In the first place, there are a variety of causes for ankle pain as indicated in the table below. Trauma is a common cause of ankle pain and spans from a strain (also called “sprain”) injury to the more serious injury of a fracture of one or more of the bones. There can be a nerve entrapment such as in tarsal tunnel syndrome. Osteoporosis is a problem of bone nutrition and can be from hormone deficiency in postmenopausal women or might be from chronic malnutrition as in chronic alcoholics.
Second, arthritis with inflammatory changes can lead to degenerative changes in the ankle joint with chronic synovitis, which causes a more dull ankle pain. Varicose vein and venous circulation problems associate with a feeling of heaviness with diffuse pain around the ankles, in the feet and lower legs.
Third, arteries can close down from severe hardening in the end stage of Buerger’s disease. Severe uncontrolled diabetes can lead to other problems like chronic infections, sores that do not heal. This can rapidly develop into deep ulcerations. Due to the lack of circulation this is an acute emergency that requires tests ordered by a cardiovascular surgeon and possibly by-pass surgery as otherwise amputation might be needed.
Other reasons for chronic ankle pain can be from contusion injuries or nerve compression injuries in the ankle, foot or lower leg area. A complex regional pain syndrome (CRPS) can cause a chronic and more severe, deep pain. Finally, more rarely cancer from other tumors can metastasize into the ankle region or start as a bone tumor in the bone of the ankle.
Common causes of ankle pain
|Tibiotalar joint (proper ankle joint)||Sprain or fracture with tripping, falling, sports or industrial injury; arthritis also common in this joint|
|subtalar joint (between talus and calcaneus bones)||often traumatic with fall onto feet, sometimes involves talar or calcaneal fracture as well; arthritis also common in this joint|
|nerve injury or entrapment||sensory branch of superficial peroneal nerve, direct injury or entrapment from ganglion, lipoma|
|osteoporosis||produces bone pain, often microfractures or ankle fracture|
|swelling around ankle||synovitis from arthritis, ankle sprain, occult fracture; may be secondary to edema from congestive heart failure or circulation problems (diabetes)|
|skin veins around ankle standing out||varicose veins with congestion and secondary swelling of tissues|
|Buerger’s disease||end stage hardening of arteries in legs due to chronic smoking, pain due to lack of oxygen in tissue|
|complex regional pain syndrome (CRPS I or II)||CRPS I : fracture, immobilization in cast can start this pain syndrome; CRPS II: direct nerve damage from nerve contusion causes this|
|cancer of bone (tibia, fibula, talar bone)||pain originates from nerve endings inside the bone|
1.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 49.
2. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders
3. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.
4. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier