Ankle Pain

WHEN TO SEE YOUR DOCTOR

* You've injured your ankle and it's so painful that you still can't put your weight on it 24 hours later.

* Your pain is not related to an injury and it lasts for more than four days.

* See your doctor immediately following an injury if, in addition to pain, you experience swelling, bruising or fever, or if the joint feels loose.

What Your Symptom Is Telling You

We treat them like beasts of burden, forcing them to support heavy weight, walk great distances, twist, turn and bend in every direction. But push an ankle beyond its limitations—as we often do in sports, for example—and it will cry for help. In some cases, that cry is more like someone screaming in pain.

"The most common injury involves twisting the outer side of the ankle," says Phillip J. Marone, M.D., director of the Jefferson Sports Medicine Center at Thomas Jefferson University Hospital in Philadelphia and physician for the Philadelphia Phillies professional baseball team. "This twist can overstress the supporting ligaments, producing a sprain. Or it could tear a muscle or fracture a bone. Each of these injuries can produce significant swelling, discoloration and loss of motion as well as severe pain."

A twist isn't the only thing that can rankle an ankle. Overuse—excessive walking, standing, climbing or stooping—can lead to tendinitis, an inflammation of the tendons that connect the muscles in the legs to the ankle and foot bones. One common site is the Achilles tendon, which runs from the heel up the back of the ankle. The Achilles tendon can easily pull or tear, especially if it's not flexible enough. Overuse can also produce bursitis—a painful inflammation of the ankle's bursa (a fluid-filled sac at the back of the heel that serves as a protective cushion).

Ankles take abuse in other ways as well. "Poor-fitting, nonsupportive footwear can cause an ankle to ache from twisting or from the impact of hard surfaces," says Edward J. Resnick, M.D., professor of orthopedic surgery at Temple University Hospital in Philadelphia. "Flimsy shoes or those not designed for the task that you are giving them will put a significant strain on the joint."

There are also a few medical conditions that can cause ankle pain. Gout—an intense, throbbing pain and swelling of the joints brought on by deposits of crystallized uric acid—often strikes the ankles. Other ankle aggravators include bone spurs, loose fragments of bone or cartilage, rheumatoid arthritis, bad circulation and nerve damage.

Symptom Relief

Ankle pain is not something to be taken lightly. Complications could arise if you delay getting proper medical treatment following an injury. Here are some suggestions for easing the pain.

Apply some RICE. Rest, ice, compression and elevation is your first line of defense for all ankle injuries . . . and most other forms of ankle pain, too.

"Rest is imperative so you don't aggravate an already angry ankle," explains Gary M. Gordon, D.P.M., director of the Running and Walking Clinic at the University
of Pennsylvania Sports Medicine Center in Philadelphia. "Bed rest is best; if you have to get around, use crutches or a cane. Ice applied 15 minutes at a time several times
per day brings down painful swelling, numbs sensitive nerve endings and constricts capillaries to prevent excess bleeding."

Apply compression with an elastic bandage or use a brace to immobilize the ankle. And elevate the ankle several inches with pillows to drain away fluids. Maintain RICE for three to five days.

Treat your ankle like a headache. Aspirin, ibuprofen and acetaminophen can significantly lessen the pain of a sore ankle, says Dr. Resnick.

Raise your heels. You can relieve a strained Achilles tendon by inserting a lift or pad in the heel of your shoe, according to Dr. Resnick. Half an inch should be sufficient. Pads are available in drugstores and lifts can be fitted by a shoemaker.

Prevent Problems with the Right Shoes

If you tend to injure your ankles often, you might want to take a long hard look at your shoes.

Wear the proper shoe. Are you jogging in tennis shoes? Out on the basketball court in running shoes? Tsk! Tsk! Always wear a shoe designed specifically to give the proper support and protection for your occupation or activity, advises Dr. Resnick.

Install an arch support. All shoes should have adequate support in the arch to prevent pronation—the tendency of the foot to roll inward. This is especially true for people with flat feet. Most quality shoes and sneakers have an adequate arch support already built in, while docksiders, sandals and some lesser-quality shoes do not. You can purchase arch supports to insert in shoes at most pharmacies or shoe stores.

Cushion the blow. If you are on your feet all day, cushioned innersoles, available at drugstores, absorb much of the impact of walking on hard surfaces, says Michael Rask, M.D., chairman of the American Academy of Neurological and Orthopedic Surgeons in Las Vegas.

Put old shoes to rest. Shoes lose their cushioning and support with wear. "Many people wear shoes for one to two years of heavy usage, and that's too long," says Dr. Gordon. "Most shoes only have a life of six to eight months of reliable support."

Dealing with Gout

Once you've been diagnosed with gout, there's a lot you can do to keep ankle pain at bay.

Change your diet. High-purine foods such as dairy products, kidney, liver, shellfish, sardines and nuts can contribute to high levels of uric acid and thus trigger gout attacks, says Dr. Rask. Staying away from these foods will help prevent the problem. Avoid alcohol, too, because it increases your body's production of uric acid. It also helps to drink lots of water; it helps flush uric acid out of the body.

Shed excess pounds. Simply being overweight can put excess stress on your ankles. It's common for people who have gout to be overweight. A lighter load may be all your ankles need.

Ask your doctor about these anti-inflammatory painkillers. Severe bouts with gout and arthritis pain are often brought under control with prescription oral medications like Indocin, Naprosyn and Colchicine. Extreme cases might be treated with injections of steroidal medications like cortisone.

See also Ankle Swelling; Joint Inflammation; Joint Pain; Joint Swelling