Q I hurt my ankle a few years ago - it was a sprain, and it has been swollen since. I hurt it again recently by missing a step. Should I go for an X-ray?
Dr Nina replies: We are rarely born with joint problems. These are usually acquired as we age and in the majority of cases it is due to a lifetime of wear and tear, injury or failure to care for our hard-working limbs. Pain in the lower leg can occur through the ankle toes, forefoot, mid foot, heel and arch.
Obesity, poor posture or balance can alter the body's centre of gravity, leading to pressure through the ankles and feet, and lastly high-intensity exercise that involves jumping or running also puts a strain on the structures of the ankle.
Pain across the ankle may be due to some arthritis or inflammation of the structures here. Pain in other areas of the foot may be due to high arches, flat feet or deformities that cause the foot to turn out, changing the angle at which it hits the ground.
A sprain occurs when the ligaments supporting the ankle are wrenched and stretched, usually as a result of injury.
Once a sprain has occurred, it is important that the ligaments heal well and the ankle remains supported. If a significant injury is missed, or proper rehabilitation doesn't occur, you may end up prone, furthering strain, or having an unstable ankle joint.
If your ankle has been swollen since the last injury and you have increasing pain now, then I would advise seeing your doctor. A registered physiotherapist may also be able to help. Your ankle and the supporting structures can be assessed. X-rays are not necessary for a simple sprain but an MRI may be needed to define a more serious ligament injury.
Arthritis can set in when a joint has been previously injured. This develops when cartilage (a tissue that covers the ends of bone in a joint) becomes worn down. Cartilage normally protects the bones and helps absorb pressure and movement in the joint. When this becomes thinner, the bony surfaces become exposed, rubbing off each other, and this leads to pain and inflammation. Over time, the joint then deteriorates further. Serious joint damage can occur. People commonly complain of pain and stiffness that get worse with exercise or use of the joint and there is often a sense of clicking or grinding. Movement often becomes quite limited. The symptoms are often worst when mobilising after prolonged rest or sleep.
When ankle pain occurs, simple measures like applying ice, raising the foot and taking over-the-counter painkillers may help. Paracetamol and ibuprofen can provide good relief. Wear good supportive shoes. If your physiotherapist prescribes exercises, it is essential that you do these to ensure good ankle rehabilitation. Finally, ensure you have adequate dairy and vitamin D to support good bone health, avoid smoking and maintain a healthy weight. This will all improve your skeletal health and get you back moving the way you would like.