cases, heel pain (for example, plantar fasciitis) may also lead to ankle pain.
Treatment of Ankle Pain
The exact treatment used for ankle pain depends on the cause of the pain. The following are some of the treatment measures commonly used for ankle pain:
- Resting the ankle is the first step in treating ankle pain. This is done by limiting body weight bearing and walking activities.
- In case of fractures, immobilization of the ankle joint is done through casts or braces. Elevating the leg may also be done.
- Cold compress is advised in case of acute ankle injuries in order to control inflammation. In case of chronic ankle pain, hot compress may be given.
- Drugs may be prescribed for pain relief (for example, non-steroidal anti-inflammatory drugs or NSAIDs). Antibiotics may be given in case of infectious causes.
- Surgery may be required in certain cases (such as rupture of Achilles tendon)
- Physical therapy is also a usual part of the treatment.