Ankle inflammation: Causes, Symptoms, and Treatment

Ankle inflammation is rare but can have few causes. For one thing, it can be an activated arthrosis, especially in older people. In younger people, on the other hand, incorrect and excessive strain can be the cause. More rarely, rheumatic diseases, autoimmune diseases or infections of the joint are responsible for the symptoms.

Inflammation of the joint itself manifests itself through swelling and overheating, usually accompanied by pain and restricted mobility.

Another disease that occurs frequently, but is not an inflammation of the ankle itself, is tendosynovitis. This leads in particular to pain and restricted movement, but hardly to any real swelling or redness.

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Causes for ankle inflammation

Inflammation of the ankle joint is, as mentioned at the beginning, not common, but a serious matter. Due to inflammation of the joint, the lack of therapy can result in damage to the joint cartilage with possible permanent damage, pain and restricted mobility.

There are five main causes of inflammation in the ankle joint and other rarer causes. The most common causes include

  • Activated osteoarthritis
  • Inflammation due to excessive and incorrect exposure
  • Rheumatic illnesses
  • Autoimmune diseases
  • Metabolic diseases
  • Activated arthrosis

Arthrosis is a so-called degenerative disease, i.e. a disease of wear and tear. Years of movement and strain on a joint can cause the cartilage to be worn away and the bones then no longer have a protective cartilage coating. This leads to painful friction between the two bone surfaces of a joint during movement.

Since each joint is surrounded by a joint capsule containing synovial fluid, there is little exchange between substances inside and outside the joint capsule, so that abraded cartilage accumulates in the synovial fluid and cannot be transported out of the joint.

Activated osteoarthritis is an inflammatory process that occurs when so-called macrophages and leukocytes, the immune system’s cells that eat and defend the joint, penetrate the joint capsule. These scavenger cells clear the abraded cartilage and other wear products from the joint capsule, as these substances cannot simply escape from the capsule.

This inflammatory process usually lasts a few days, is also known as an “arthrosis attack” and is very painful. Anti-inflammatory drugs such as Diclofenac or Celebrex® should be taken to contain the inflammation and prevent an excessive inflammatory reaction.

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Incorrect loading causes ankle inflammation

Massive (incorrect) loads in the area of the ankle joints also cause damage to the joint, usually with very small cracks, compressions and cartilage abrasion. In the worst case, such stress can lead to swelling, redness and pain in the joint. This is not a classic inflammation, but a very similar mechanism that is intended to help repair the damaged joint structures.

Such a massive misloading is very rare, as tendon sheath inflammation in this area usually occurs beforehand. This is explained in more detail below.

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Infections

A very rare cause of inflammation in the ankle joint is an infection caused by bacteria. This does not occur just like that, but mainly only after operations on the joint, such as arthroscopy. This is a very rare, but all the more serious complication that requires the fastest possible effective therapy.

Rheumatic diseases

Rheumatic diseases, such as rheumatoid arthritis, can also lead to inflammation of the ankle or tendon inflammation in rheumatism. Although inflammation of the finger joints is much more typical, theoretically any joint can be affected by the inflammation. Psoriasis (psoriasis) can also lead to joint inflammation (so-called psoriatic arthritis).

Especially in children and adolescents, infections of the respiratory tract can lead to inflammation in the ankle joints (so-called reactive arthritis), which is caused by overactivity of the immune system. As a rheumatic cause of inflammation in the ankle joint, diseases from the group of juvenile polyarthritis can also be considered in children. These are, so to speak, the rheumatic diseases in children and they are all accompanied by inflammation of the joints.

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Autoimmune diseases

Very typical for a painful inflammation in the ankle joints, especially in younger women, is acute sarcoidosis, also called Löfgren’s syndrome. In addition to the inflammation of the ankle joints, painful red nodes on the skin of the legs and an enlargement of the lymph nodes in the lungs are also common.

Other autoimmune diseases, such as systemic lupus erythematosus, can also in principle target components of the joints and thus lead to inflammation.

Metabolic disorders

Some metabolic disorders can also lead to inflammation in the ankle joints due to crystal deposits. These crystals are caused by the excessive presence of certain metabolic products such as uric acid or calcium in the blood, which then precipitates. Inflammation in the ankle joints is not typical of any metabolic disorder, but none of them can be ruled out.

Gout, for example, can lead to the loss of uric acid crystals (so-called urate crystals) in various joints, typically in the base of the big toe joint. The crystals form when there is a lot of uric acid in the blood over a long period. The pain usually develops fairly quickly within a few days and leads to painful swelling and redness of the affected joint.

The so-called pseudo-gout (also called chondrocalcinosis) can also be caused by crystal deposits, here now calcium phosphate crystals, in the joints. Typically, in addition to the joints, menisci and intervertebral discs are also affected and therefore painful. The cause of this is not yet fully understood, but a connection is seen with other diseases, such as diabetes.

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Tendon injuries and tendosynovitis

Injuries to the tendons of the ankle joint are common. They can occur as a result of a compression or twisting of the foot. However, it does not always have to be the acute accidents that are painfully remembered by those affected. Even chronic, i.e. permanent overloading of the tendon apparatus leaves microscopic traces on the tendons, which impair their stability and smooth functioning.

One speaks of tendinosis when the tissue of a tendon dies, i.e. degenerates, due to repeated damage or permanent overloading. This phenomenon can also occur in the area of the ankle joint and lead to chronic pain.

If additional signs of inflammation such as redness, swelling and overheating occur, one speaks of tendinitis, an inflammation of the tendon in the foot. It also develops based on constant irritation or repeated injuries. If the affected muscles and joints are not spared when tendinosis or tendinitis occurs, the diseased tendon heals with scarring. In addition to its stability, this also influences its ability to slide in the tendon sheath. Persistent pain during movement and repeated inflammatory conditions can be the result. A frequent tendon inflammation in the area of the ankle joint is the so-called Achilles tendon inflammation.

Also, inflammatory processes in the area of the tendon sheaths (technical term: tendovaginitis) and ligaments are among the most common diseases of the ankle joint. Tendosynovitis mostly affects the wrist. The reason for this is the fact that this joint in particular is subjected to extensive stress every day. If an inflammation of the tendon sheaths in the area of the ankle occurs, this disease is also often associated with unusual physical strain, which can lead to a loss of mobility and a loss of mobility.

Typical diseases of the ankle joint include sprains and torn ligaments. Depending on the extent of the injury, a torn ligament can also lead to impairment of the joint capsule and/or the bony structures. In this case there is a strong, painful swelling of the ankle joint, which is then no longer fully mobile.

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After a torn ligament

If not enough time is invested in the protection and healing of the joint after such severe injuries, changes in the structure and development of the ankle joint can occur. This can lead to incorrect loading of the joint surfaces and thus to increased wear and tear of the joint.

Wear and tear of the cartilage surface of joints is called arthrosis and it occurs mainly in joints that are subject to great stress. Knee joint arthrosis is the most common arthrosis in humans and the disease can also occur occasionally on the ankle joint. The likelihood of this is increased if the joint is pre-damaged as a result of injury and the joint function is disturbed as a result. A torn ligament in the foot or ankle joint can also lead to osteoarthritis as a late consequence. An arthrosis disease should always be treated by a physician. In the case of severe ankle arthrosis, an inflammation of the ankle or an acute inflammatory flare-up can also occur in the course of the disease.

Inflammation of the ankle joint is also one of the complications of the surgery, as it must occasionally be performed after a torn ligament to restore the ligament apparatus.

Incorrect debits

Other causes of inflammation of the ankle joint are usually excessive strain and/or unusual movements. When an inflammation of the ankle joint is present, the affected patients typically feel stabbing pain that can radiate to the tip of the foot and lower leg.

Women who frequently wear high shoes also have a significantly increased risk of developing damage and injury to the ankle joint.

Particularly for people who are frequently engaged in sports or who are exposed to great physical strain, there is an increased risk of developing inflammation of the tendon sheaths of the ankle joint. Especially cross-country skiers or joggers often develop inflammation of the tendon sheaths of the foot muscles.

To stabilize the joint and avoid possible overloading, the ankle can be taped or an ankle bandage can be applied.

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Symptoms of the ankle inflammation

Inflammation of the ankle joint manifests itself in swelling, redness, overheating and restricted movement of the joint, accompanied by severe pain. Depending on the cause, such an inflammation usually develops within a few days and lasts for several weeks without therapy.

Patients suffering from an inflammation in the ankle usually notice stabbing or pulling pain early on. Cooling compresses usually improve the symptoms.

A pronounced inflammation in the ankle joint already leads to severe complaints when the patient is at rest. Furthermore, a feeling of friction when performing movements is one of the typical symptoms of an inflammation in the ankle joint. This rubbing sensation is usually perceived by the affected patients as vibration. The normal range of movement is also significantly restricted when there is an inflammation in the ankle joint.

In mildly inflammatory processes, pain is mainly caused by movements of the ankle joint, especially when the foot rolls and while walking.

In most cases, tendosynovitis of the foot heals without any problems, provided the impaired joint is immobilized. However, if the inflammatory processes continue over a longer period, there is a risk that the disease will take on a chronic course. For this reason, patients who experience the corresponding symptoms should consult an orthopedic specialist as soon as possible and appropriate treatment should be initiated.

Diagnosis of the ankle inflammation

The diagnosis of suspected ankle inflammation comprises several steps. The most important step is the detailed doctor-patient consultation (anamnesis). Above all, the exact localization and description of the pain perceived by the patient and its temporal course can provide the treating physician with an initial indication of its cause.

This doctor-patient consultation is usually followed by an orienting, physical examination of the ankle joints inside comparison.

Typical indications for the presence of inflammation of the tendon sheaths at the ankle joint are pressure pain when palpating and tapping the tendons.

In the case of rheumatological, autoimmune or infectious causes, further examinations, such as blood tests, can help to clarify the cause.

If the findings are unclear, radiological images or magnetic resonance imaging may be useful. Above all, the exclusion of chronic diseases that can lead to the development of inflammation in the area of the ankle joint is particularly important in this context.

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Therapy of the ankle inflammation

General measures

In the case of an ankle injury, even simple first aid measures can help to effectively relieve the symptoms. Patients affected should note in this context that the impaired foot should not be loaded until the pain has completely subsided. Nevertheless, the muscles should be activated from time to time, e.g. by simple tensing and careful movements, so that they do not regress. Furthermore, the pain and the inflammatory processes can be alleviated by carefully cooling the affected foot. However, the coolant (e.g. a cooling pad) must be never placed directly on the skin surface. Otherwise the skin can be seriously damaged.

A doctor should always be consulted to clarify the exact causes of the complaints and to rule out the possibility of a fracture.

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Medication

In the case of ankle joint inflammation, anti-inflammatory and pain-relieving drugs are primarily used. In this case, preparations from the class of non-steroidal anti-inflammatory drugs, NSAIDs for short, are particularly suitable.

Ibuprofen and diclofenac belong to the typical NSAIDs used in ankle joint inflammation. Taken in tablet form, these preparations can quickly bring about a significant improvement in symptoms. Diclofenac is also available as an ointment and can be applied externally to the affected areas of the body. Treatment with NSAIDs should always be monitored by a physician, as long-term use can promote the occurrence of gastritis and gastric ulcers. If necessary, a stomach protection preparation should be taken as a supplement.

Treatment with antibiotics is only indicated if it is a bacterial inflammation of the ankle joint. This is relatively rare.

For rheumatic or autoimmune diseases of the ankle, cortisone is often used, which inhibits the excessive and defective immune reactions.

Home remedies

An ankle joint inflammation is usually treated conservatively, i.e. without surgery, only by taking medication and by sparing the affected extremity. Those affected can support the healing process with proven home remedies. In the case of an ankle joint inflammation, the diseased joint should be cooled. So-called curd compresses, which can be produced at home with simple means, can help here. To make a quark wrap, a cool quark is applied to a thin cloth. The cloth is then folded and fixed in the desired place with a gauze bandage. The application should be repeated several times a day.

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Prevention of the ankle inflammation

Inflammation in the ankle area can often be prevented by following simple rules of conduct. Especially the change of risky habits plays a decisive role in this context. To prevent the development of an inflammation in the ankle joint, long-lasting, uniform movements should be avoided. Besides, patients at risk should take care to consciously prevent incorrect posture of the body during sports or work. Furthermore, sports and work equipment should be checked for ergonomics and replaced if necessary. Also, taking regular breaks between exercise intervals can be considered a suitable preventive measure against inflammation of the ankle joint.

Structure of the ankle joint

The ankle joint represents a complex, mobile unit which makes it possible to achieve a relatively large range of motion with the foot. The ankle joint itself is made up of five bony structures: the shin bone, the fibula, the ankle bone, the heel bone and the scaphoid bone. Also, the mobility of the ankle joint is naturally limited by various ligaments, thus stabilizing the joint. Numerous muscle tendons, nerves and vessels can be found in the area of the ankle joint.

In general, there are three different parts of the ankle joint: the upper ankle joint, the anterior lower ankle joint and the posterior lower ankle joint. Only through the joint capsule, muscles and the ligamentous apparatus surrounding the bony joint can these three joint parts function as a functional unit. The range of movement of the joint is particularly extensive. This is necessary above all so that the foot can adapt ideally to the ground. When walking or running, the aim is to create as much contact surface as possible, even on uneven ground. However, to prevent the ankle joint from becoming overly mobile and causing damage, the surrounding ligaments limit the range of movement.

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However, since the ankle joint is not directly surrounded by muscles, the possibilities for injury in this area can be very diverse. Also, if the ankle joint is impaired, injuries to the adjacent tendons, nerves or blood vessels can occur under certain circumstances.

Due to its complex structure, the ankle joint is susceptible to many diseases. The most common problems in the area of this joint are caused by traumatic events, such as twisting. People who are frequently involved in sports and/or wear shoes with high heels are, particularly at risk.

Prognosis

Even in patients with only mild symptoms, an inflammation of the ankle joint is in urgent need of treatment. Failure to initiate appropriate therapy carries the risk of chronicity of the inflammatory processes. In general, however, it can be assumed that an inflammation in the area of the ankle usually heals without complications.

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