An in-depth guide to sports-related ankle pain

While we love to engage in sports, both for fun and as a form of exercise, this can have an impact on the body, leading to injuries causing ankle pain. We speak to renowned consultant orthopaedic surgeon Mr Hisham Shalaby, who explains what first aid measures to take for a painful ankle, when to seek medical attention for ankle pain and the available treatment methods.

What are the common causes of ankle pain following a sports injury?

Sports injuries are prevalent, and experiencing pain afterwards is also very common. Fractures are the most frequent source of pain, often occurring as a result of sports-related incidents. While it's commonly assumed that a broken bone would make someone unable to walk and in considerable pain, this isn't always the case. In some instances, individuals with fractures can still bear some weight, leading to the potential oversight of injuries like ankle fractures and some midfoot and hindfoot fractures.

Another common cause of significant pain is ankle ligament injuries, where the ligaments surrounding the ankle tear due to excessive stress or rotational forces. Osteochondritis or cartilage lesions present yet another source of pain. These are localised lesions on the joint surface, often resulting from a loss of blood supply to a focal area of bone beneath the cartilage due to impact, leading to its subsequent deterioration and inability to support the overlying cartilage.

Achilles tendon ruptures also contribute to pain in sports injuries. In these cases, patients may suddenly feel as though they've been kicked, despite no one tackling them, and experience a sharp pain in the tendon, indicating either a partial or a complete rupture.

How can I differentiate between a sprained ankle and a more serious injury?

Ankle sprains, as previously mentioned, are quite common, but they can vary in severity and presentation. Firstly, the extent of the injury plays a crucial role. Was it a simple fall or trip, or did the ankle twist severely, perhaps due to a significant impact? This initial assessment helps determine the severity of the injury.

Secondly, the level of pain experienced is indicative of the damage sustained. More intense pain suggests potential ligament damage or even a fracture.

Thirdly, the ability to bear weight immediately after the injury provides valuable insight. Could you walk normally, or was the pain too severe, requiring assistance or making it impossible to bear weight?

Additionally, the presence of swelling and bruising further indicates the severity of the injury. Increased swelling and extensive bruising suggest a more significant injury.

Finally, the rate of recovery is essential. A mild sprain typically improves within a couple of days, with full recovery expected within a few weeks. However, a severe sprain, involving significant ligament or joint surface damage, may result in persistent pain and delayed recovery, especially with continued physical activity or sports involvement.

What are the recommended first aid measures for a painful ankle after sports?

Immediately after suffering from a sports-related injury, it's important to adhere to the RICE protocol. (rest, ice, compress, elevate).  Begin by resting the affected joint, ideally immobilising it with a splint or boot to promote rest and reduce swelling while preventing calf muscle tightness. Applying ice or cold compressions helps to further minimise swelling and prevent the formation of blood collections around the joint. Compression techniques, such as using crib bandages or tubigrips, can also aid in reducing swelling by supporting the joint. Elevating the leg is crucial for swelling reduction.

If the injury is deemed severe, seeking proper assessment at an accident and emergency department or minor injuries unit is advisable, as an X-ray may be necessary to rule out fractures.

When should I seek medical attention for persistent ankle pain post-sports injury?

Two common types of pain that often follow an ankle injury are:

1. A deep, dull ache that is not well localised and occurs during physical activity or exercise. This type of pain typically indicates a deep issue within the ankle joint, such as a focal cartilage lesion.

2. Pain localised on the outer aspect of the ankle, extending up the leg and possibly down the outer aspect of the foot. This pain is usually attributed to the peroneal tendons, either due to injury or overuse compensating for underlying instability.

Persistent of either of these types of pain beyond the initial weeks post-injury warrants medical attention for proper evaluation. Initially, physiotherapy may be recommended, but if pain persists, a specialist in foot and ankle conditions should be consulted. Other important symptoms to note include feelings of instability or the ankle giving way, joint locking or catching, which may indicate a cartilage issue, and weakness in the calf muscles or difficulty with pushing off or standing on tiptoes, suggestive of Achilles tendon or calf muscle injury.

What are the available treatment options to relieve and recover from a painful ankle after sports?

The primary causes of post-ankle injury pain commonly involve ankle instability and focal cartilage lesions. Fortunately, clear treatment pathways exist for both conditions.

For ankle instability, initial treatment typically involves conservative measures such as physiotherapy to strengthen muscles and rehabilitate tendons. If instability and pain persist despite conservative efforts, surgical intervention to repair ligaments becomes necessary. This procedure not only restores immediate stability but also prevents further joint damage over time.

In the case of osteochondritis or focal cartilage lesions, conservative treatment options are generally ineffective. Surgery is often the preferred course of action, tailored to the size, location, and depth of the lesion. Surgical techniques range from minimally invasive procedures, such as keyhole surgery for lesion stimulation, to more extensive approaches involving bone grafting and surface reconstruction using collagen membrane scaffolds. Given the variety of reconstruction methods available, seeking guidance from a foot and ankle specialist, particularly one with expertise in sports injuries, is essential for optimal treatment outcomes.

If you are experiencing ankle pain due to a sports injury and would like to book a consultation with Mr Shalaby, simply visit his Top Doctors profile today.