Ankle joint

Anatomy: upper and lower ankle joint

The ankle joint consists of two functional units. The upper ankle joint (OSG) forms a hinge between the shinbone (tibia), fibula and ankle bone (talus). It primarily controls the flexion and extension of the foot. The lower ankle joint (USG) is formed by the talus and heel bone (calcaneus) as well as other articular surfaces and enables inward and outward tilting movements of the foot - important for walking on uneven surfaces.

• Ligaments: Outer ligament complex (anterior and posterior talofibular ligament, calcaneofibular ligament), inner ligament (deltoid ligament), syndesmosis between tibia and fibula
• Cartilage: smooth joint surfaces on the talus and tibia/fibula for low-friction movement
• Tendons: etc. Peroneal tendons (outer side), tibialis posterior tendon (inside), Achilles tendon (heel) - they stabilize and move
• Soft tissues: capsule, bursa, fat bodies and the structures of the sinus tarsi

The balance between bony guidance, ligament stability, muscle strength and sensorimotor control (proprioception) determines resilience and susceptibility to injury.

Typical ankle symptoms

Complaints vary depending on the structure. After twisting an ankle, acute pain, swelling and bruising dominate; In the case of chronic overload, start-up pain, pain under strain and feelings of instability are often typical.

• Pain externally (often ligaments/peroneal tendons) or internally (inner ligament/tibialis posterior tendon)
• Swelling, warmth, bruising after trauma
• Feeling of “bending away”, insecurity when changing direction quickly
• Cracking/rubbing, feeling of blockage (indication of impingement or loose joint body)
• Stress-dependent pain on hard surfaces, pain going down stairs
• Morning stiffness or pain at rest (e.g. in osteoarthritis, inflammatory diseases)

Illnesses and symptoms – an overview of your subtopics

The following categories lead to more in-depth pages. There you will find causes, typical symptoms, diagnostics and treatment options in detail.

• Ligament injuries/instabilities: from ligament stretching to tearing, recurring twisting, chronic instability – see “ligament injuries/instabilities” subpage.
• Joint/cartilage: Cartilage damage to the talus (OCD), loose joint bodies, osteoarthritis of the OSG/USG, impingement – ​​see “Joint/Cartilage”.
• Bone/Structure: Fractures, stress reactions, axial deviations, bony impingements – see “Bones/Structure”.
• Muscles, tendons, ligaments, soft tissues: Peroneal tendon syndrome, tibialis posterior dysfunction, Achilles tendon suture, bursa - see “Muscles, tendons, ligaments, soft tissues”.
• Soft tissues/bursa: Bursitis, irritation in the sinus tarsi, capsule thickening – see “Soft tissues/bursa”.
• Loading, incorrect loading, overloading: Running volumes, footwear, need for insoles, training errors – see “Loading, incorrect loading, overloading”.
• Trauma: acute twisting event, syndesmosis injury, bone bruise – see “Trauma”.
• Systemic / rheumatic: e.g. E.g. rheumatoid arthritis, psoriatic arthritis, gout – see “Systemic / rheumatic”.
• Functional / chronic pain syndromes: long-lasting symptoms without clear structural changes, risk of CRPS - see “Functional / chronic pain syndromes”.

First aid for twisting an ankle: What you can do yourself

In the case of a recent twist, the focus is on controlling the swelling. The PECH rule has proven itself - but it does not replace medical evaluation in the event of severe symptoms or suspected fracture.

• Avoid in the first 48 hours: heat, intensive stretching/massaging, alcohol.
• If there is significant instability or inability to bear weight: get medically examined.

Diagnostics in our practice in Hamburg

In the orthopedics department at Dorotheenstrasse 48, 22301 Hamburg, we clarify ankle joint problems in a structured manner. The aim is to identify the affected structure and realistically assess its resilience - the basis for an individual therapy plan.

• Medical history: course of the accident, previous illnesses, sports profile, shoes/insoles, previous therapies.
• Clinical examination: inspection, palpation, stability tests (e.g. anterior drawer, Talartilt), neurovascular control.
• Sonography: dynamic assessment of ligaments/tendons, evidence of effusion.
• X-ray: if fracture, bony impingement, signs of osteoarthritis are suspected.
• MRI: in case of unclear findings, cartilage damage (OCD), bone marrow edema, syndesmotic lesions.
• Functional diagnostics: gait and stance analysis, ankle joint mobility, orthotics check if necessary.

Note: We make the decision to have an X-ray based on the clinical examination and established criteria (e.g. Ottawa Ankle Rules: tenderness over malleoli or inability to walk 4 steps).

Conservative therapy: first exploit the potential

In conservative orthopedics, the focus is on reducing swelling, controlling pain, restoring stability and safely returning to everyday life and sport. The plan is customized based on diagnosis, severity, and your activity profile.

• Immobilization/protection: functional orthoses or tape for early, guided mobilization; Short-term relief with forearm crutches as needed.
• Medication: anti-inflammatory painkillers for a limited time and according to the indication; local cold/heat over time.
• Physiotherapy: swelling management, mobilization, strengthening of the peroneal muscles, stretching of the calf muscles, stabilization and proprioception training.
• Manual techniques: soft tissue techniques close to the joints and mobilizations, if appropriate.
• Taping/bandages: for short-term stability in everyday life/sports.
• Insoles/shoe advice: Correction of the hindfoot axis, cushioning depending on the load, if necessary ankle orthoses for sports with changes of direction.
• Activity adjustment: temporary change to joint-friendly endurance (e.g. cycling/swimming), gradual increase in load.
• Accompanying factors: weight, metabolism, smoking – influence healing and the risk of osteoarthritis.

Regenerative and interventional procedures – with a sense of proportion

In selected situations, additional measures may be considered. We provide you with transparent advice on the data situation, benefits and risks. We do not make a promise of healing.

• Targeted infiltrations: under ultrasound control to irritate the bursa or capsule; only if there is a clear indication.
• PRP (autologous blood plasma): can be considered for certain tendon irritations or early cartilage problems; Study situation heterogeneous, benefits individual.
• Hyaluronic acid on the ankle joint: off-label; can be discussed in individual cases for symptom relief.
• Shock wave therapy: for irritation of the tendon attachment (e.g. heel area) depending on the findings.

We always check conservative basic measures first and weigh costs, expectations and alternatives with you.

Surgical options – when are they really necessary?

Surgery is considered when conservative measures have been exhausted or when acute structural damage (e.g. unstable fractures, severe syndesmosis injuries) requires prompt stabilization. The decision is made individually and after careful information.

• Arthroscopy: Removal of free joint bodies, debridement for impingement, cartilage therapies (e.g. microfracturing) - depending on the defect.
• Ligament reconstruction (e.g. Broström technique) for chronic lateral ligament instability.
• Syndesmosis stabilization in severe injuries.
• Cartilage/bone procedures: e.g. B. Mosaicplasty/OATS for localized defects, on a case-by-case basis.
• Arthrodesis (stiffening) or endoprosthesis at the OSG: in advanced osteoarthritis after conservative exhaustion; strict indication.
• Fracture treatment: anatomical reconstruction and stabilization after an accident.

After surgical procedures, structured rehabilitation and proprioception training are crucial for a good functional outcome.

Prevention: How to protect your ankle in everyday life and sports

• Warm up and activate the calf and foot muscles before exercise.
• Regular balance training (e.g. one-legged stand, wobble board) for proprioception.
• Appropriate footwear with sufficient stability; timely replacement of worn shoes.
• Insoles or rear foot guidance for misalignments – individually adjusted.
• Gradual increase in training volume and intensity; Pauses in case of overload signs.
• Bandage/tape in sports temporarily in case of instability, combined with training.
• Maintain mobility: Practice ankle mobility and calf flexibility regularly.
• Surfaces vary and choose slippery/uneven surfaces carefully.

This is how we support you in Hamburg

Our approach is personal, evidence-based and relevant to everyday life. We clarify your symptoms in a structured manner, prioritize conservative measures and discuss alternatives transparently. In complex cases, we coordinate diagnostics and – if necessary – operational partners.

You can find us at Dorotheenstraße 48, 22301 Hamburg. You can easily request appointments online via Doctolib or by email.