Ankle osteoarthritis / ankle pain

Author: K. Zbinden

Definition

What are ankle complaints?

The ankle joint – also called the ankle – forms the connection between the lower leg and the foot and is one of the most heavily loaded joints in the human body. Anatomically, the ankle is divided into two main areas:

• ◉ Upper ankle joint (UAJ): It consists of the tibia, fibula and the talus. The UAJ mainly enables flexion and extension of the foot.
• ◉ Lower ankle joint (LAJ): The lower ankle joint is further divided into an anterior and posterior lower ankle joint. It lies between the talus, calcaneus and navicular bone and is responsible, among other things, for rotational and tilting movements.

Stabilising ligaments, tendons, muscles and cartilage structures provide guidance and cushioning. If overuse, inflammation or wear occurs, ankle pain develops. In broad terms, the following three types of ankle complaints can be distinguished:

• ◉ Ankle osteoarthritis

  Osteoarthritis in the ankle is a degenerative joint disease in which the protective cartilage in the ankle gradually breaks down, resulting in cartilage damage in the ankle. Common causes are previous injuries, foot malalignments or persistent incorrect loading and overuse. Typical symptoms include ankle pain, ankle pain when walking, ankle pain at night and start-up pain in the morning. Pain around the ankle bone and restricted mobility are also common signs of osteoarthritis in the ankle.

• ◉ Ankle inflammation

  Ankle pain when walking, ankle pain at night and start-up pain in the morning. Pain around the ankle bone and restricted mobility are also common signs of osteoarthritis in the ankle. Ankle inflammation is an irritation or inflammation of joint structures, tendons or the synovial membrane. Inflammation in the ankle can occur acutely or chronically and is often accompanied by ankle pain, swelling and warmth. Those affected report pain in the ankle, swollen ankles, restricted movement and a feeling of instability.

• ◉ Ankle injuries

  Ankle injuries are usually caused by twisting the ankle, falls or sports. These include ligament injuries, capsular irritation or bruising. Typical symptoms of an ankle injury are sudden ankle pain, pain around the ankle, instability and joint swelling around the ankle. If left untreated, such injuries can lead to ankle osteoarthritis or chronic ankle pain in the long term.

Causes of ankle complaints

The causes of ankle complaints are often rooted in modern lifestyle and changed environmental conditions. The ankle is a complex, highly resilient joint that must absorb, transmit and control forces with every step. If it is not moved enough, is loaded incorrectly or is constantly exposed to one-sided forces, its function changes. These functional changes form the basis for ankle pain and long-term structural damage.
While our ancestors walked barefoot on natural, uneven ground and continuously mobilised and strengthened the upper and lower ankle joints, today’s everyday life is characterised by sitting, monotonous movements and hard floors. These conditions directly affect the stability, mobility and load-bearing capacity of the ankle.

Lack of movement and a sedentary lifestyle

A lack of movement means that the ankle can no longer utilise its natural range of function. Joints depend on regular movement to remain well supplied, stable and resilient. If the ankle is moved too little, several functional adaptations occur.

• ◉ Declining muscular stabilisation

  The ankle is mainly guided and stabilised by muscles, tendons and ligaments. With a lack of movement, this musculature loses strength and responsiveness. For the joint, this means reduced active guidance. It moves less in a controlled manner, which places greater stress on individual joint surfaces. This uneven loading increases pressure on cartilage, ligaments and the joint capsule in the ankle and can therefore lead to ankle complaints.

• ◉ Changes in joint alignment

  If muscular guidance is lacking, the ankle tends to deviate from its optimal position when walking. It may tilt more inward or outward, shifting the load to certain areas of the joint. The upper ankle joint is particularly sensitive to such axis deviations because it is responsible for controlled roll-through.

• ◉ Increased tension in the joint region

  A sedentary lifestyle promotes shortening in the muscle and fascia chains of the legs. These structures directly influence the position and mobility of the ankle. Increased tensile forces mean that the joint is under constant stress and can move less freely. The joint’s natural ability to adapt decreases, creating fertile ground for inflammation and injuries.

• ◉ Reduced joint mobility

  If the ankle is not regularly used through its full range of motion, it loses mobility. The joint surfaces no longer glide optimally against each other, resulting in increased friction. This makes the joint more susceptible to overuse reactions, especially during everyday loads such as walking or climbing stairs.

Hard, flat floors and rigid, supportive shoes

In addition to lack of movement, today’s environmental conditions also have a significant impact on the ankle. Hard floors and stiff shoe soles change the natural biomechanics of every single step.

• ◉ Increased impact load in the ankle

  On hard, flat surfaces, impact forces can hardly be cushioned. These forces are transmitted directly to the ankle. The joint has to absorb this load abruptly, which increases pressure on cartilage and joint surfaces. The upper ankle joint is particularly affected because it controls the first contact with the ground.

• ◉ Shortened reaction time of the stabilising musculature

  Due to the early and high force impact, the musculature has less time to actively stabilise the ankle. As a result, the joint loses active guidance and relies more heavily on passive structures such as ligaments and the capsule. Over the long term, these are subjected to greater strain, which can promote ankle inflammation.

• ◉ Restriction of the natural movement sequence

  Rigid and supportive shoes restrict the natural roll-through from the heel, via the midfoot, to the big toe joint. Reduced foot motion is often observed here. For the ankle, this means it is repeatedly loaded in the same movement angles. Certain joint areas are overused while others are hardly moved. Overused structures tend to become inflamed and injured, while underloaded areas deteriorate and stiffen.

• ◉ Reduced intrinsic activity of the ankle

  Due to the supportive function of modern shoes, the footwear takes over part of the work that the ankle and surrounding musculature should actually perform. As a result, the supporting structures (especially the muscles) weaken, the joint becomes less resilient and reacts more sensitively to everyday or sporting demands.

Symptoms of ankle complaints

It is important to note that the following lists contain the most common symptoms of ankle complaints. The list is not complete or conclusive, and atypical symptoms may also occur. The severity of ankle pain depends, among other things, on the cause, the degree of severity, the duration of the complaints and individual physical constitution. For a clear diagnosis of ankle pain or persistent ankle pain, a medical professional should be consulted.

• ◉ General ankle pain: Can occur when walking, standing or running and may be load-dependent or persistent.
• ◉ Pain in the ankle joint: Often localised deep in the joint and intensifies with movement or prolonged loading.
• ◉ Pain at the ankle joint: Often noticeable at the front or outer side of the joint.
• ◉ Upper ankle joint pain: Pain when rolling the foot or climbing stairs, typical for loads in the UAJ.
• ◉ Lower ankle joint pain: Complaints during rotational and tilting movements of the foot, especially on uneven ground.
• ◉ Pain around the ankle: Localised around the ankle area, often intensified by pressure or movement. Often combined with a feeling of instability in the ankle.
• ◉ Ankle pain at night: Rest pain that can occur when lying down or during rest phases.
• ◉ Start-up pain: Ankle pain after getting up following prolonged lying or sitting that improves briefly after a few steps.
• ◉ Ankle pain during loading: Increasing ankle pain when walking, running or standing for longer periods.
• ◉ Ankle pain when walking: Particularly pronounced on hard or uneven ground.
• ◉ Ankle pain after jogging: Complaints that occur after sporting activity or the following day.
• ◉ Sudden ankle pain: Acute shooting pain, often after a misstep or unusual loading.
• ◉ Joint swelling in the ankle: Visible or palpable swelling around the ankle.
• ◉ Swollen ankle: Combination of swelling and pressure pain in the ankle area, which can occur on the inside or outside.
• ◉ Redness and warmth: Indication of inflammation in the ankle.
• ◉ Ankle inflammation: With ankle inflammation, symptoms such as swelling, pain on movement, warmth and reduced load-bearing capacity are often present.
• ◉ Restricted movement: The ankle can no longer be fully flexed, extended or rotated.
• ◉ Feeling of instability: Feeling of buckling or insecurity in the ankle, especially on uneven ground.
• ◉ Talus pain: Deep-seated pain in the centre of the joint, often noticeable under load.

The symptoms listed for ankle complaints can occur individually or in combination and may change over time. Early clarification of persistent ankle pain is crucial to avoid long-term limitations.

Conventional therapies - What helps with ankle complaints

Various conventional therapy approaches are available for treating ankle pain. The measures listed below represent a selection of common forms of treatment and are not exhaustive. Several therapy approaches are often combined to relieve ankle pain. A medical assessment is recommended to determine the appropriate form of therapy on an individual basis.

• ◉ Rest and load reduction: Temporary relief of the ankle can help calm acute irritation. Strenuous activities should be reduced and then gradually rebuilt.
• ◉ Cooling: Cold applications relieve acute ankle pain, reduce swelling and have an anti-inflammatory effect in cases of ankle inflammation.
• ◉ Physiotherapy: Targeted mobilisation and strengthening techniques improve mobility in the upper and lower ankle joints and promote stability.
• ◉ Manual therapy: Special techniques can improve joint mobility and release a possible ankle joint blockage.
• ◉ Stretching exercises: Regular stretching supports ankle mobility and can reduce tension in the joint area.
• ◉ Strengthening exercises: Targeted development of the foot and lower-leg muscles stabilises the ankle and relieves joint structures.
• ◉ Medication therapy: Pain-relieving and anti-inflammatory medication can reduce ankle pain in the short term.
• ◉ Bandages and braces: Stabilising aids support the ankle and reduce uncontrolled movements in cases of instability.
• ◉ Orthopaedic insoles: Insoles can improve pressure distribution in the ankle and reduce joint pain around the ankle bone.
• ◉ Shoes for ankle osteoarthritis: Special shoes can reduce ankle pain in cases of ankle osteoarthritis.
• ◉ Injection therapy: Cortisone or hyaluronic acid injections are used for persistent ankle pain or ankle osteoarthritis.
• ◉ Shockwave therapy: Sound waves stimulate circulation and can support chronic ankle pain.
• ◉ Taping: Specific tapes promote stability and can relieve pain around the ankle.
• ◉ Electrotherapy and ultrasound therapy: These physical applications can support regeneration in the ankle.
• ◉ Anti-inflammatory ointments: Applied locally, they can help in cases of ankle inflammation.
• ◉ Weight reduction: Reducing body weight lowers the load on the ankle.
• ◉ Surgery: In severe cases, for example with advanced ankle osteoarthritis or persistent ankle pain, a surgical intervention may be necessary.

Although these measures often provide short-term relief from ankle pain, they do not sufficiently address the underlying functional causes. The goal of any treatment should be to sustainably improve the loading conditions of the ankle. As described above, lack of movement, a sedentary lifestyle, as well as hard floors and rigid shoes play a central role. kybun’s mode of action addresses exactly these factors and offers a holistic approach to sustainably relieve the ankle.

kybun mode of action - What helps with ankle complaints

kybun products aim to eliminate the health-damaging effects of hard, flat floors and rigid, supportive shoes, while actively addressing lack of movement and a sedentary lifestyle. Thanks to the elastic-springy properties of kybun products, the feet are relieved on the one hand and activated on the other. The relief ensures that, in a first step, ankle pain is reduced. Through activation, the causes of ankle complaints are addressed so that the complaints become a thing of the past in the long term. This makes kybun shoes ideally suited for ankle complaints, as they help treat ankle pain through the following effects:

• ◉ Reduction of the force impact from hard, flat floors through a cushioning effect

  When stepping in kybun shoes, the elastic-springy sole material is compressed. Similar to an airbag, the compressible sole absorbs a large part of the forces acting on it. This significantly relieves the ankle and protects it from incorrect loading and overuse.

Balance and EMG

Balance ability was measured with a force plate by tracking the movement of the body’s centre of mass from front to back (ant-post) and side to side (med-lat) while standing. In parallel, electromyography (EMG) recorded muscular activity.

During heel strike, the foot can sink into the kybun material, which delays the onset of load on the ankle over time. This gain in time enables the musculature to actively stabilise the joint. Well-activated musculature protects cartilage, ligaments and tendons in the ankle, reduces incorrect loading and overuse, and minimises the risk of inflammation and injuries.

• ◉ Activation of the foot and lower-leg muscles through elastic-springy properties

  The feet must continuously remain slightly in motion on the elastic-springy kybun sole to stabilise balance. This trains the foot and leg muscles. Strong musculature stabilises the upper and lower ankle joints, relieves passive structures such as ligaments and the joint capsule, and supports physiological movement guidance. At the same time, minor misalignments such as a lowered longitudinal arch or overpronation can be corrected. This continuous activation prevents muscular deficits and reduces ankle pain when walking.

• ◉ Natural foot roll-through thanks to muscle activation and roll-off function

  During heel strike, the foot can gently sink into the kybun material. This means the load on the ankle does not start abruptly, but is delayed over time. This crucial gain in time enables the surrounding musculature to react early and actively stabilise the joint. This allows the foot to roll through in a controlled manner after heel contact and prevents the harmful “slapping foot”, which reduces the risk of ankle inflammation or ankle osteoarthritis.

The roll-off function of the kybun sole enables a natural movement sequence over the forefoot. This increases the range of motion of the ankle, gently stretches the joint structures and keeps them flexible, improving resilience. At the same time, incorrect loading in the ankle is reduced.

• ◉ Protection against fascia dysfunction thanks to a physiological movement sequence

  Controlled roll-through and active muscle control promote a healthy fascial network around the ankle. Adhesions and tension are reduced, supporting joint mechanics and balancing the load on tendons and ligaments. This helps minimise inflammation in the ankle and maintain mobility in the ankle.

• ◉ Improved circulation through higher movement activity

  The ankle is far from the heart and therefore sensitive due to circulation. Active movement in kybun shoes promotes blood flow to muscles, tendons and joints. This improves the supply of oxygen and nutrients, facilitates the removal of pro-inflammatory substances, and supports healing and regeneration processes.

• ◉ Optimised pressure distribution

  When walking and standing in kybun shoes, the entire sole of the foot is surrounded by the elastic-springy material. This results in optimised pressure distribution in the foot and ankle. This can reduce point pressure on the ankle and surrounding structures. In addition, the constant slight movement on kybun Joya products enlarges the load-bearing area, which can further reduce local pressure peaks. In this way, the ankle can be relieved and the cartilage and ligament structures near the joint can be protected from overuse and wear.

• ◉ Promotion of movement and reduction of sedentary behaviour

  The elastic-springy kybun products increase enjoyment of movement because they relieve the ankle during walking and standing. Muscle activation strengthens the musculature and promotes circulation. At the same time, the duration of sedentary activities can be reduced and harmful shortening as well as blockages of the myofascial structures can be prevented. Each step gently stretches the ankle, increases flexibility and reduces complaints in the long term. This makes the ankles more supple and restores natural joint mechanics.

Usage tips for ankle complaints

Before wearing kybun shoes for the first time, you should observe a few usage tips. Correct use of the shoes for ankle pain can help relieve discomfort.

• ◉ At the beginning, wear kybun shoes only for as long as your body tolerates. Take breaks if ankle pain increases or fatigue develops in the foot and leg muscles. Treating ankle pain takes time. Due to the activating properties of kybun products, the musculature is trained, which can lead to so-called initial reactions, especially at the start.
• ◉ Press your heel slowly and in a controlled manner into the elastic-springy material and feel the give of the sole. Find a load point at which the ankle pain is reduced or does not occur. At the beginning, be careful not to force the roll-through over the forefoot too strongly.
• ◉ Take small, controlled steps. Place the foot as flat as possible to minimise tension in the upper and lower ankle joints. Initially reduce the roll-through motion, especially in acute ankle inflammation or pain in the lower ankle joint. Over time, you can increase the range of motion as soon as the joint has become accustomed to the activation.
• ◉ Pay attention to even loading of the ankle. Try to avoid overpronation or supination so that the ankle is loaded in a controlled manner. The elastic-springy sole helps distribute force evenly and reduce incorrect loading.
• ◉ Combine the use of kybun shoes with targeted exercises. Complementary strengthening and mobilisation exercises support stabilisation of the ankle, promote circulation and enhance the effect of the shoes. The exercises should be performed regularly to sustainably improve joint mechanics and reduce ankle pain in the long term.

Helpful exercises for ankle complaints

To enhance the effectiveness of kybun shoes and increase the likelihood that ankle complaints will decrease, we recommend the following exercises. The exercise selection is not exhaustive and can be supplemented with additional exercises. As a general rule: symptoms must not become worse during the exercises. Mild, pleasant and releasing “pain” is normal and desirable.
The exercises are divided into the following areas: “Proper walking in kybun shoes”, “Muscle length training”, “Fascia rolling” and “Strengthening”. Ideally, the areas are combined to support the treatment of ankle complaints.

Proper walking in kybun shoes

The quality of each individual step is crucial in the treatment of ankle pain in order to reduce pain and eliminate incorrect loading and overuse. kybun shoes therefore offer an ideal therapy for ankle pain.

Controlled heel strike

• ◉ Press the heel deeply into the elastic-springy material to benefit from cushioning and muscle activation.
• ◉ When the heel makes contact, find a load point at which ankle pain is reduced or no longer occurs.
• ◉ Control foot alignment so that the foot does not tip inward or outward.
• ◉ Place the midfoot and forefoot down slowly and in a controlled manner so the ankle is not overloaded.
• ◉ Active roll-through over the forefoot should not be performed yet. The focus is on physiological heel strike.

Controlled roll-through

• ◉ Pay attention to a light and natural roll-through over the forefoot without actively or forcefully pushing off with the big toes. Particularly in the case of existing blockages in the ankle area or inflammation in the ankle, the range of motion of the feet should initially be adapted individually to the personal condition.
• ◉ Test the possible range of motion of the feet without ankle pain occurring or increasing. Increase the range of motion if possible.

Muscle length training

Muscle length training plays a central role in the treatment of ankle complaints, as these are often caused by shortening and tension of the surrounding musculature. These muscular limitations can negatively affect ankle mobility and lead to incorrect loading or overuse. Targeted stretching exercises can actively reduce shortening and tension, improving mobility and functionally relieving the ankle.

Calf muscles

• ◉ Starting position in a lunge.
• ◉ Back heel remains in contact with the ground and should not be lifted.
• ◉ Slowly bend the front knee forward until a pulling sensation is felt in the calf.
• ◉ 3 x 30 seconds per side.
• ◉ Perform 1–2 times daily.

Foot twisting

• ◉ Take the foot in both hands.
• ◉ Twist the ankle in all possible directions and hold the stretch.
• ◉ 3 x 30 seconds per side.
• ◉ Perform 1–2 times daily.

Fascia roller

Fascia training with the fascia roller plays an important role in treating ankle complaints. These complaints often arise from shortening and tension of the myofascial structures. Regular rolling of the tense and shortened myofascial chain can improve mobility and relieve the ankle. The fascia roller is therefore suitable as an active therapy to alleviate ankle complaints and at the same time supports restoration of function and stability of the joint.

Calf muscles

• ◉ One leg bent and the other leg on the fascia roller. Increase pressure by placing both legs on top. Further increase by stacking the legs.
• ◉ If pain occurs in the wrist, the exercise can also be performed on the forearms.
• ◉ Actively roll out the calf from just above the heel to just below the back of the knee.
• ◉ Perform the exercises slowly and in a controlled manner.
• ◉ Adjust pressure to personal sensation, but go up to a tolerable pain threshold.
• ◉ Roll out focal adhesions more intensively or hold the position at that point.
• ◉ At least 3 minutes per side.
• ◉ Perform 1–2 times daily.

Shin muscles

• ◉ Place the fascia roller under the shin. Bend the other leg to stabilise. Position the hands shoulder-width apart and use them to lift the upper body.
• ◉ If wrist pain occurs, the exercise can also be performed on the forearms.
• ◉ Actively roll out the shin from the ankle to the knee.
• ◉ Perform the exercises slowly and in a controlled manner.
• ◉ Adjust pressure to personal sensation, but go up to a tolerable pain threshold.
• ◉ Roll out focal adhesions more intensively or hold the position at that point.
• ◉ At least 3 minutes per side.
• ◉ Perform 1–2 times daily.

Strengthening

Targeted strength training for the feet and ankle is particularly important for foot malalignments such as flat feet, splayed feet or knock-ankles to protect the ankle from overuse and incorrect loading. Strong foot and leg muscles relieve the ankle and help reduce complaints. Targeted strength training is therefore an effective measure for therapy and prevention of ankle complaints and supports the stability and functionality of the joint. The following exercises can be performed on the floor and on the kybun mat. On the kybun mat, pressure on the feet is reduced and muscle activity is increased.

Heel raises

• ◉ Starting position: standing hip-width apart
• ◉ Slowly and in a controlled manner lift both heels. Hold the position briefly at the highest point. Slowly and in a controlled manner lower the heels again.
• ◉ 3 sets of 8–12 repetitions.
• ◉ Perform 2–3 times per week.

Single-leg stand

• ◉ Starting position: standing hip-width apart
• ◉ Lift one leg and keep your balance.
• ◉ Hold 3 x 60 seconds per side.
• ◉ Perform 2–3 times per week.