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Why Do Your Ankles Hurt?

Known as chronic lateral ankle pain, the recurring or chronic pain you feel on the outer side of the ankle often develops after an injury such as a sprain. However, several other conditions may also cause chronic ankle pain.

What are the symptoms of chronic lateral ankle pain?

  • Pain, usually on the outer side of the ankle, may be so intense that you have difficulty walking or participating in sports. In some cases, the pain is a constant, dull ache.
  • Difficulty walking on uneven ground or in high heels
  • A feeling of giving way (instability)
  • Swelling
  • Stiffness
  • Tenderness
  • Repeated ankle sprains

What causes chronic lateral ankle pain?

According to ThMISP_Blog_12_No 111690407e American Orthopaedic Foot & Ankle Society, the most common cause for a persistently painful ankle is incomplete healing after an ankle sprain. When you sprain your ankle, the connecting tissue between the bones is stretched or torn. Without thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. As a result, you may experience additional ankle injuries.

Other causes of chronic ankle pain include:

  • An injury to the nerves that pass through the ankle. (The nerves may be stretched, torn, injured by a direct blow or pinched under pressure, known as “entrapment.”
  • A torn or inflamed tendon
  • Arthritis of the ankle joint
  • A fracture in one of the bones that make up the ankle joint
  • An inflammation of the joint lining, called “synovium.”
  • The development of scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, thus putting pressure on the ligaments.

How is chronic lateral ankle pain diagnosed?

The first step in identifying the cause of chronic ankle pain is taking a history of the condition. Your health care provider may ask you several questions, including:

  • Have you previously injured the ankle? If so, when?
  • What kind of treatment did you receive for the injury?
  • How long have you had the pain?
  • Are there times when the pain worsens or disappears?

Because there are so many potential causes for chronic ankle pain, your health care prodider may  need to conduct several tests to pinpoint the diagnosis, beginning with a physical examination. S/he may feel for tender areas and look for signs of swelling, and may have you move your foot and ankle to assess range of motion and flexibility. Your provider may also test the sensation of the nerves, and may administer a shot of local anesthetic to help pinpoint the source of the symptoms.

Your health care provider may also order X-ray views of your ankle joint. If needed, you may also need to get X-rays of the other ankle so the doctor can compare the injured and non-injured ankles. In rare cases, additional tests such as a bone scan, computed tomography (CT) scan or magnetic resonance image (MRI) may be needed.

What are treatment options?

Treatment will depend on the final diagnosis and will be personalized to your individual needs. Both non-operative and surgical treatment methods may be used.

Some conservative treatments include:

  • Anti-inflammatory medications such as aspirin or ibuprofen to reduce swelling
  • Physical therapy, including tilt-board exercises, directed at strengthening the muscles, restoring range of motion and increasing your perception of joint position
  • An ankle brace or other support
  • An injection of a steroid medication
  • In the case of a fracture, immobilization to allow the bone to heal

If your condition requires it, or if conservative treatment doesn’t bring relief, your doctor may recommend surgery. Many surgical procedures can be done on an outpatient basis. Some procedures use arthroscopic techniques; other require open surgery. Rehabilitation may take six to 10 weeks to ensure proper healing. Surgical treatment options include:

  • Removing (excising) loose fragments
  • Cleaning (debriding) the joint or joint surface
  • Repairing or reconstructing the ligaments or transferring tendons

Prevention

Almost half of all people who sprain their ankle once will experience additional ankle sprains and chronic pain. You can help prevent chronic pain from developing by following these simple steps:

  • Follow your doctor’s instructions carefully and complete the prescribed physical rehabilitation program.
  • Do not return to activity until cleared by your physician.
  • When you do return to sports, use an ankle brace rather than taping the ankle. Bracing is more effective than taping in preventing ankle sprains.
  • If you wear high-top shoes, be sure to lace them properly and completely.

Plantar Fasciitis FAQs (Frequently Asked Questions)

plantar fasciitisMaybe you’ve heard of plantar fasciitis. Maybe you have been diagnosed with it. Maybe you’re wondering what your chronic or recurring foot and ankle pain is. Here are a few FAQs regarding Plantar Fasciitis.

Q: What is plantar fasciitis?

A: This is an injury caused by overuse that affects the sole of the foot. The tendon (fascia) that connects the heel bone to the bottom of your toes is typically swollen and tender. Many patients confuse plantar fasciitis with arthritis in the foot, ankle injuries and plantar’s warts, all of which can inhibit walking. Your health care team needs to diagnose plantar fasciitis definitively.

Q: What are the symptoms?

A: The major symptom is pain in the foot and Achilles’ Tendon. Pain tends to be most acute after a period of not moving, so waking up in the morning is particularly tough.

Q: Who is at risk for plantar fasciitis?

A: Being overweight can be a risk factor for plantar fasciitis. Also at risk are people who do a lot of walking or running on hard surfaces (so city dwellers who walk on sidewalks for several miles a day are at risk as are warehouse workers who are on their feet on a hard concrete surface.) The “tightness” of your Achilles’ Tendon also contributes to plantar fasciitis. Finally, foot anomalies like flat feet or high arches can also contribute to many foot issues including plantar fasciitis.

Q: Can plantar fasciitis be treated?

A: Firstly, it’s really important to treat plantar fasciitis, because it typically does not resolve on its own. Patients often curtail their physical activity and unknowingly change their gait to try to compensate for the pain, which can lead to back, knee, leg and hip issues.

Q: What are the treatment options?

A: Physical therapy is actually the most effective and also the most cost effective treatment. Learning the specific stretches to relieve and prevent plantar fasciitis can make an enormous difference. These exercises should be done in the evening and in the morning.

Some patients also find relief from applying ice to the sore area.

Other patients find foot massages to be helpful in reducing pain as well as reducing stress.

In addition, over the counter non-steroidal anti-inflammatory drugs like ibuprofen (Motrin) or naproxen sodium (Aleve) can also provide relief.

Your health care team may also counsel you to change or alter your footwear, particularly if you have high arches or flat feet, so that your sole gets better support.

In serious cases, steroid injections may be advised. In the most serious cases, surgery may be necessary.

Plantar fasciitis can be painful, but it is treatable. Talk to your pain specialist team for a definitive diagnosis and a treatment plan. 

Treating Ankle Pain: Using all of the Tools Available

ankle braceLast week’s blog was about the possible causes of ankle pain and how best to diagnose it.

This week, we will discuss ankle pain treatment. Ankle pain can be treated with various modalities: medication, fracture repair and physical therapy are the most commonly-used tools.

Medications for treating ankle pain include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDS), which can be particularly useful if the underlying condition is arthritis of all forms.
  • Steroid injections into the affected joint is also utilized for arthritic ankles.
  • Pain medications like aspirin, ibuprofen and naproxen sodium can be used, with supervision.
  • Oral steroid medication
  • Specific arthritis medications

Fracture repair typically means one of the following:

  • Splinting and/or bracing a broken ankle.
  • Surgical repair, including the insertion of a metal screw and/or metal plate to fortify a joint that cannot heal on its own. Sometimes ankle fusion is also recommended, although this limits mobility forever, but can be quite effective in lessening chronic pain.
  • Ankle arthroscopy is a less invasive surgery, where a narrow instrument can be utilized to remove small segments of cartilage or bone chips or even to tie or repair a torn ligament.

Physical Therapy to Combat Ankle Pain is really important. Your ankles bear the weight of your body and their appropriate, relatively pain-free functioning is the key to lifetime mobility.

Typical physical therapy regimens will work to

  • Strengthen the ankle joint,
  • Strengthen the muscles that support the functioning of the ankle
  • Increase the range of motion
  • Increase flexibility
  • Decrease pain

Ankle pain can be debilitating. A proper diagnosis of the cause and a multifaceted approach to easing pain including medication, surgical options (as a last resort) and physical therapy can be a very effective combination.

Why Do My Ankles Hurt?

ankleAnkle pain is not unusual. Some people perceive that they have “weak ankles” and are prone to twists and sprains. Others notice a gradual change in their ankle pain and functioning.

The ankle is actually a complex joint between three bones: the tibia, the fibula and the talus with bands of ligaments that connect the bones.

In addition to the bones and the ligaments, several tendons traverse the ankle. The tendons connect the muscles of the lower long to the ankle and foot bones. The most famous of these tendons is the Achilles tendon.

It’s important for your health care team to diagnose the cause of ankle pain accurately. Some typical causes of ankle pain include:

  • Sprains, which occur when ligaments are overstretched typically as a result of an injury or fall, often a missed step.
  • Broken ankles: these fractures are actually quite common, again, usually the result of a fall or missed step, sports injury or traumatic event like a car accident.
  • Rheumatoid arthritis affects the synovium, which lines the joints, causing pain, swelling and immobility. Most people with rheumatoid arthritis have ankle issues.
  • Osteoarthritis, which contributes to a deterioration of the cartilage in the joints. As this cartilage wears away, the bones rub against one another, and can cause pain, swelling and immobility.
  • Gout is another type of arthritis which can affect the joints and is caused by a buildup of uric acid throughout the joints of the body.
  • Lupus, an autoimmune disease, often affects many joints, Although many forms of arthritis and related conditions can affect the ankles, the most common cause of ankle pain is a sprain. A sprain occurs when the ligaments that support the ankle become stretched or torn. Here is what you need to know about sprained ankles and some other common ankle injuries.

Your health care team will evaluate your pain, your mobility and the circumstances that surrounded your ankle issues. They will then order a series of exams including x-rays and perhaps other diagnostic tools to determine their next steps. It is very important for a physician to distinguish between sprains and fractures of ankles because they often present themselves in a similar fashion.

Next week: Recovery from ankle pain

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