Ankle pain - ankle pain: causes and treatment

Ankle pain - ankle pain: causes and treatment

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Ankle pain

Knuckle pain is a very common complaint due to the enormous stress to which the ankle is exposed in everyday life and during sporting activities. The ankle forms the upper part of the ankle, i.e. the transition between leg and foot. It is divided into the outer ankle at the lower end of the fibula and the inner ankle at the lower end of the shin.


From a medical-anatomical point of view, ankle pain is limited to the area of ​​the upper ankle, but in common usage it describes all painful complaints in the area between the lower leg and foot. These can occur in the upper ankle (OSG) as well as in the lower ankle (USG). In addition to pain in the joint, pain in the surrounding ligaments and muscles is also perceived as ankle pain.

Symptom ankle pain

The ankles are exposed to extreme loads in sports such as basketball, soccer, tennis or hockey. Accordingly, athletes often suffer from painful sprains, ligament stretching or even fractures in the area between the foot and leg. Depending on whether the bones, muscles or ligaments are the cause of the complaints, these can be observed in different intensities and localizations.

Impairments at the transition between bones and ligaments are perceived, for example, as punctual pain, while the pain of ruptures of the inner or outer ligaments spreads more flatly on the respective side of the foot. Because ligament tears and ligament stretching are accompanied by massive swelling, which presses on the surrounding tissue and thus causes pain here too.

Ankle pain is generally accompanied by swelling, redness and bruising around the ankle.

Regardless of whether the symptoms appear as spot or area pain, they usually increase with pressure and stress. When standing, walking and running, the pain on the ankle is usually significantly increased and external pressure, such as when palpating, leads to an increased feeling of pain.

An accompanying instability is not uncommon. Patients bend slightly when climbing stairs, at the curb or on uneven terrain. This further increases the risk of ligament stretching, tearing and ankle fractures. The foot can theoretically bend inwards or outwards, but in most cases the affected person bends away with the foot inwards. Accordingly, they tend to damage the outer ligaments. The ankles can also bend the ankle, which also causes ankle pain.

The ankle is stabilized by numerous ligaments and so-called syndesmoses (band-like connections from connective tissue). In the area of ​​the ankle the ligamentum tibiofibulare interosseum, ligamentum tibiofibulare anterius (anterior syndesmosis band), the ligamentum tibiofibulare posterius (posterior syndesmosis band) and the ligamentum tibiofibulare transversum should be mentioned here. They give stability to the upper ankle, but are exposed to correspondingly high loads.

Other ligaments that hold the ankle together are the deltoid ligament (so-called delta ligament) and the lateral collateral ligament (outer ligament). In the back area between the foot and lower leg is the strongest ligament of the human body, the Achilles tendon. All of the ligaments mentioned can be damaged in their structure or even tear and thus cause corresponding ankle pain. However, the most common are strains, strains and ruptures of the outer ligaments.

Causes of ankle pain

Possible causes of pain in the ankle area are damage to the surrounding ligaments. These can in turn be due to chronic overload, trauma injury due to twisting or an inborn weak ligament.

In view of the high stress to which the ankle is exposed, particularly during sporting activities, signs of wear and tear in the joint can often be observed in athletes, which under certain circumstances can also lead to ankle arthrosis. This causes the cartilage layer in the joint to shrink, the resilience drops significantly and those affected complain of pulling pain inside the ankle. In the long term, the ankle completely loses its functionality and becomes stiff.

Violent ankle flexion can cause an ankle fracture, which in turn causes massive ankle pain. Such an ankle fracture is usually associated with stretching or rupturing the ligaments. Another trigger is the so-called Os-trigonum syndrome. The trigonum is a small bone at the back of the anklebone. If the surrounding ligament structures (ligamentum fibulotalare posterius and ligamentum deltoideum) are stressed, irritation at the level of the os trigonums can occur, which leads to persistent pain behind the outer ankle.

Since ligament tears or stretching as well as ankle fractures are usually accompanied by massive swelling and bruising, scarring of the tissue may occur during healing, which can lead to painful blockages in the ankle area. The mobility of the ankle is clearly limited and in certain positions there is an extremely painful pull.


In addition to scanning the ankle, imaging methods such as X-rays and magnetic resonance imaging are well suited for diagnosis. They can be used to visualize the structure of ligaments, muscles, cartilage and bones and to clearly identify ankle fractures, ligament tears or arthrosis diseases. Os trigonum syndrome can also be determined with the help of imaging techniques. Ultimately, diagnosing ankle pain is usually not a problem. However, the treatment of the causes is often much more difficult.

Treatment for ankle pain

Basically, the therapy for an aching ankle depends on the respective causes of the symptoms. For example, in the event of a ligament tear, there is still no way around a splint, in the event of an ankle fracture, plaster is usually required and sprains are fixed with a bandage. Accompanying the immobilization, cooling and putting up against the swelling should help.

If torn ligaments do not grow together again despite the splint, an operation may be necessary in which the existing ligaments are either reconnected or replaced. Surgical intervention may also be necessary for ankle arthrosis and Os-trigonum syndrome.

With the minimally invasive procedure of so-called ankle arthroscopy (mirroring of the ankle), detached bone fragments that threaten to block the joint can be discovered and removed after an ankle fracture. This method can also be used to stop the osteoarthritis-related shrinkage of the cartilage layer.

In any case, physiotherapy is an elementary component in the treatment of ankle pain. Physiotherapy is intended to avoid incorrect loads, stabilize the joints and alleviate pain in the long term. Physiotherapy also tries to eliminate existing movement impairments.

Holistic treatment approaches

Massages can also help relieve the discomfort. Rolfing and osteopathy also offer possible treatment approaches for therapy. In accordance with their holistic approach, these methods take into account further patient complaints, such as knee pain, patella pain, difficulty walking, back pain, low back pain or even neck tension when treating ankle pain. Although the connection between the symptoms may not be obvious to outsiders at first glance, the success often proves these holistic treatment approaches to be right.

Prevent ankle pain

In order to minimize the risk of ankle pain, it is particularly important to wear suitable footwear when exercising. In addition, stretching exercises can help against existing problems and at the same time have a preventive effect against ankle complaints.

Physiotherapy also plays an outstanding role in prevention. If, for example, a ligament tear or a ligament stretch does not adequately stabilize the ligaments through appropriate training, there is a risk of permanent instability and the risk of renewed injuries increases. Taping the ankle while exercising or a stabilizing support stocking can eliminate the susceptibility to twisting, but these aids cannot replace the fully resilient and functional structure of the straps. (fp)

Author and source information

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.

Dipl. Geogr. Fabian Peters


  • Clinic of the University of Munich: osteoarthritis of the ankle, (accessed 02.09.2019), LMU
  • Michael Hammer: Rheumatoid Arthritis (chronic polyarthritis), Deutsche Rheuma-Liga Bundesverband e.V., (accessed 02.09.2019), Rheumatism League
  • Nikolaus Wülker et al .: Pocket textbook on orthopedics and trauma surgery, Thieme Verlag, 3rd edition, 2015

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