Why Does My Ankle Pop?

The popping or cracking sound you hear on your ankles in the morning is just the snapping and stretching of the tissue lining your joints. Many factors can cause ankle popping. Most often, the popping is of little concern. However, ankle popping with accompanying pain, swelling, or instability is not normal. If you have these symptoms, visit your podiatrist for evaluation and thorough examination of the ankle.

What are the common causes of ankle popping?

1. Anterolateral impingement syndrome.

• The main feature of anterolateral impingement syndrome or ALIS, as it is sometimes called, is pain at the front and outside aspect of the ankle (anterolateral aspect).

Lateral view of the human ankle. By An svg version of image:Ankle.PNG by me (Jak). via Wikimedia Commons

• This may be caused by ankle sprains, especially recurrent ankle sprains, forced plantarflexion and supination, and activities that require repeated dorsiflexion of the ankle such as landing and deep squatting.

• Pain may be exacerbated following certain activities such as walking or running uphill, deep squatting, lunging, and landing from a jump.

Anterolateral Impingement: Typical Location of Pain. Photo courtesy of www.footeducation.com

• Symptoms include tenderness on palpation of the ankle joint and swelling of the ankle joint.

• Ankle popping or clicking sensations during certain ankle movements.

• Basic management for anterolateral impingement syndrome involves effective pain management through active rest, icing the area, applying a compression bandage, elevating the injured ankle to reduce puffiness, and anti-inflammatory medicines to reduce pain and swelling. Bracing and orthotics may also be done. For some patients, steroid injection into the affected area may give relief. Electrotherapeutic modalities may also be helpful. Once improved, physiotherapy can help restore function.

• It is not common to undergo surgery for ankle impingement, except in persistent cases and particularly for athletes. This involves removal of the soft tissue or bone spur. Arthroscopic excision and debridement is the treatment of choice.

2. Popping Peroneal Syndrome.

• This may be caused by a structural defect, specifically a shallow groove that causes the slipping and popping of the tendon. Another cause is tears in the retinaculum, allowing the tendon to slip in and out of the groove.

• Pain, tenderness and swelling may also be noted over the tendon behind the rectinaculum.

• An experienced podiatric surgeon would assess the ankle in all ranges to check whether the tendon would slip out.

• X-rays and/or an MRI exam may be necessary to confirm the diagnosis. X-rays are done to ensure that there are not any other injuries while an MRI will provide information about abnormal positioning or tears of the peroneal tendons.

• Treatment depends on the extent and nature of the condition. If there is an acute injury, crutches are usually used to avoid weight being applied to the foot. Other management methods include compressive wrap to decrease swelling, anti-inflammatory medications and ice to help decrease swelling. The patient may be placed in a cast or removable cast boot at this time. If the injury has not healed after six weeks, further treatment may be necessary.

• Surgical correction is necessary in moderate to severe injuries. This typically involves tendon rerouting, fibula osteotomies or groove deepening.

The cause of ankle popping may or may not be a cause of concern. If accompanied by other symptoms such as pain and swelling, this would best be managed by prompt diagnosis and intervention. An experienced orthopedic surgeon, or a foot and ankle surgeon, should be consulted in cases of continued ankle pain or instability. Visit us at NaplesPodatrist.com

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