1. Symptoms

The ankle joint is the meeting of leg bones and foot, and controls up and down motion of foot. The composition of ankle often considered to be the ankle joint plus the surrounding anatomic region, including the lower end of the leg and the start of the foot flat part. The ankle pain could result from inflammation or injury to any regions in ankle structures, including the joint space, cartilage, tendons, ligaments, bones, and muscles. Ankle pain can be associated with other symptoms including:^[1]

• swollen
• bruising
• redness
• numbness or tingling
• instability
• burning pain
• inability to bear weight on the affected ankle
• stiffness
• weakness

Which, tenderness, painful, hard to move, walk or withstand weight, stiffness and selling is the specialized symptoms of Osteoarthritis.^[2]

2. Causes

Normal reasons of ankle problems include injuries such as a sprain, or a medical condition, for example, the arthritis (specifically osteoarthritis^[3]).^[4]

2.1. Sprained Ankle

It is one of the most normal causes of ankle pain, consisting of about 85 percent of total ankle problems, according to the National University of Health Sciences (NUHS), which occurs when the ankle is twisted, leading to the ligaments overstretched, or even get torn in the worst situation.^[5] Most ankle sprains are lateral sprains that can occur when your feet roll, causing your lateral ankles to twist to the ground.^[4] Small blood vessels also will tear and cause swollen ankle.^[5] The action damages the ligaments, which is a short band of tough, flexible, fibrous connective tissues holding the bones together.^[6] Ankle rolling could also hurt cartilage or tendons.^[4] Sprained ankle usually swells and bruises for approximately one week or two, while serious injuries can take several months to fully heal.^[4]

Most ankle sprains are lateral sprains that can occur when your feet roll, causing your lateral ankles to twist to the ground. This action stretches or tears the ligament.

Athletes have greater risks of sprained ankles.^[5] They usually happened in people who play ball games such as football, basketball or volleyball.^[1]

Among 10 people with severe ankle sprains, about 1 to 2 have long-term (long-term) instability of the ankle.^[1]

The sprained ankle is sometimes permanently weakened and more unstable than normal ankles once healed. The biggest risk factor for an ankle sprain is the previous ankle sprain according to a review published by the American Academy of Family Physicians (AAFP).^[4]

2.2. Gout

Gout happens in the body when uric acid (which is a by-product from old cells normal breakdown), builds up to a higher-than-normal concentration level. depositing crystals in the joints and causing sharp pain.^[4]

Other conditions include pseudogout, which results from calcium deposits building up in the joints.^[4]

The symptoms of gout often include pain, redness and swelling.^[7]

2.3. Arthritis (Specifically Osteoarthritis)

Arthritis is the joints inflammation, which swells in and around the joints of the body and surrounding soft tissues.^[8] Inflammation can cause pain and stiffness^[8] and is one of the common reasons causing ankle problems.^[4]

In many types of arthritis, progressive joint degeneration in the joint occurs and smooth "buffered" cartilage is gradually lost, causing the bones rub against each other and wear, as well as the soft joint tissue. Arthritis could be unbearably painful and ultimately leads to limited movement, seriously loss of joint function, or deformity of affected joints.^[8]

There are my types of arthritis, while osteoarthritis is very common cause of ankle pain, which is caused by tear and wear, causing pain, swelling and deformity.^[8] It usually develops in the old people, the probability of osteoarthritis develops as the age increases.^[2]

How osteoarthritis influence on the feet and ankles^[8]

Each foot has 28 bones and more than 30 joints. The following are the most common foot joints for osteoarthritis:

• The three foot joints, including the heel, the medial and the mid-foot bone
• big toe and foot bone joint
• Joints where the ankle and the tibia meet

rheumatoid arthritis is also one of the causes.^[3]

tendinitis

One of the most common causes of pain in the foot or ankle. The muscles of the legs, feet and ankles are fixed to the bones by tendons, which are strong rope-like structures. Tendinitis is inflammation around the tendon. You will have pain in the activity, it usually rests and can only return again.^[9]

Common ankle and foot tendonitis include Achilles tendonitis, posterior tibial tendonitis, peroneal tendinosis, flexor tendonitis, and extensor tendonitis.^[10] Self-care measures usually heal these injuries in a few weeks

Common causes

• Overuse: The most common cause of tendinitis is overuse, which means that the tendon is overstretched and may be slightly pulled apart or torn. This happens when activities increase, including everything from walking to participating in competitive sports.^[11]
• Abnormal foot structure: Problems such as flat feet or high arches can create muscle imbalances that put pressure on one or more tendons.^[11]
• Trauma: Injury to the foot or ankle can cause tendinitis. This can happen by sudden and powerful actions such as jumping. Another form of trauma is chronic friction on the shoe, which usually occurs at the top of the foot or heel, causing tendinitis in these areas.^[12]
• Medical conditions: Certain diseases that cause general inflammation can cause tendinitis. Inflammation of rheumatoid arthritis, gout and spondyloarthropathy can cause Achilles tendinitis or posterior tendonitis.^[12]

2.4. Joint Infection

Septic arthritis is a type of arthritis causing by the bacterial or fungal infection around the areas of ankles.^[4]

2.5. Injuries

Injuries could cause ankle problems, for example, tripping or going over on the ankle.^[13]

3. Diagnosis

Diagnosis of ankle problems(especially of osteoarthritis) might involve:^[8]

Medical history

Medical examination

X-ray^[8]

Magnetic resonance imaging (MRI) or CT scan^[8]

4. Treatments

4.1. Home Treatment (Nonsurgical Treatment)

For immediate home caring of ankle pain, we recommend the RICE method. Which include at the following:

Rest^[4]

Avoid applying too much weight on the ankles. Try moving as little as possible when ankle pain just happen. If have to move or walk, use a cane or crutches.^[4]

Ice^[4]

Firstly, put a bag of ice on the ankle to chill, for at least 20 minutes and freeze for 90 minutes. Do it 3 to 5 times one day for totally 3 days after injury happened, which helps to reduce swelling and numbness.^[14]

Compression^[4]

Use elastic bandages to wrap the hurt area, such as an ACE bandage. Do not wrap it too tightly to prevent the ankles from becoming numb or the toes turning blue.^[4]

The process of wrapping an ankle.^[15] https://handwiki.org/wiki/index.php?curid=1645801

Altitude^[4]

Lift the ankle as far as possible to a pillow or other type of support structure above the heart level.^[14]

Drug use

You can take over-the-counter medications, for example, acetaminophen or ibuprofen to cure pain and swollen ankle.^[4]

Exercise

• Gently exercise your ankles by rotating the circle to relieve when the pain relieves. Rotate in both left and right directions and stop if it still hurts.^[16]

Exercise of rotation preventing ankle problems.^[17] https://handwiki.org/wiki/index.php?curid=1779345

• You can also gently bend your ankles up and down by hand.^[4]

Ankle bending to exercise and prevent.^[18] https://handwiki.org/wiki/index.php?curid=1697275

• Achilles stretches. Place the palm flat on the wall, lean against the wall, put one foot forward, and put one foot backwards. Tilt forward and place the heel on the floor. You can feel the tension between the Achilles tendon and the calf. Repeat this exercise three times, each repetition lasting 10 seconds.^[19]
• Big toe stretches. Put a thick rubber band around your big toe. Pull the big toes away from each other. Hold this position for five seconds and repeat the exercise 10 times.^[19]
• Pull the toes. Place a rubber band around the toes of each foot and apply the toes. Hold this position for five seconds and repeat the exercise 10 times.^[8]
• Make toes curled, pick up the marbles with your toes.^[19]

These exercises will make you feel painless, strong and flexible, restore your range of motion, helping exercise the ankles and reduce the risk of re-injury.^[16]

Treatment focus on arthritis

If your ankle problem is resulting from arthritis, you will not be able to thoroughly eliminate and cure the pain, while there are some approaches to relieve it:^[4]

• Use painkillers
• Use non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain, inflammation or swelling^[19]
• Use pads or arches to support^[19]
• Stay active physically, following a moderately exercised fitness program
• Having healthy eating routines and habits
• Stretch the ankles to maintain a good range of motion of the joint^[3]
• Keep a healthy range of weight to relieve the joint stress

• Use braces for supporting the joint
• Physical therapy
• Custom shoes ^[19]

4.2. Surgery Option

More than one type of surgery may be needed to treat ankle problems, especially to osteoarthritis. Your doctor can choose the type of surgery that works best for you, depending on your level of arthritis. Here are some surgical options for foot and ankle osteoarthritis:

Fusion surgery.

This type of surgery, also known as arthrodesis, involves the use of rods, needles, screws or plates to fuse the bones together. After healing, the bones remain fused together.^[19]

Joint replacement surgery.

This type of surgery involves replacing the ankle joint with an artificial implant and is used only in rare cases.