Pain in the ankle is a non-specific symptom that indicates the pathology of the ankle joint, the epiphyseal ends of the bones that form it, as well as ligaments, tendons and tendon sheaths. The pain syndrome can be based on a variety of causes - mechanical damage, autoimmune inflammation, malignant neoplasm, degenerative process. Pain can be aching, throbbing, burning, pulling, arching, etc., sometimes depending on external factors. Diagnosis is carried out using radiography, CT, MRI, arthroscopy, joint puncture. Until the cause is clarified, rest, the use of painkillers is recommended.
Causes of ankle pain
Injuries
Pain syndrome is often provoked by trauma (domestic, sports). Traumatic injury occurs when falling, twisting the foot, direct impact. At the time of the lesion, the pain is acute and severe, subsequently the pain sensations become dull. Frequent bruising, abrasions. Pain is accompanied by swelling. There are the following types of damage:
- Ankle injury. The most common ankle injury. It occurs with direct impact - a fall, a kick or a blunt object. Immediately after the injury, the pain is acute, has a high intensity, then weakens, becomes dull. Pain is localized at the site of injury. Restriction of movements is slight or moderate. A bruise can be complicated by hemorrhage into the joint (hemarthrosis), while the pain becomes bursting.
- Stretching and tearing of ligaments. Usually, damage to the anterior talofibular ligament is detected as a result of a sharp twisting of the foot. The injury often occurs during the period of ice. In case of damage, intense acute pain is felt along the anterolateral surface of the ankle. In the future, pain sensations decrease somewhat, local edema develops rapidly, the damage zone becomes cyanotic or cyanotic-purple. Movements are sharply limited, the foot is deflected inwards. Walking is possible only when resting on the heel.
- Achilles tendon injury. Achilles rupture is a professional injury of gymnasts, ballet dancers, occurs during a jump, when falling from a height. The pain is localized in the back of the ankle slightly above the heel. At the time of injury, the pain is sharp, very strong. The pain gradually subsides, but persists for a long time. Edema develops rapidly. When torn, the patient feels a click or crunch of the torn fibers. There is a pronounced decrease in the strength of the calf muscle. Plantar flexion is weakened.
- Fractures and fractures. Usually there is an isolated fracture of the ankles or a fracture in combination with subluxation of the foot, due to the twisting of the leg. The pain in the ankles is sharp, painful, becomes unbearable with any touch or movement, can radiate to the lower leg, only slightly weakens with time. On palpation, there is a crunch, pathological mobility. Frequent bruising extending to the entire foot and ankle. Foot support is not possible. In osteoporosis (in elderly patients, in a number of diseases), the clinical manifestations are smoothed out, resembling a bruise.
Degenerative-dystrophic diseases
Degenerative pathologies of the joint are caused by a violation of metabolic processes and microcirculation, which leads to the gradual destruction of cartilage tissue, subchondral areas of bones, and surrounding soft tissue structures. Often accompanied by the formation of bone growths (osteophytes). The course is chronic, slowly progressive. The outcome may be disability due to significant deformity of the foot and limitation of movement. There are the following types of degenerative processes:
- Arthrosis of the ankle joint. Osteoarthritis often occurs in older people. In young patients, it can develop against the background of previous joint injuries. Initially, aching pains are noted along the anterior and lateral surfaces of the joint, appearing in the evening or against the background of a prolonged load, passing after rest. With the progression of the pathology, pain increases, becomes shooting, occurs at night, at the beginning of the movement (“starting pains”). Sometimes a crunch is heard while walking. In the final stage, it is possible to form a permanent deformity of the joint, severe limitation of support and walking.
- Osteochondropathy. The defeat of the navicular bone of the foot (Kohler's disease I) is usually found in boys aged 3-7 years, observed in the formation of foci of aseptic necrosis due to impaired blood circulation in the subchondral areas of the bone. Clinical signs include swelling of the dorsum of the foot, pressing or burning pain in the anterior part of the joint and in the medial parts of the foot, aggravated by walking. Lameness is determined with support on the outer edge of the foot.
Inflammatory pathologies
The basis of inflammatory processes in the ankle joint and its ligamentous apparatus is often aseptic inflammation due to an abnormal load on the ankle (obesity, wearing high-heeled shoes, flat feet, professional sports). In other cases, the etiological factor is the penetration of an infectious agent through damaged skin or through the blood. The following inflammatory diseases are distinguished, accompanied by pain in the ankle:
- Achilles tendinitis. Inflammation of the Achilles tendon is often found in people involved in athletics, sometimes due to long-term use of antibiotics from the fluoroquinolone group. At first, the pain in the area of the calcaneal tendon in the back of the ankle is insignificant, has a pulling character, disturbs only in the first minutes of the load. Subsequently, the intensity of the pain gradually increases, it becomes burning, constant. Even a long rest does not bring relief. There is a slight local swelling and difficulty in movement. Growths of fibrous tissue may form around the tendon.
- synovitis. Inflammation of the synovial membrane occurs in many acute and chronic pathologies of the joint. In an acute process, the pain is diffuse, bursting, intense, the joint is significantly enlarged in volume, movements are limited. In chronic synovitis, the pain is weak, aching, occurs gradually, intensifies as fluid accumulates in the joint. The volume of the joint depends on the amount of effusion.
- Bursitis. Achilles bursitis and ankle bursitis are formed with increased loads, injuries, rheumatic pathologies. Increasing burning and arching pain in the back and sides of the ankle, progressive swelling are characteristic. Sometimes a soft tumor-like formation is palpated. Movements are usually saved. When infected, the pain intensifies, becomes diffuse. The skin over the bursa turns red, signs of general intoxication join - weakness, fever, chills.
- Viral arthritis. Arthropathies in viral infections (measles, chickenpox, hepatitis B, C) usually appear in the prodromal period, preceded by other symptoms - skin rash, jaundice, etc. The joints of the hands, knees, and ankles are symmetrically involved. Pain is moderate, aching, localized on the anterior surface of the ankle, does not restrict movement. There may be slight swelling. Arthritis regresses on its own without any treatment, does not leave deformities, contractures.
- Tuberculous arthritis. It is usually diagnosed in older people and children with pulmonary tuberculosis. Initially, arthralgias are mild, do not have a clear localization, disturb the patient only with sudden movements and quickly disappear. As tuberculosis progresses, the pain increases. The joint gradually swells, the skin becomes hot, but does not turn red, movements are limited. In the outcome, deformation and contractures are often observed. Arthritis is accompanied by a general clinic of tuberculosis - subfebrile fever, weight loss, sweating.
- Gonococcal arthritis. Occurs in 5% of patients with gonorrhea, mainly in young women. Asymmetric lesions of the ankles and knees are characteristic. Typical migratory aching arthralgia, transient swelling due to inflammation of the tendons and synovial bags. Ankylosis can develop quite quickly. With massive colonization of gonococci, the pain becomes diffuse, bursting, the skin over the joint turns red. Arthropathy is accompanied by skin pustulosis, fever.
- Brucella arthritis. Inflammation of the joints is the most common manifestation of brucellosis (about 90%). There are symmetrical diffuse aching, pulling pain sensations localized in large joints, spine. The course of arthritis is undulating. Due to damage to the periarticular tissues (ligaments, tendons), the ankle area swells strongly, movements in the joint are limited. Sometimes ankylosis develops.
- Purulent arthritis. Purulent inflammation of the ankle joint is usually the result of an open fracture or osteomyelitis of the distal tibia. Strong, diffuse, throbbing, bursting pains appear. The joint swells, the skin acquires a red tint, becomes hot to the touch. Any movement causes a sharp pain reaction. With the accumulation of a large amount of purulent effusion, the phenomenon of fluctuation joins. Symptoms of general intoxication are expressed - fever, chills, weakness.
Rheumatological diseases
Pain in the ankle often indicates the presence of rheumatological pathology. The pathogenesis of such diseases is due to the formation of autoantibodies that attack the own cells of the macroorganism, including the cells of the synovial membrane. Distinctive features of diseases of this group are the uncertainty of the etiological factor (an exception is rheumatism), a chronic course with exacerbations and remissions, diffuse pain over the entire surface of the joint, the presence of extra-articular lesions, and a variety of clinical manifestations. The most common rheumatic pathologies:
- Rheumatoid arthritis. It is more common in young women (30-4 years old). It is characterized by a systemic process with symmetrical involvement of several joints (especially the hands), but it can also debut from the ankle. Arthralgias are long-lasting, aching, more intense at rest, passing about an hour after the start of motor activity. Typical morning stiffness. With the progression of the process, the pain intensifies, a persistent deformity of the joints develops, which disables the patient.
- Ankylosing spondylitis (Bekhterev's disease). Diagnosed in young men. The spine, sacroiliac joints, large joints, entheses in the lower extremities are predominantly affected. Pain in the ankle is slightly expressed, but has a permanent character. The pains are aching, dull, worse in the second half of the night and in the morning. Swelling and restriction of movements are practically absent. Uveitis (redness of the eyes, lacrimation, photophobia) is also noted.
- Psoriatic arthritis. Associated with severe skin disease - psoriasis. Typically, the development of progressive asymmetric oligoarthritis, leading to disability. In the ankle there are constant aching pains of moderate intensity, slight swelling. The color of the skin is burgundy-cyanotic. Specific signs are arthritis of the distal interphalangeal joints, damage to the nails (punctate depressions, degeneration of the nail plates, onycholysis). Localization of psoriatic plaques - scalp, elbows, knees, intergluteal folds.
- Rheumatic fever. Arthritis is considered the main symptom of rheumatism. Characterized by short-term arthralgia that occurs about a week after suffering an acute streptococcal infection of the upper respiratory tract. Joints increase due to edema, movements are limited. Pain aching, pulling, moderate activity, migrate (pass from one joint to another). The inflammation is benign, quickly disappears without any residual effects. Almost always accompanies rheumatic carditis.
- Reactive arthritis (Reiter's syndrome). The main reason is recent urogenital (chlamydia, mycoplasmosis) or intestinal infections (shigellosis, dysentery). Often seen in young people. There is an asymmetric lesion of the lower extremities (joints, tendons, entheses). The severity of arthritis has a wide range - from minor undulating to constant unbearable pain with a sharp swelling. The process is prone to chronicity with an unfavorable outcome. Typical sacroiliitis. Arthritis is accompanied by urethritis, conjunctivitis.
- collagenoses. The group of diffuse connective tissue diseases includes systemic lupus erythematosus, systemic scleroderma, dermatomyositis. They are united by the variety of the clinical picture, the involvement of the skin, internal organs, joints (including the ankles). Arthritis often comes to the fore and is the initial symptom of the disease. Arthralgias are usually symmetrical, with moderate aching pains, pass quickly, do not restrict movement, are not accompanied by edema, and do not lead to deformities.
- Inflammatory bowel disease. Sometimes pain in the ankle indicates inflammatory bowel disease (Crohn's disease, ulcerative colitis, Whipple's disease). Typical spondyloarthritis, asymmetric arthritis of the knees and ankles with slight aching migrating pain. There is no movement restriction. The degree of arthralgia correlates with the activity of intestinal inflammation. The deformity does not develop. Along with arthropathies, the clinical picture includes enteritis, iridocyclitis, and erythema nodosum.
In some diseases, increased production or reduced utilization of certain substances leads to the accumulation of various proteins or metal ions in internal organs and joints. This group of pathologies is distinguished by a hereditary nature or predisposition, a wide range of clinical signs, a progressive course, and resistance to therapy (gout is an exception). Pain in the ankle may be accompanied by the following metabolic diseases:
- Gout. It is caused by increased formation and reduced excretion of uric acid, which leads to its accumulation in the tissues of the joints. It proceeds spasmodically. Gouty attack is provoked by the intake of fatty foods, alcohol. Pain is sharp, burning, bursting, sometimes unbearable. The joint is swollen, the skin over it is hot. Possible tophi on the skin. The attack is accompanied by fever, chills. There are no symptoms in the interictal period.
- Amyloidosis. It is characterized by the deposition of a special fibrillar amyloid protein. Inflammation of the joints is usually destructive, proceeds like rheumatoid arthritis - with morning stiffness, arthralgias of several joints, aggravated at rest and relieved by movement. A distinctive feature of pain in amyloidosis is a higher intensity at night. The outcome is almost always deformity. Also there are neuropathies, renal, heart failure.
- Hemochromatosis (bronze diabetes). With hemochromatosis, chondrocalcinosis develops due to the deposition of calcium pyrophosphate. The arthropathy may develop gradually with "mechanical" arthralgias, as in osteoarthritis, or as acute arthritis resembling gout. The skin takes on a dark brown or bronze color. Due to hormonal disorders, baldness, diabetes mellitus, and hypogonadism join. 30% of patients have liver cancer.
Tumors and tumor-like diseases
Quite a rare cause of pain in the ankle are tumors or tumor-like formations. The pains are usually diffuse, have no connection with motor activity. Pain syndrome can be caused by benign hyperplasia of the synovial villi, cartilage metaplasia, aggressive tumor growth, less often by metastatic lesion of the joint tissue. The following pathologies are distinguished, accompanied by pain in the ankle area:
- benign neoplasia. Synovial chondromatosis, pigmented villonodular synovitis. As a rule, one joint is involved. The development is gradual. Pain sensations are dull, non-intense, slowly progressing. Sometimes a hard formation is felt in the joint area. Young men are more often affected.
- Malignant neoplasms. This group includes synovial sarcoma, chondrosarcoma, metastases from other organs. The pain is growing, diffuse, severe, debilitating, can spread to the lower leg, is accompanied by severe movement restrictions, correlates with tumor growth. Arthralgia can also occur as a manifestation of paraneoplastic syndrome, in which the body responds to the growth of a malignant tumor by producing antibodies that attack the tissues of the joint. In such cases, one or more joints may be affected by the type of reactive or rheumatoid arthritis.
Survey
With pain in the ankle, you need to contact an orthopedic traumatologist, a rheumatologist. When making a diagnosis, the specialist takes into account the nature of pain, their duration, evaluates the configuration of the joint, the range of motion, the color of the skin, the presence and nature of edema. To find out the cause and assess the severity of the process, an additional examination is prescribed, including:
- Blood studies. In the general blood test, markers of inflammation can be determined - leukocytosis, a shift of the leukocyte formula to the left, an acceleration of the erythrocyte sedimentation rate. In autoimmune pathologies, acute phase proteins (C-reactive protein), various antibodies (rheumatoid factor, antinuclear, anticentromeric antibodies) are detected in the blood. In infectious arthropathies, specific immunoglobulins to antigens of bacteria and viruses are detected.
- Arthrocentesis. If you suspect microcrystalline and infectious arthritis, arthropathy in malignant neoplasms, a study of the synovial fluid obtained during joint puncture is indicated. In order to detect crystals of uric acid salts, bacteria, atypical cells, polarizing microscopy, bacterial culture, and cytological analysis of punctate are performed.
- Imaging studies. To assess the structure of the joint and surrounding tissues, imaging methods are very informative: radiography of the joint, computed tomography and magnetic resonance imaging. In some cases, an ultrasound of the joint is prescribed. The presence of pathology is evidenced by the narrowing of the joint space, subchondral osteoporosis, cartilage destruction, effusion in the joint cavity.
- Arthroscopy. An endoscopic examination is prescribed for a detailed study of the articular structures. The technique makes it possible to visually assess the condition of the articular ends of the bones and the joint capsule, to take a biopsy for histological examination.
Ankle fixation bandage
Symptomatic treatment
Treatment of pain in the ankle should be carried out taking into account the root cause of the disease. Symptomatic therapy can alleviate the patient's condition, but is only a temporary measure. For the purpose of pain relief and to reduce inflammation, non-steroidal anti-inflammatory drugs in the form of tablets, injections, ointments can be used. After an ankle injury, it is recommended to apply cold (a heating pad with cold water, an ice pack) to reduce swelling and the severity of pain.
If possible, it is worth limiting movement in the ankle, while walking it is necessary to apply a fixing bandage. At rest, the leg should be elevated. You can not overload the joint (running, jumping, fast walking), use warm compresses. Some conditions (injuries, synovitis) require urgent medical intervention, therefore, in case of deformation, pathological mobility (“looseness”), severe pain and swelling of the ankle, and an intense feeling of fullness, an ambulance should be called.