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Diagnostic Guide - Ankle Pain

Injuries > Ankle Pain

 

Patients suffering from ankle pain are commonly seen in physiotherapy practice. Pain is usually caused by local structures within or around the ankle, however, in rare cases, pain may be referred from other sources (such as the lower back).

The most common mechanism of injury in patients suffering from sudden onset ankle pain is a 'rolled ankle'. This is typically due to an inversion movement whereby the foot and ankle turn inwards relative to the lower leg (figure 1). In these instances, damage to the lateral ligament of the ankle (figure 2) most commonly occurs (Sprained Ankle (Lateral Ligament). However, other structures may also be involved, such as the shock absorbing cartilage within the ankle joint, peroneal muscles or local bones (i.e. a fracture) (figure 3).

Gradual onset ankle pain often occurs in those patients involved in sports or activities that involve excessive walking or high running loads (particularly with rapid changes of direction, on uneven surfaces or in inappropriate footwear). In these cases, overuse injuries to the tendons around the ankle are common. One of the most common causes of gradual onset pain located at the front of the ankle is Tibialis Anterior Tendonitis . Patients with gradual onset pain located at the outer aspect of the ankle are often due to Peroneal Tendonitis, whilst those suffering from gradual onset pain located at the inner aspect of the ankle are often due to Tibialis Posterior Tendonitis. Patients with gradual onset pain located at the back of the ankle are often due to Achilles Tendonitis (please refer to the Achilles & Heel Diagnostic Guide). In older patients with gradual onset ankle pain, the most likely cause of symptoms may be degenerative changes in the ankle, such as Ankle Arthritis.

There are numerous other causes of ankle pain, some of which present suddenly due to a specific incident, others which develop gradually over time.

Below are some of the more common causes of pain in the ankle region with a brief description of each condition to aid diagnosis.

Conditions have been organised according to sudden or gradual onset and common or less common conditions for ease of use.

Find out what may be causing your ankle pain:


Sudden Onset Ankle Pain

Common Injuries

Lateral Ligament Sprain

Tearing of the lateral ligament of the ankle (figure 2) typically following a rolled ankle (inversion Injury figure 1). Associated with outer ankle pain, pain on firmly touching the lateral ligament of the ankle (figure 2), pain on turning the foot and ankle inwards excessively (inversion figure 1) and often swelling or bruising. Arguably the most common cause of acute outer ankle pain.

Osteochondral Lesion of the Talar Dome

Damage to cartilage or bone located at the top of the talus bone (figure 3), usually due to compressive forces such as a landing from a jump and often in association with a rolled ankle. Symptoms may increase during weight bearing activities such as excessive walking or running (especially up hills or on uneven surfaces) or during hopping or jumping. Pain may also increase on firmly touching the region of the talus bone, often at the front of the ankle (figure 4).

Ankle Pain - Talus Region

Figure 4 Talus Region (May be tender to firmly touch in patients with an Osteochondral Lesion of the Talar Dome).

Medial Ligament Sprain

Tearing of the medial ligament of the ankle (figure 6) typically following a rolled ankle (eversion Injury figure 5). Associated with inner ankle pain, pain on firmly touching the medial ligament of the ankle (figure 6), pain on turning the foot and ankle outwards excessively (eversion - figure 5) and often swelling or bruising.

Ankle Diagnosis - Ankle Eversion

Figure 5 Eversion of the ankle

Ankle Pain - Medial Ligament of the Ankle

Figure 6 Medial ligament of the ankle


Less Common Injuries

Distal Tibiofibular Joint Injury

Tearing of connective tissue holding the tibia and fibula bones together just above the ankle, typically in association with more severe ankle injuries. Often associated with significant pain usually at the front of the ankle, reduced function and tenderness on firmly touching the affected region (figure 7).

Ankle Diagnosis - Distal Tibiofibular Joint Region

Figure 7 Distal Tibiofibular Joint Region (May be tender to firmly touch in patients with a Distal Tibiofibular Joint injury).

Lateral Malleolus Fracture

Fracture of the bony process at the outer aspect of the ankle usually due to traumatic forces (e.g. landing from a height) often in association with a rolled ankle. Associated with significant outer ankle pain (particularly during weight bearing), swelling and tenderness on firmly touching the affected region of the bone (Figure 8 Lateral Malleolus).

Ankle Pain - Lateral Malleolus Anatomy

Figure 8 Lateral Malleolus

Medial Malleolus Fracture

Fracture of the bony process at the inner aspect of the ankle usually due to traumatic forces (e.g. landing from a height) often in association with a rolled ankle. Associated with severe inner ankle pain (particularly during weight bearing), swelling and tenderness on firmly touching the affected region of the bone (figure 9).

Ankle Diagnosis - Medial Malleolus Anatomy

Figure 9 Medial Malleolus

Talus Fracture

Fracture of the talus bone (figure 3) usually due to traumatic forces (e.g. landing from a height) and associated with severe pain often at the front or sides of the ankle (particularly during weight bearing) and swelling. Pain may also increase on firmly touching the talus bone, often at the front of the ankle (figure 4).

Pott's Fracture

Fracture of one or more bony processes located at the sides of the ankle (e.g. the medial and lateral malleolus figures 8 & 9) usually due to traumatic forces such as landing from a height or in association with a severe ankle sprain. Associated with severe pain (particularly during weight bearing), swelling, sometimes deformity and tenderness on firmly touching the affected region of bone (figures 8 & 9).

Dislocated Ankle

Separation of the ankle joint due to traumatic forces (e.g. motor vehicle accident / fall from a height) with severe pain, loss of function, swelling, deformity and often associated with one or more fractures.

Peroneal Tendon Subluxation

Movement of the peroneal tendon (figure 10) out of its normal position causing a sensation of the tendon flicking in and out of position at the outer aspect of the ankle (over the lateral malleolus figure 8) during certain movements. Associated with pain or ache located at the outer aspect of the ankle often with swelling, bruising and tenderness on firmly touching the peroneal tendon (figure 10).

Peroneal Tendon Anatomy

Figure 10 Peroneal Tendon Anatomy

Peroneal Tendon Rupture

Rupture of one or more peroneal tendons (figure 10) associated with sudden onset pain in the outer aspect of the ankle usually due to a specific incident followed immediately with loss of function and significant weakness on attempted ankle eversion (figure 5). A snap or tear may be audible during injury. Swelling, bruising and tenderness on touching the tendon is typically present (figure 10).

Tibialis Posterior Tendon Dislocation

Movement of the tibialis posterior tendon (figure 11) out of its normal position causing a sensation of the tendon flicking in and out of position at the inner aspect of the ankle (over the medial malleolus figure 9) during certain movements. Associated with pain or ache located at the inner aspect of the ankle often with swelling, bruising and tenderness on firmly touching the tibialis posterior tendon (figure 11).

Tibialis Posterior Tendon Anatomy

Figure 11 Tibialis Posterior Tendon Anatomy

Tibialis Posterior Tendon Rupture

Rupture of the tibialis posterior tendon (figure 11) associated with sudden onset pain in the inner aspect of the ankle usually due to a specific incident, followed immediately with marked loss of function, weakness on attempting a heel raise (figure 12) and later an observable drop in height of the inner arch of the foot during weight bearing. A snap or tear may be audible during injury. Swelling, bruising and tenderness on firmly touching the tendon (figure 11) is typically present.

Single Leg Heel Raise

Figure 12 Single Leg Heel Raise


Gradual Onset Ankle Pain

Common Injuries

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Less Common Injuries

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Diagnosis of ankle pain

A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose the cause of ankle pain. Investigations such as an X-ray, ultrasound, MRI, CT scan or bone scan are often required to confirm diagnosis and rule out other injuries (particularly fractures).


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Physiotherapy Products for Ankle Pain

 

 Physiotherapy products for ankle pain

 

 

Some of the most commonly recommended products by physiotherapist for patients with ankle pain include:

  1. Crutches
  2. Ice and Heat Packs
  3. Ankle Braces
  4. Ankle Supports
  5. Heel Wedges
  6. Orthotics
  7. Sports Tape (for protective taping)
  8. Wobble Boards (for rehabilitation)
  9. Resistance Band (for strengthening exercises)

To purchase physiotherapy products to assist with ankle rehabilitation click on one of the above links or visit the PhysioAdvisor Shop.


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Patients suffering from ankle pain are often seen in clinical practice. Pain is usually caused by local structures within or around the ankle, however, in rare cases, may be referred from other sources (such as the lower back). There are many conditions that may cause ankle pain. One of the most common causes is a sprained ankle which typically occurs when twisting an ankle during weight bearing activity. Assessment and treatment by a physiotherapist is vital for an optimal outcome.


Return to top of Ankle Pain.

Ankle Inversion

 

 

 

 

 

 

 

 

Figure 1 - Ankle Inversion

 

Ankle Pain Anatomy

 

 

 

 

 

 

 


Figure 2 Ankle Pain Anatomy

 

Bones of the Ankle

 

 

 

 

 

 

 

Figure 3 Bones of the ankle

 

Ankle Eversion

Figure 4 Ankle Eversion

 

Medial Ligament of the Ankle

Figure 5 - Medial Ligament of the Ankle

 

Hot and Cold Pack

 

Ankle Braces

 

Crutches Ad

 

Ankle Supports

 

Wheat Heat Pack

 

Wobble Boards

 

Sports Tape 38mm

 

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