The Underlying Causes Of Ankle Pain

Some people go a whole lifetime of sport and recreation with no rolled ankles, no sprained ankles and no ankle pain. At the other end of the spectrum are those who have stubborn ankle pain, punctuated by repeated, dramatic, slow healing ankle sprains. The good news is that very few cases of ankle pain can be attributed to random bad luck and that in most instance the underlying causes of ankle pain are very identifiable and very manageable. 

Ankle Pain Caused By Muscle Wasting 

All weight bearing joints rely heavily on muscle for support, injury prevention and stability. The majority of people who attend our clinic with a chronic history of ankle pain issues also show up with long standing patterns of muscle weakness and/or wasting from their hips right through to their feet. The primary ways that this manifests are typically very poor scores on muscle testing, poor ‘functional strength’ and very poor balance. Most were not aware of the degree of weakness they had developed because it happened slowly without them realising. 

The human ankle is a very delicate and extraordinarily hard working joint with almost no ‘local’ muscle support. Consider for a moment how much ‘meat’ there is around hip compared to the ankle, and yet they must both bear your entire body weight thousands of times per day. The ankle relies very heavily on the muscles around the hip and knee for the prevention of pain and injury therefore muscle weakness is a serious topic for sufferers of ankle pain. 

Ankle Pain Caused By Scar Tissue

To be at risk of lasting scar tissue all it appears to take is 1 badly rolled ankle that is poorly rehabilitated. The vast majority of sprained ankles in our culture come under the poorly rehab’d heading for the record. For those who have had multiple poorly tended sprains obviously things can be significantly worse. 

Over the years we have developed a very strong belief, that scar tissue which has been poorly resolved due to a lack of quality rehab can predispose you to further rolled ankles. If this is the case it may be due to excessively tight scar tissue that can’t flex normally.  It may be that with appropriate hands on treatment, stretches and rehab exercises this need not happen. 

Ankle Pain Caused By Damaged Collagen Fibres

In the latest chapter of scientific research into stubborn pains like ‘tendonitis’ ‘plantar fasciitis’ and RSI (all of which are close relatives of stubborn ankle pain) we have discovered a whopper of a misunderstanding.

The whole scientific & healthcare community had thought that these type of stubborn pain conditions  (ankle, foot and otherwise) were based on inflammation build up. Oops. With red faces we must now report that conditions like RSI, plantar fasciitis and possibly also ankle pain are actually more degenerative in nature. That means that under a microscope we see damage to collagen fibres in the connective tissue as opposed to inflammation of connective tissue. This may well be especially relevant in cases of stubborn ankle pain because the ankle is very densely populated with and reliant upon its connective tissue supports. 

Ankle Pain Caused By Loss of Motor Control

This can be an issue for ankle pain that can be traced back to ankle, knee or hip injury. Pain and injury have been shown to have a very disruptive effect on healthy, normal nerve signals. After a bad rolled ankle you might say that the nerve pathway between the ankle and the brain becomes ‘disorganised’. This type of change can develop a kind of permanence in particularly bad ankle sprains that are not rehabilitated effectively. If you have poor balance standing on one leg this might have happened to you.

 It can be interesting to compare (carefully) your balance on your right with your left and see if there is any correlation between old rolled ankles, ankle pain and unsteadiness on the same side. 

Ankle Pain Caused By Hard Surfaces

Concrete, tarmac and paving are not natural surfaces and they are not what we evolved to stand and walk on. For a million generations all your direct ancestors lived for the most part on soft, uneven surfaces. For the past 150 years only have we lived on the extremely hard flat surfaces we live on now. 

Spending our lives on hard surfaces is a major source of stress for the connective tissues of the ankle. If you have stubborn ankle pain it is quite likely that living on unnatural terrain has contributed to your issues. For some of you this is magnified by jobs and/or hobbies that involve standing and moving a lot on hard surfaces like concrete and tarmac.

Ankle Pain Caused By Osteoarthritis

Osteoarthritis is the medical term for ‘wear & tear’ in a joint. It should not be too much of a surprise to learn that a joint that bears as much body weight ( 3 million steps plus per year and a whole heap of standing ) is prone to osteoarthritis. 

Osteoarthritis can most definitely cause pain, stiffness and locking in an ankle. There are those of us who are doomed to requires ankle fusion surgery to reduce our ankle pain later in life. The good news for those who do have osteoarthritis in an ankle is that often the pain isn’t coming from the osteoarthritic joint itself but from the soft tissues around the arthritic joint… this generally makes the pain a lot more manageable than you might think.

Ankle Pain Caused By Diseases

There are many disease states and health issues that may cause ankle pain. Inflammatory forms of arthritis, gout and even bone cancers can be causes of ankle pain. There is wisdom in not trying to self diagnose stubborn pain so if you are even remotely concerned about your health as it relates to ankle pain be sure to seek some professional advice. 

Closing Thoughts

So there are some small insights into the types of themes that may be playing out in your ankle if you suffer pain or repeated rolled ankle scenarios. The good news is in most cases these type of issues are diagnoseable and can be managed extremely well.. When it comes to stubborn ankle pain and rolled ankles rehabilitation is king !