Common causes of stiff ankles in the morning

You know how frustrating it can be if you are one of the many people who experience stiff ankles in the morning. It can make it difficult to get out of bed to start the day, and the stiffness often lasts several hours. While there are many potential causes of stiffness of the ankles in the mornings, some of the most common include osteoarthritis, rheumatoid arthritis, tendonitis, oedema, trauma, medications and gout. We will discuss these in a little more detail below and give you some prevention strategies and treatment options to consider. Read on to find out more!

Osteoarthritis

Osteoarthritis is one of the most common causes of morning stiffness in the ankle joints, especially in older adults. According to Goldring and Barenbaum (2015), it’s a degenerative joint condition that can affect any joint in the body but is particularly common in weight-bearing joints such as the hips, knees and ankles. Osteoarthritis occurs when the cartilage that cushions and protects the ends of the bones breaks down, causing the bones to rub against each other (1).

It can lead to pain, inflammation and stiffness, particularly in the mornings when the joints have been at rest all night. It is to be noted that athletes and those individuals whose occupation involves carrying heavy loads are at risk for developing osteoarthritis. Treatment for osteoarthritis often includes pain relief medication, physiotherapy (physical therapy if you are not from the British commonwealth) and exercise.

Rheumatoid arthritis

Rheumatoid arthritis (RA) is another type of arthritis that can cause morning stiffness in the ankles and other joints. Hitchon and El-Gabalawy (2011) believe that rheumatoid arthritis is an autoimmune disease, which means the body attacks itself. In the case of rheumatoid arthritis, the immune system attacks the tissues that line the joints (synovium), causing them to become inflamed and, if left untreated, can lead to irreversible damage (2).

Morning stiffness associated with rheumatoid arthritis often lasts for more than an hour. It is usually worse on waking up or after a period of rest. Other symptoms of rheumatoid arthritis can include fatigue, weight loss and fever. Treatment for rheumatoid arthritis often includes medication such as methotrexate, disease-modifying anti-rheumatic drugs (DMARDs) and biologics, as well as physiotherapy and occupational therapy.

Tendonitis

Tendonitis is another common cause of morning stiffness in the ankles. It is an inflammation of the tendons, the tough fibres that attach muscle to bone – injury results from overuse of the tendon. The most common type of tendonitis affecting the ankle is Achilles tendonitis, an inflammation of the tendon that attaches the calf muscle to the heel bone.

Other types of tendonitis that can affect the ankle include peroneal tendonitis and tibialis posterior tendonitis. The flexor hallucis lungus, flexor digitorium longus, extensor hallucis lungus and tibialis anterior tendons also cross the ankle and, although not very common, can also cause tendonitis. Treatment for tendonitis may include rest, ice, compression, elevation (RICE), physiotherapy, anti-inflammatory medication and footwear change.

Oedema

Oedema is a condition characterised by the buildup of fluid in the tissues. It can happen for various reasons, such as heart failure, liver failure, kidney disease or even simply standing or sitting in one position for too long. When this excess fluid accumulates in the lower limbs, it is called peripheral oedema. It can cause morning ankle stiffness due to the extra weight and pressure on the joints.

Treatment for oedema often includes elevating the affected limb when possible and wearing compression stockings and diuretics medication. More aggressive treatment may be necessary if the underlying cause is serious, such as heart or liver failure.

Trauma

Trauma to the ankle joint can predispose the ankle to morning stiffness. It can be due to a direct blow to the ankle or an ankle injury such as a sprain or fracture. Morning stiffness associated with trauma is usually accompanied by pain, swelling and bruising. The trauma does not have to be acute. Those who have had a long-standing injury that is not fully healed can experience stiff ankles in the morning due to the constantly occurring inflammation.

Treatment for trauma-related ankle stiffness depends on the severity of the injury. However, it can include RICE, medications, physiotherapy, orthotics, steroids injection or surgery.

Medications

Certain medications can also lead to morning stiffness in the ankles. These include beta-blockers, which are often used to treat high blood pressure and heart conditions but can cause inflammation in the joints. Calcium channel blockers can cause swelling of the ankle leading to stiffness. Additionally, statins, used to lower cholesterol levels, can also cause joint pain and morning stiffness. Other medications that can have this side effect include lithium, interferon and some cancer treatments.

If you are on medication and experience morning stiffness in your ankles, it is advisable to speak to your clinician about alternative options before you stop taking them.

Gout

Gout is a form of arthritis caused by the buildup of uric acid in the blood. It can lead to the formation of crystals in the joints, which causes inflammation and pain. The big toe is the most common joint affected by gout, but it can also affect the ankles. Morning stiffness is often one of the first symptoms of gout. Other symptoms include redness, warmth, swelling and intense joint pain.

Treatment for gout often includes non-steroidal anti-inflammatory drugs (NSAIDs), colchicines and possibly steroids. If these don’t work, other options for long-term management may consist of allopurinol or febuxostat. Surgery is rarely ever needed.

Ankylosing spondylitis

Ankylosing spondylitis (AS) is a type of arthritis that primarily affects the spine. It can also affect the peripheral joints, such as the ankles. Garcia Montaoya et al (2018) believe that AS is a chronic inflammatory condition that can lead to the fusion of the vertebrae in the spine. Morning stiffness is often one of the first symptoms of AS due to the inflammation of the joints. Other symptoms include pain and stiffness in the lower back and buttocks, fatigue and weight loss. It also causes inflammation at the point where tendons insert (enthesitis) (3).

Treatment for AS usually includes NSAIDs, disease-modifying anti-rheumatic drugs (DMARDs) or biologics. Physiotherapy can also help relieve pain and morning stiffness. In some cases, surgery may be necessary if the AS has progressed to a point where it is causing severe deformity or pain.

Scar tissue

Scar tissue can form in or around the ankle joint after an injury or surgery. Velasco et al (2020) suggested that If it’s caused by surgery, it is called arthrofibrosis. It can lead to morning stiffness due to the restriction of movement caused by scar tissue. Morning stiffness associated with scar tissue is often accompanied by pain and swelling(4).

Treatment for scar tissue-related ankle stiffness includes physiotherapy, massage, range of motion exercises and, although counterintuitive, possibly surgery. This option will have to be carefully considered, especially if it was caused by surgery in the first place.

High BMI

Lastly, a high body mass index (BMI) or being overweight is a risk factor for developing morning stiffness in the ankles. Carrying excess weight adds stress or trauma to the joints, especially the ankles.

If you are overweight or obese, losing weight may help reduce the risk of developing or getting morning stiffness in your ankles, along with other health benefits.

Prognosis

In most cases, morning stiffness in the ankles is not a serious medical condition. By making a few changes to your lifestyle, you can have good clinical outcomes. However, if the condition is severe and does not improve with self-care, it is essential to see a doctor as it may be a sign of something more serious. A doctor will be able to give you an ankle diagnosis and recommend the best course of treatment.

FAQs and answers

1. How can you prevent stiff ankles in the morning from happening again?

A few things can be done to help prevent stiff ankles in the morning. First, try to maintain a healthy weight. Excess weight puts extra stress on the joints, which can lead to stiffness and pain. Second, exercise regularly. This will help to keep the joints flexible and strong. Finally, make sure to warm up before participating in any physical activity. Warming up helps to increase blood flow to the muscles and joints, which helps prevent injury.

2. Are there any remedies or treatments for stiff ankles in the morning that don’t require medication or surgery?

Yes! Firstly, try applying ice to the area for 20 minutes several times a day. It will help to reduce inflammation and pain. Secondly, try a hot bath or a heating pad on the affected area. This will help to increase blood flow and relax the muscles. Finally, stretch the ankle joint before getting out of bed in the morning. Stretching helps to increase flexibility and range of motion.

3. I’ve been having morning stiffness in my ankles for a while now. Should I be worried?

If it’s been going on for more than a few days, it is vital that you see a doctor. While morning stiffness is usually not serious, it can be a sign of an underlying condition that needs addressing. A doctor will be able to give you a diagnosis and recommend the best course of treatment.

4. I’m pregnant, and I’ve been having morning stiffness in my ankles. Is this normal?

It is not uncommon for women to experience morning stiffness during pregnancy. This is due to the added weight and stress on the joints from the pregnancy. If the morning stiffness is severe or does not improve with self-care, see your care provider for help.

5. When should you see a doctor about your stiff ankle problem, and what will they do to help you resolve it?

You should see a doctor if the morning stiffness is severe or does not improve with self-care.

Thanks for reading! We hope this article has helped you better understand what might be causing your stiff ankles in the morning and how you can resolve the issue. Remember, your health is your wealth! So always seek help!

References

1. Goldring, M. and Berenbaum, F. (2015). Emerging Targets in Osteoarthritis Therapy. Current opinion in pharmacology. 22(1), pp.51-63. [Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4470796/ [Accessed 17 September 2022].

2. Hitchon, C. and El-Gabalawy, H. (2011). The Synovium in Rheumatoid Arthritis. Open rheumatology journal. 5(1), pp.107-114. [Online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3263474/ [Accessed 17 September 2022].

3. Garcia-Montoya, I., et al. (2018). Recent advances in ankylosing spondylitis: understanding the disease and management options. F1000Research. 7(1), pp.1-11. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173104/[Online] [Accessed 17 September 2022].

4. Valasco, B. and Patel, S. (2020). Arthrofibrosis of the Ankle. Foot & Ankle Orthopaedics. 5(4). Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257355/ [Accessed 17 September 2022].