Ankle Synovitis and Ankle Joint Effusion
What is Ankle Synovitis? Discover correct prevention, treatment and recovery strategies, plus strength exercises and ankle stretches.
by Brad Walker | Updated February 14, 2023
Ankle Synovitis (also known as Ankle Joint Effusion) is an injury to the synovial membrane in the ankle. It is an inflammation of the synovium that causes pain and swelling.
This inflammation can result in excess fluid leaking into the joint, which can result in a blockage of nutrients to the surrounding surfaces, a degradation of the cartilage, and instability in the joint. The inflammation may also result in swelling of the membrane placing extra pressure on the surfaces of the joint.
What Causes Ankle Synovitis?
The ankle joint is susceptible to many injuries, including ankle sprains, fractures and arthritic conditions. Athletes, who commonly make quick direction changes or run on uneven surfaces, are at a higher risk for ankle injuries.
Ankle synovitis can be caused by prior injuries to the joint, such as sprains or fractures. These injuries may result in acute damage directly to the synovial membrane, or they could cause an imbalance or misalignment of the bones leading to a chronic condition. Chronic imbalance or misalignment issues can also cause irritation to the synovium.
Ankle synovitis can also be caused by an infection, either bacterial or viral, in the area. Rheumatoid arthritis or gout may lead to synovitis.
Reduced strength or muscular imbalances are also potential causes for injuries to the synovial membrane.
Anatomy of the Ankle Joint
The ankle joint consists of the distal end of the tibia and fibula, and the proximal end of the talus. These bones are held together by several strong, fibrous ligaments. The ends of the bones are protected by cartilage and the space in the joint is protected and cushioned by a synovial membrane. This is why the ankle is considered a synovial joint.
The ankle joint is surrounded by a synovial membrane that cushions and protects the bone ends. This membrane provides cushion and lubrication for the joint. Although the ends of the bones are covered with cartilage, the synovial membrane cushions the open space, keeping the bone ends separated just enough to allow movement. The synovial fluid also provides lubrication to the joint, which further protects the bones and reduces friction.
This membrane can become inflamed and cause an increase in the fluid inside the cavity (joint swelling), causing increased pressure on the structures of the joint. This may cause an uneven, or excessive, wear to the cartilage at the end of the bones.
Signs and Symptoms of Ankle Synovitis
This condition may be accompanied by pain and heat in the ankle joint. The pain may range from mild aching to a sharp burning pain.
Swelling and inflammation deep in the ankle joint may also be associated with ankle synovitis. It may or may not be visible on the exterior of the joint.
A reduced range of motion and loss of function may occur, depending on the degree of pain and inflammation involved. When excess fluid is released into the joint, or severe swelling occurs within the synovium, a tightness may be felt in the joint itself, further reducing range of motion.
Treatment and Recovery
Rest, ice and NSAIDs will help reduce the inflammation and reduce stress on the synovial membrane. Corticosteroid injections and a walking cast (or boot) may be necessary for more severe injury.
Heat may be used later to improve function and reduce stiffness within the joint, but avoid using heat in the initial stages of treatment.
A correction of the condition that caused the inflammation will also be required to prevent it from occurring again. This may require intervention by a physical therapist or sports medicine professional. Orthotic devices might help correct imbalances and structural issues within the foot. This condition will usually respond within 3 to 6 weeks of treatment.
Preventing Ankle Synovitis
Prevention for ankle synovitis itself may be difficult due to the secondary nature of this injury, but avoiding the injuries or disease processes that can lead to this condition will help reduce the likelihood of developing synovitis.
- A proper warm-up will help prepare the muscles and joints for any activity they might be called upon to complete. This helps reduce the effects of any existing muscle imbalances and prepares the muscles to support and protect the joints during the activity.
- Avoid activities that cause pain. This should be a commonsense rule, but many athletes try to push through the pain hoping it will just go away. Pain is a signal from your body that something is not right, listen to it and avoid those activities until they are pain free.
- Adequate rest between training sessions helps reduce chronic, or overuse injuries. Rest time is when the body repairs and rebuilds previous damage. Without rest time built into a program the muscles, tendons, and ligaments are not given an opportunity to heal.
- Proper nutrition and hydration are also important because the nutrients needed to keep the muscles, bones, and joints healthy come from the foods taken in throughout the day. Water is needed to keep the many processes of metabolism going and to replenish moisture lost through perspiration, respiration, and urination.
- Use of tape or other ankle strapping to protect the injury while playing on uneven surfaces, or during contact sports, may also protect the joint from injury.
- Reversing any conditions that might cause injury to the synovium is also important for prevention. Correcting muscle imbalances and structural abnormalities will reduce the stress on the joint and synovial membrane, which will help reduce injuries.
- Increasing overall strength helps provide a protective support system for the bones and joints, by strengthening the muscles and tendons.
- Improving flexibility allows the joints to go through a larger range of motion without incurring injuries. It also improves the ability of the muscles to contract and protect in those extended ranges.
Leaning Heel-Back Calf Stretch (1:19) Stand upright and lean against a wall. Place one foot as far from the wall as is comfortable and make sure that both toes are facing forward and your heel is on the ground. Keep your back leg straight and lean towards the wall. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Leaning Heel-Back Achilles Stretch (1:17) Stand upright while leaning against a wall and place one foot behind the other. Make sure that both toes are facing forward and your heel is on the ground. Bend your back leg and lean towards the wall. Make sure the toes of your back leg are facing forward. Letting your toes point to one side will cause this stretch to put uneven tension on the calf muscles. Over an extended period of time, this could lead to a muscle imbalance. Regulate the intensity of this stretch by lowering your body. Hold the stretch position for a minimum of 20 seconds and then repeat with the opposite leg.
Research and References
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Franson, J. Baravarian, B. (2011). Lateral Ankle Triad: The Triple Injury of Ankle Synovitis, Lateral Ankle Instability, and Peroneal Tendon Tear. Clinics in Podiatric Medicine and Surgery, 28(1): 105-115.
- Martini, F. Tallitsch, R. Nath, J. (2009) Human Anatomy, 9th Edition (ISBN: 978-013432076X)
- Porter, D. Schon, L. (2008). The Foot and Ankle in Sport, 2nd Edition (ISBN: 978-0323023580)
- Thein, R. Eichenblat, M. (1992). Arthroscopic treatment of sports-related synovitis of the ankle. The American Journal of Sports Medicine, 20(5): 496-498.
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Wikipedia contributors. (2021, March 29). Synovitis, In Wikipedia, The Free Encyclopedia.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.
