Ankle stiffness: Causes, Treatments and Exercises

Ankle stiffness is a common complaint that occurs in a large proportion of the population. It is a common symptom in poorly managed ankle sprains as well as common foot conditions such as osteoarthritis, plantar fasciitis or achilles tendinitis. In some cases, ankle stiffness can be a byproduct of the condition, whilst in some cases a stiff ankle can be the primary cause. The ankle traditionally loses mobility in two directions. Plantar flexion (toes down towards the floor) or dorsiflexion (toes up towards the ceiling). In this article, our physiotherapist Jason Lee identifies how to improve dorsiflexion.

Key Insights

• Ankle stiffness can limit daily activities and reduce overall quality of life. Common causes include poorly managed injuries, arthritis, and conditions like plantar fasciitis or Achilles tendinitis. 
• Stiffness often results from the tightening of connective tissues, limiting motion in key directions like plantar flexion (toes down) or dorsiflexion (toes up). 
• Preventive measures include daily stretching, using supportive footwear, and maintaining a balanced diet rich in anti-inflammatory nutrients. 
• For treatment, physiotherapy is effective for severe cases, while self-care can help manage mild stiffness. Early diagnosis and personalised care are crucial to prevent complications.

What are the Primary Symptoms to Watch For?

Recognising the early signs of ankle stiffness can help in seeking timely intervention and treatment. Key symptoms to be aware of include:

• Reduced Range of Motion: One of the most apparent symptoms is the inability to move the ankle freely in its normal range. This can manifest as difficulty in pointing toes upwards (dorsiflexion) or downwards (plantarflexion).
• Pain or Discomfort: Stiffness is often accompanied by varying levels of pain, from mild discomfort to intense, sharp pain, particularly during movement or after periods of inactivity.
• Swelling: In many cases, the affected ankle might appear swollen due to inflammation or fluid buildup around the joint.
• Tightness or Rigidity: A feeling of tightness or a “locked” sensation in the ankle joint, making it hard to flex or extend the foot.
• Difficulty in Performing Daily Activities: Routine tasks such as walking, climbing stairs, or even standing for long periods can become challenging due to stiffness and pain.

Why is ankle mobility important?

Ankle dorsiflexion mobility is crucial for almost anything that we do when our feet are on the ground. Dorsiflexion is crucial for a number of day-to-day tasks, from walking, getting out of a chair, to going up and down stairs.
During the walking cycle, dorsiflexion is critical for the mid-stance phase when the opposite leg is swinging through. Without enough dorsiflexion, more force and stress is placed on other structures, including the hip and knee, due to the compensation pattern.

How to assess for ankle stiffness?

In order to perform the test, set yourself up in front of a wall. The aim is to assess the maximum distance between the wall and your toes when you lunge forwards, allowing your knee to touch the wall. Record the distance on one side and compare the difference between left and right. Whilst ankle flexibility may vary from person to person, the distance should be within 10% of left and right.

Additionally, depending where you feel it on the knee to wall can be a good indication of what may be restricting your ankle flexibility. If you feel mainly restricted at the back of the ankle, it is likely that muscles are restricting your ankle flexibility. If you notice it mainly at the front or middle of the ankle, it is likely that your ankle stiffness is related to either the joint or the bone.

Physiotherapy for Ankle Stiffness

Physiotherapists often recommend a variety of exercises aimed at improving ankle mobility and flexibility, reducing stiffness, and alleviating pain. These may include:

• Range-of-Motion Exercises: These involve gentle movements of the ankle to its full range, such as ankle circles, heel-toe walks, and calf stretches.
• Stretching: Regular stretching of the calf muscles, Achilles tendon, and the anterior part of the ankle can significantly improve flexibility and relieve stiffness.
• Strengthening Exercises: Building strength in the muscles surrounding the ankle, such as using resistance bands for dorsiflexion and plantarflexion, can enhance stability and reduce the likelihood of future stiffness.

Engaging in these exercises consistently is crucial for optimal results. Patient-specific modifications might be necessary, depending on the severity and underlying cause of the stiffness.

When to See a Physiotherapist for a Stiff Ankle

Most cases of ankle stiffness respond well to self-care and exercise. However, it’s important to seek professional assessment if:

• Pain persists for more than a few days without improvement
• Swelling is significant or getting worse
• You are unable to put weight through the ankle comfortably
• Stiffness is affecting your ability to walk, work, or exercise
• You have previously had an ankle sprain or fracture that was not fully rehabilitated

A physiotherapist can assess what structure is limiting your mobility, whether that’s muscle tightness, joint stiffness, or a bony restriction, and tailor a treatment plan accordingly. Early intervention tends to lead to faster and more complete recovery.

Exercises for a Stiff Ankle

These exercises are designed to gradually restore movement to a stiff ankle. They should not cause sharp pain. If any exercise increases your symptoms, stop and consult your physiotherapist.

Exercise 1: Calf stretch (step)

Stand with your toes on the edge of a step, holding onto a wall or rail for support. Slowly lower both heels downward. You should feel a stretch through the back of the lower leg. Hold for 30 seconds and repeat 5 times.

Exercise 2: Ankle dorsiflexion stretch with a towel

Sit on a chair or the floor. Place a towel under the ball of your foot and gently pull your toes toward you. Hold the stretch for a few seconds, feeling the pull through the back of your calf. Repeat 10 times.

Exercise 3: Ankle circles

Sit with your legs straight in front of you. Rotate your foot in a slow, controlled circle. Complete 10 rotations in each direction. This helps restore the full range of motion to the ankle joint.

Exercise 4: Ankle alphabet

Lying down or seated, lift your foot slightly off the floor. Use your toes and ankle to trace each letter of the alphabet. Keep movements controlled and deliberate. The variety of motion works the ankle in all directions.

Exercise 5: Passive inversion stretch

Seated in a chair, cross your affected foot over your opposite thigh. Gently hold your foot and pull it inward and upward. Hold briefly and repeat 10 times. This targets the outer structures of the ankle that often become restricted after injury.

These exercises are adapted from evidence-based physiotherapy guidelines. If you are unsure whether any of these exercises are appropriate for your condition, speak with one of our physiotherapists before starting.

Managing Ankle Pain at Home

Alongside exercises, the following self-care strategies can help reduce symptoms while your ankle recovers:

• Rest: Avoid activities that aggravate your ankle, particularly high-impact exercise, while symptoms are present.
• Ice: Apply an ice pack wrapped in a cloth to the ankle for 15 minutes at a time, a few times a day, to help reduce swelling and pain.
• Compression: A light compression bandage can help manage swelling. Make sure it is firm but not restrictive.
• Elevation: Where possible, rest with your ankle raised above the level of your heart to reduce fluid build-up around the joint.

Over-the-counter anti-inflammatory medications such as ibuprofen can also assist with short-term pain management. If pain is severe or persistent, a healthcare provider may consider corticosteroid injections or other interventions.

How Do Personalised Therapy Plans Improve Treatment Outcomes?

Personalised therapy plans are tailored to meet the specific needs of each patient, taking into consideration factors like the severity of stiffness, underlying causes, overall health, and lifestyle. Benefits include:

• Targeted Interventions: Customised plans address the unique aspects of each patient’s condition, leading to more effective and quicker relief.
• Patient Compliance and Engagement: Personalised plans are often more aligned with a patient’s lifestyle and capabilities, making adherence easier and more consistent.
• Continual Assessment and Adjustment: Physiotherapists can constantly monitor progress and make adjustments to the treatment plan as necessary, ensuring that the therapy remains effective throughout the recovery process.

If you are experiencing a stiff ankle, be sure to see your physiotherapist. Book online or call our friendly team today.

FAQ

What is ankle stiffness?

Ankle stiffness refers to the limited mobility and flexibility in the ankle joint, often accompanied by pain and a feeling of tightness.

How long does it typically take to recover from ankle stiffness?

Recovery time varies depending on the cause and treatment methods but can range from a few weeks to several months. Consistent treatment and physiotherapy significantly speed up recovery.

What are the common causes of ankle stiffness?

Common causes include injuries such as sprains or fractures, arthritis, tendonitis, morning stiffness, overuse from physical activities, or post-surgical recovery.

Are there preventive measures to avoid ankle stiffness after an injury?

Preventive measures include following recommended rehabilitation exercises, wearing proper footwear, avoiding overexertion, and ensuring ample rest and recovery time for the injured ankle.