One of the most delicate joints of the entire skeletal system is the ankle. Due to traumas or degeneration of tissues, its function can be easily compromised. For example, an ankle may weaken because it is unstable after undergoing a distortion not followed by adequate rehabilitation, or because it becomes stiff: “In the latter case, the ankle is as if it were blocked and the patient cannot carry the tip of the foot completely towards the leg or in the other direction,” explains Dr. Lara Castagnetti, osteopath and specialist in Physical Medicine and Rehabilitation at Humanitas.
“This is a condition opposite to the one of ankle instability. In this case there is laxity of ligamentous tissues that make the joint “soft”. However, be careful because an unstable ankle can also be preceding the condition of a stiff ankle,” adds the specialist.
Among the main causes of ankle stiffness are arthrosis and Achilles tendinitis: “The degeneration of cartilage leads to arthrosis, the leading cause of stiff ankle. Being a condition that tends to be typical of old age, it is not uncommon that this is also associated with the degeneration of the Achilles tendon, the body’s major tendon, which connects the muscles of the calf to the heel”.
This tendon can degenerate, stiffen, thicken and sometimes even undergo calcification: “Its tissues become thicker, and this alteration can even be visible to the naked eye. The tendon – explains the doctor – thus loses its elasticity and the ankle becomes stiff, unable to perform the movements of dorsiflexion and flexure”. In other words, the joint does not move at its best, with relapses in terms of symptomatology: “Pain in movement, especially if there is arthrosis, is the main symptom along with swelling and functional limitation of the ankle”, adds the specialist.
Even overuse, i.e. the repeated use of the joint over time associated with sporting activity, can cause the Achilles tendon to degenerate and lead to a stiff ankle: “If ankle arthrosis is favored by traumas, such as a malleolar fracture, tendinopathy is above all a consequence of overuse, especially in subjects dedicated to running. In addition, the degeneration of the tendon can also imply the degeneration of the plantar band, the thick band of tissue that flows under the sole of the foot, from the heel to the toes. Since it is no longer sufficiently elastic, the tendon begins to “pull” the other tissues including the plantar band.
Finally, stiffness can be favored by the instability of the ankle: “This condition protracted in time following a distortion favors the onset of arthrosis because the bone caps come in contact more easily with the onset of arthrosis”.
What to do?
In order to restore a certain degree of joint mobility, several instruments can be used: “It is necessary to start moving the ankle by lifting the leg and moving the tip of the foot up and down, and then imagine writing the letters A, B and C and then replicating the first exercises with an elastic band that causes resistance in order to recover the muscular strength of the lower limb. Stretching of the Achilles tendon and plantar band is also useful. For example, the foot rests on the tip of the fingertips, when sitting or crouching, while the Achilles tendon can be stretched by placing the foot on a step and raising it on the tip, thus keeping this position for a few seconds “.
Other options include “shockwave therapy for Achilles tendinitis, correction with the support of a customized insole, to be used strictly on both feet. Rarely, and in very serious cases, ankle arthrosis requires surgery with a prosthesis,” concludes Dr. Castagnetti.