Ankle Pain: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment 

What is ankle pain?

The ankle joint is an articulation of three bones – talus, tibia, and fibula. Three ligamentous systems stabilize the ankle joint. These include the medical deltoid ligament, the syndesmotic ligaments, and the lateral ligament complex. [1] The ankle joint is subjected to traumatic injuries accompanied by injury to the ligamentous systems. The lateral ankle pain attributes to the injury of the lateral ligament complex, particularly the injury of the anterior talofibular ligament. The common mechanism of injury is the inversion of the foot and ankle, manifesting as lateral ankle pain. Ankle pain may also be accompanied by instability of the ankle joint. [1, 2] The following sections describe the causes, risk factors, normal healing cycle, healing cycle in chronic conditions, ineffective treatments, and effective treatments of ankle pain.  

Causes and Risks of Ankle Pain

The following are the causes and risk factors associated with the development of ankle pain. [1, 3, 4]

  1. Sports-related activities such as running, jumping, and playing tennis
  2. Male gender
  3. Running while wearing worn-out shoes 
  4. Tight muscles of the calf
  5. Bone spur
  6. Diseases such as high blood pressure and psoriasis
  7. Medications such as antibiotics including fluoroquinolone
  8. Prior history of ankle sprain 
  9. Ankle joint laxity 
  10. Position of the player in sports
  11. Duration and intensity of sports 
  12. Athletic and military populations 

Normal Healing Cycle 

Wound healing is a biological process that occurs in the human body. The phases of wound healing include hemostasis, inflammation, proliferation, and maturation or remodeling. For successful wound healing, it must occur in the designated sequences and in the proper time duration. The description of the phases of wound healing including physiologic and cellular events is as follows. [5]

  1. Hemostasis

During this phase of wound healing, vascular constriction occurs. The platelets undergo aggregation, degranulation, and eventually fibrin formation leading to the development of a blood clot or thrombus. 

  1. Inflammation

This is the second phase of wound healing. In inflammation, the neutrophils, lymphocytes, and monocytes infiltrate the site of injury. The monocytes differentiate into macrophages. The cardinal signs of inflammation include pain, swelling, increased temperature, redness, and loss of function at the site of injury. 

  1. Proliferation

The proliferation phase is the third phase of the wound healing process. During proliferation, the injured site undergoes angiogenesis or the formation of the blood vessels, re-epithelization of the wound site, formation of the extracellular matrix, and the synthesis of collagen. It is the proliferation stage during which the trigger points and scar tissue are formed as well as muscle spasms and fascia restrictions occur. 

  1. Maturation or Remodeling 

The maturation or remodeling phase is the last stage of wound healing. During this stage, vascular maturation and regression occur, and the collagen undergoes remodeling. 

Chronic Conditions and Healing Cycle 

Chronic and non-healing wounds are characterized by derangement in the wound healing cycle. A chronic wound is defined as a wound that heals in more than 12 weeks. Increased levels of oxidative stress and inflammation in chronic wounds lead to senescent cell induction. In chronic wounds, the wound healing cycle oscillates between the inflammation and resolution stages and is unable to attain resolution. [6] 

Ineffective Treatments

People may often use different therapeutic strategies for relieving ankle pain. These therapeutic measures are common yet ineffective. Following is a list of treatments that are ineffective for ankle pain resolution. 

  1. Application of heat and ice 
  2. Electrical stimulation of the site of pain or injury
  3. Use of foam roller and massaging on the site of pain or injury
  4. Stretching of the ankle joint 
  5. Mobilization of the ankle joint 
  6. Strength exercises during the inflammatory stage of the wound healing cycle 

Effective Treatment of Ankle Pain 

The effective treatment strategies for the resolution of ankle pain include the following. 

  1. Walking with a normal gait 
  2. Wearing good shoes while engaging in sports-related activities 
  3. Maintaining a correct posture of the pronated foot
  4. Resolution of the inflammation stage of the wound healing cycle 
  5. Resolution of the proliferation stage of the wound healing cycle 

Following is a description of the strategies for the resolution of the inflammation and proliferation of the wound healing cycle and the use of different tools during the treatment process. 

Inflammation Stage 

There are various ways of resolution of the inflammation stage of the wound healing cycle. One may use the MagnaHeal device, which employs magnetic fields to modulate wound healing. Magnetic fields influence angiogenesis, collagen, and proteoglycans in the wound. [7] Dietary patterns also modulate the resolution of chronic pain. Lesser consumption of vegetables and fruits along with increased consumption of refined grains, processed meat, and sugary foods cause the increased synthesis of pro-inflammatory mediators. An anti-inflammatory diet comprises unsaturated fats, vegetables, fruits, fish, and whole grains. [8] One may also address nutrient deficiencies to modulate the inflammation stage of the healing cycle. [9]

Proliferation Stage 

The resolution of the proliferation stage of the wound healing cycle involves the release of scar tissue, trigger points, and fascia restrictions. A1 Tool is useful for releasing both superficial and deep fascia restrictions. A3 Tool is useful for the release of superficial scar tissue and superficial muscle trigger points. A5 Tool is important for the release of deeper scar tissues and deeper muscle trigger points. A5 Tools is also useful for releasing endomysium, epimysium, and perimysium fascia restrictions. 

Conclusion

Ankle pain can occur due to sports-related injuries, wrong shoes, improper position of the joint, and certain medications and diseases. Ankle pain may also affect the mobility of an individual and hinder routine activities. Similar to other wounds, the wound at the ankle joint undergoes hemostasis, inflammation, proliferation, and maturation stages of the healing cycle. Failure of the healing cycle to attain resolution causes the cycle to oscillate between the inflammation and proliferation stages. While individuals may opt for traditional methods such as joint mobilization and the application of heat and ice for the resolution of ankle pain, these methods are ineffective. Effective treatment strategies include normal gait, good shoes, the correct posture of the pronated foot, and the resolution of the inflammation and proliferation stages of the wound healing cycle. 

References 

  1. Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2022 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/
  2. Choudhary, S., McNally, E. Review of common and unusual causes of lateral ankle pain. Skeletal Radiol 40, 1399–1413 (2011). https://doi.org/10.1007/s00256-010-1040-z 
  3. Hubbard, T. J., & Wikstrom, E. A. (2010). Ankle sprain: pathophysiology, predisposing factors, and management strategies. Open access journal of sports medicine1, 115–122. https://doi.org/10.2147/oajsm.s9060
  4. Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World journal of orthopedics11(12), 534–558. https://doi.org/10.5312/wjo.v11.i12.534
  5. Guo, S., & Dipietro, L. A. (2010). Factors affecting wound healing. Journal of dental research89(3), 219–229. https://doi.org/10.1177/0022034509359125
  6. Wilkinson, H. N., & Hardman, M. J. (2020). Wound healing: cellular mechanisms and pathological outcomes. Open biology10(9), 200223. https://doi.org/10.1098/rsob.200223
  7. Henry, S. L., Concannon, M. J., & Yee, G. J. (2008). The effect of magnetic fields on wound healing: experimental study and review of the literature. Eplasty8, e40.
  8. Dragan, S., Șerban, M. C., Damian, G., Buleu, F., Valcovici, M., & Christodorescu, R. (2020). Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients12(9), 2510. https://doi.org/10.3390/nu12092510
  9. Oz H. S. (2017). Nutrients, Infectious and Inflammatory Diseases. Nutrients9(10), 1085. https://doi.org/10.3390/nu9101085