Most ankle pain comes in the form of a sprain, where your foot rolls (mostly) inwards as a result of stepping on an uneven surface/
There are several other causes of ankle pain, but often these are a result of a previous ankle sprain.
Unfortunately, once sprained, the ankle is likely to sprain repeatedly over the years, depending on the magnitude of the original sprain.
1. Ankle Pain Causes
As with other peripheral joints, there are several causes of pain – which can be broken up into two categories:
- Local causes of ankle pain
- Referred causes of ankle pain
This obviously requires a decent history and examination to arrive at the conclusion as to what/where the real source of the issues are.
Local causes of ankle pain
While the ankle itself doesn’t have “local” muscles – they originate in the leg just above, all of the muscles run across the ankle joint.
Easily the most common of all causes of ankle pain we see. A “sprained ankle” is perhaps one of the most common injuries that humans can get!
Usually this is inflammatory – behind your achilles tendon. The pain can be from an inflamed “fat pad” thats in this pace as well.
Tendons in the ankle have to run underneath “retinaculums” or around bony grooves, under which they can definitely become inflamed!
Nerve pain can occur as a result of injury to the lower back, or somewhere along the line the nerves run in to the feet.
The joints in your ankle can cause major pain from poor biomechanics from footwear, weakness in the foot, leg and hip muscles.
Even bad ankle sprains can force injury to occur inside the joint, not only in the ligaments on the outside.
Sometimes people have fractures of the bones in/around the ankle. Usually exquisitely painful – and definitely warranting imaging to check!
2. Ankle Pain Assessment
Ankle pain is usually relatively straight forward as assessment goes, because the joint is naturally limited in range and movement.
Osteopaths will look at your ankle based on the history.
History questions can include (but not limited to):
- How long have you had this pain?
- Was there an injury? How did it happen?
- Where exactly is the pain?
- What does it feel like? i.e. is it sharp or achy etc
- Does it hurt to do any movements?
- Can you take the pain away?
If there is a genuine tear or sprained structure, you’re going to be very sore, and most likely swollen.
We will check the joint and all the usual ligament “suspects” and sometimes refer for imaging.
In our opinion the ankle is your bodies most important joint.
Because when you can’t move it – it affects every other joint and muscle in your entire body, more than if you immobilise ANY other joint.
So it’s super important to get right!
But generally, before we go down this pathway, we’ve done the standard sequence of:
- Active range of motion
- Passive range of motion
- Active resisted strength tests
- Special tests
Only after this can we choose which is the best course of action in treatment of your ankle pain.
3. Ankle Pain Diagnosis
To diagnose ankle pain, after your history, an Osteopath will:
Check active ankle range of motion.
Can you move your ankle in all directions? does it hurt in one direction? Multiple directions?
We’re trying to see how good your movement is – initiated by YOU.
Is there pain at any point in movement? At what stage of the movement is it sore?
Check passive ankle range of motion.
Will your brain let us take your wrist through range? i.e. not you doing the movement. We do the movement for you.
If your brain automatically protects you… this means that the overriding “self protection” mechanisms are at play – usually indicating a structure that’s injured such as joint, tendon, or ligament.
Check “active-resisted” ankle muscle strength.
There are no “perfect” muscle tests – especially with the feet!! The ankle and foot muscles are very strong, and hard to resist (from our point of view).
However, as Osteopaths – we’re thinking of the CHAIN of muscles above into the knee and hip and elsewhere.
After this – we’re looking for other signs with special tests, and if necessary – diagnostic imaging.
4. Ankle Exercises
As you can imagine – there are endless numbers of videos online explaining ankle pain and telling you all the reasons why their video will solve your ankle pain.
For the most part – the videos about ankle pain are simply those that are trying to show you ways of reducing ankle movement, increasing ankle movement and stabilising ankle movement, therefore reducing pain.
This is best done with passive things like taping the ankle, which is a really effective way of reducing the “threat” that the brain sees when there’s an injury.
The only other common type of video is about increasing ankle movement, which is the last thing you want to do when you’ve sprained it.
Typically – this is around trying to improve your squatting ability, as the ankle plays a huge part in the squatting motion.
Increasing ankle stability is often a focus of exercises – especially post sprained ankle, as the ability of the ligaments to “tell the brain” that the joint is nearing end range, is reduced.
So you’ll roll your ankle again, because the stretch signal takes longer to reach your brain, eventually (and unfortunately) making ankle rolling so annoyingly easy to do!
Usually specific stability exercises are good for this.
Having said all that, sometimes mobility and stretches will make your ankle pain worse.
Sometimes activating and strengthening will make your ankle pain worse.
It’s truly so variable – that only skilled practitioners like Osteopaths can help you as fast as possible.
5. Ankle Pain Relief
Because ankle pain could be from bone, joint, arthritis, nerve, tendons and many other things, some manual therapy treatments may not change pain.
If we think that manual therapy treatment will help you – we’ll offer it!
Medication for ankle pain relief
As we’ve said on many pages on this site, medication simply masks the true causes of the problem.
Please understand that it may not fix the “reason” you’ve got that ankle pain!
Osteopathy for ankle pain relief
Osteopathic treatment for ankle pain will only be effective if we’ve got a great history, and have performed a good physical assessment.
We’ve got to know what we’re dealing with to effectively help you with ankle pain.
Exercises for ankle pain relief
A s we highlighted above, exercises are almost always required to help ankle pain, but can in some instances make you worse
Osteopaths know the reasons why and when your wrist pain can be made worse, so we take steps to help you a lot BEFORE you start exercises.
6. Ankle Pain Prevention
If the cause of the ankle pain is from a sprain, it makes complete sense to embark on a controlled ankle stability program.
This can involve exercises on devices such as a wobble board, or standing and challenging your ankle control with single leg postures.
As the ankle is unfortunately very likely to re-injure itself, if you’re doing exercises that are more likely to allow this to happen (e.g. basketball, netball) – then you really should strap or brace your ankle.
Strapping and bracing an ankle simply limits movement.
Strapping is possibly better, using solid/rigid tape, as the practitioner can follow ligament lines to really limit movement in certain ways.
On occasion people are required to wear a “moon” boot – to completely eliminate the movement.
The theory being that reducing movement will help the cause of pain.
But – you can’t (and shouldn’t) rely on these forever!
7. Osteopathic Treatment Of Ankles
You’ll find that an Osteopath can use many standard “treatments” but we never EVER just look at your ankle – always other structures as well.
Osteopathic treatment of ankle pain will be dependent on what you present with, and why.
After consideration as to the actual cause of your problem, typical Osteopathic treatment can/may involve a combination of:
- Soft tissue massage
- Joint mobilisation
- Dry needling
- Mobility exercises
The whole point of seeing an Osteopath for ankle pain is to a) diagnose the problem, and b) do something about it.
Do you need stabilising?
Do you need mobilising?
What’s going to help you return to your activities the fastest?
We combine all these thoughts into ways that can help you as fast as possible and get you back on the field, or back doing what you love.