Why do both ankles ache at night?

by Paula
(Littleton, CO US)

When I sleep at night, both ankles ache like a toothache. My left heel is stiff in the am, but after walking a few minutes it seems fine. I sleep on my stomach and find myself being woken up several times a night with my ankles aching like a toothache. The feeling goes away after getting up. I am 49, 5'-6" and weight 130. I jog, walk, do aerobics and am pretty active. I have taken 3 weeks off at Christmas time to rest my body. The ankle aches never went away, although the aching heels have diminished. There is no swelling, redness, or anything visual to see. I stretch and do feel as though the front of my ankle needs to be cracked to relieve pressure. Sometimes it does crack when I stretch my toes up and feel relief. The ankle aches are the biggest problem.

RESPONSE

Hi Paula,

On the surface, based on your narrative, it sounds mainly like some arthritis within the ankle joint itself. The fact that both ankles are bothering you also leads me to believe it nothing more serious than arthritis.
You say you are active, you exercise. Well, depending on how active you are, you could be over using the ankle joint so at night they begin to ache. This happens quite often. The pain is not necessarily present during your active day, but after an active day, a body part may begin to ache.
The simplest problem could be simply arthritic degeneration within the ankle mortise (joint) itself. You are in the age range where this could be happening, however, when it comes to the ankle joint, other considerations need to be taken into account.
For example, the way your foot lines up relative to the lower leg, thus forming the ankle joint, can have a bearing on whether or not the ankle joint begins to wear down sooner rather than later.
What I mean by this is if your foot over pronates (flattens out too much) or even supinates (excessive arch height), these two situations may create an abnormal alignment within the ankle joint. This abnormal alignment will cause an erosion of the ankle function, as the foot does not move through the ankle range of motion as well as it should. It is the equivalent of driving with unbalanced tires. What happens? The tires wear out prematurely.
The same thing can happen in the ankle joint. If there is over pronation or supination, the joint will not function properly and there will be pain, particularly in active individuals. I see this a lot in active people.
So what do you do? My advice would be to see a foot specialist in your community, have an x-ray of both ankles to make sure there is no arthritic changes within the ankle joints themselves. Assuming the x-rays show no ankle pathology, I would then recommend you have your gait analyzed to see if you exhibit excessive pronation or supination. If that turns out to be the case, this type of problem can usually be treated with an orthotic device within your shoes. One type of orthotic will help reduce pronation (overflattening of feet) and another type will help absorb shock which can be very helpful in treating people with high arches, that supinate.

Marc Mitnick DPM
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