Ankle and Achilles Pain: Diagnosis and Treatment

Ankle and Achilles tendon pain in runners

Do you like running , but have problems with your ankle? Do you often sprain your ankle or do you have pain in your Achilles tendon ? You are not alone, a large number of runners suffer from ankle injuries, it is the second most common injury. In this article, you will learn a lot of important and interesting things about Achilles tendinopathy and sprained ankles .

Ankle pain

Why does my ankle hurt from running?

Ankle pain can have many causes. Chronic ones can include osteoarthritis , arthritis , or general overload with the gradual development of inflammation . Runners are more often affected by acute ankle injuries , from the most common ankle sprain or dislocation to less common fractures or ligament injuries . In any case, it is important to visit a surgical, orthopedic, or traumatology clinic, where they will help you with the correct diagnosis.

What is a sprained ankle?

A sprained ankle , or ankle sprain, is an acute injury caused by an incorrect step , typically on the little toe side of the foot. It is experienced by around 80% of people and in about 85% it is purely a damage to the soft structures , mainly the ligaments . Less than 15% is accompanied by a fracture. Depending on the severity of the tendon injury, the orthopedist will assign a class. Class 1 means a stretched ligament, class 2 means micro tears and class 3 means torn ligaments (1).

How do I recognize a sprained ankle?

In most cases, the injury is preceded by a bad and painful step . Swelling , pain when moving, and bruising occur relatively quickly. If you have these symptoms, you need to have an X-ray to rule out a fracture (1).

Source: www.mayoclinic.org

How to speed up the healing of a sprained ankle?

To help your ankle heal as quickly as possible, there are a few things you need to follow. You should rest your ankle for at least the first three days after the injury, and you can add ice , compression , and elevation . The combination of these elements should help reduce pain , reduce swelling , and promote healing . Pain and inflammation can be prevented by taking anti-inflammatory painkillers such as ibalgin or diclofenac, but there is a risk of stomach upset (1), (2).

Studies show that for the fastest return to sports, it is optimal to start ankle rehabilitation after 2 weeks of rest from the injury. It is best to consult a physiotherapist about exercises and, most importantly, be aware of your pain and discomfort so as not to worsen the situation. Rehabilitation will probably involve training the range of motion in your ankle, stretching and strengthening the surrounding muscles so that the ankle does not become weak (1).

When can I start training again?

The answer to this question must be answered on a case-by-case basis. In general, a mild sprain (grade 1) should be ready for gradual weight bearing after 2 or more weeks . A severe sprain (grade 3) may be ready for weight bearing after 6 weeks . Depending on the severity of the injury, 2-6 weeks is the minimum amount of time the ankle should be rested. (1).

Achilles tendon pain and injury

The Achilles tendon attaches the calf muscles to the heel bone. It is the strongest tendon in humans and is used with every step or jump we take. It can become injured when subjected to prolonged high loads . Chronically, this can lead to Achilles tendinopathy , and acutely, the tendon can tear or rupture (3).

Achilles tendon tendinopathy - what is it?

This is a very painful , chronic tendon injury . It is common in athletes, especially runners . In one study, up to 83% of middle-distance runners reported experiencing pain and symptoms characteristic of this injury in their lifetime. And about 30% of those injured described pain in both legs (4).

Source: www.canva.com

How do I recognize Achilles tendinopathy?

Achilles tendinopathy is characterized by pain , swelling , and loss of strength . Morning stiffness and tenderness of the tendon are common. Inflammation, and thus redness and warmth at the tendon site, may or may not be present . If inflammation were present, the condition would be more accurately called tendinitis. A detailed examination of the tendon may reveal thickening of the tendon and changes in the protein content of the tissue (4).

What causes Achilles tendinopathy?

As with most running injuries , repetitive mechanical overload without adequate rest and recovery time is to blame. Typically, the injury occurs in runners who have increased their training intensity beyond their norm in recent weeks (4). Another sport in which an increased incidence of Achilles tendon or ankle injuries due to overload is seen is soccer .

Duration and method of treatment

Achilles tendinopathy can be treated for up to a year . The problem is that there has been some pathological remodeling of the tendon and it takes a long time to return to a pain-free state during sports. The best method of treatment is rehabilitation and gradual loading of the tendon . Exercises that may be prescribed to you include, for example, raising the toe up and down while sitting, over time repeatedly standing on the toes and back on the heels, first on both legs and with progress on one leg, and finally you will gradually load the tendon in sports . We must warn you that this process is not for a few weeks and it is not a good idea to rush recovery. It is always a good idea to consult a doctor or physiotherapist about exercises and pain (4).

Resources:

1. Gaddi, Diego et al. "Acute Ankle Sprain Management: An Umbrella Review of Systematic Reviews." Frontiers in medicine vol. 9 868474. 7 Jul. 2022, doi:10.3389/fmed.2022.868474
2. Ortega-Avila, Ana Belen et al. "Conservative Treatment for Acute Ankle Sprain: A Systematic Review." Journal of clinical medicine vol. 9,10 3128. 27 Sep. 2020, doi:10.3390/jcm9103128
3. Järvinen, Tero AH et al. "Achilles tendon disorders: etiology and epidemiology." Foot and ankle clinics vol. 10.2 (2005): 255-66. doi:10.1016/j.fcl.2005.01.013
4. Silbernagel, Karin Grävare et al. "Current Clinical Concepts: Conservative Management of Achilles Tendinopathy." Journal of athletic training vol. 55.5 (2020): 438-447. doi:10.4085/1062-6050-356-19