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Ankle Pain

Innovation Podiatry  >  Conditions  >  Ankle Pain

Common ankle pain conditions, symptoms and treatments are outlined below.

Peroneal Tendinopathy (click to open/close)

Overview

With peroneal tendinopathy, you may experience pain around the lateral malleolus (outer ankle bone) and/or along the outside border of the foot. This pain usually increases with activity and reduces with rest, and can occur when turning the foot in or out. Ankle instability and swelling may also be present.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programmes that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

The main principle of treating tendinopathies is to reduce the load on the tendon and increase the ability of the tendon to tolerate load. Shockwave therapy, dry needling and western medical acupuncture can all help, as can strapping – which can help temporarily reduce the load on the tendon and may be enough to help pain settle.
Other treatment options include:

  • Relative rest and activity modification
  • Footwear advice
  • Rehabilitation exercises to progressively load the tendon
  • Foot orthotics if there are biomechanical factors that need addressing moving forward.
Ankle sprain

Overview

Ankle sprains are very common injuries that often occur during vigorous sporting and physical activities, as well from trips, falls and uneven ground. In most cases, an ‘inversion’ sprain occurs, where the foot rolls forcibly inwards. In this scenario, damage occurs to the ligaments on the outside of the ankle. You may hear or feel a ‘pop’, followed soon after by pain, bruising and swelling.

The mechanism of injury can determine the different signs and symptoms that may be displayed after an ankle sprain. The mechanism of injury is the way in which the injury was sustained.

  • Lateral ankle sprain: This happens when turning the toes in while pointing them down (usually from inversion with plantarflexion) leading to injury of the ligaments on the outside of the ankle. With this sort of injury the signs and symptoms are:
    • Potential significant swelling within 2 hours because of the rich blood supply.
    • Tender to the touch over the outside ankle ligaments, bruising that drains into the foot.
    • Different levels of instability (depending on grade of the sprain).
    • Positive tests for ligament laxity of your outside ankle ligaments.
    • X-ray shows no signs of fracture.
  • Medial ankle sprain: This happens when turning the toes out while pointing them up (usually from eversion with dorsiflexion)  leading to injury of the ligaments on the medial side of the ankle.  Because the ligament here (deltoid ligament) is very strong, this injury is rarer and can take up to twice as long to heal than lateral sprains.  It is also often associated with fractures of the fibula or other bones in the ankle (medial malleolus, talar dome, articular surfaces). With this sort of injury the signs and symptoms are:
    • Tender to the touch over the inside ankle ligament.
    • Bruising and swelling along the medial side of the ankle
    • Positive test for ligament laxity of the inside ankle ligament.
    • X-ray needed to rule out avulsion fracture (bone fragment pulled away from the bone) or fracture of the inside ankle bone, or top of the ankle.
  • Syndesmotic sprain: Injury to the front and/or back lower ligaments of the ankle. This often occurs from hyperdorsiflexion (pointing the toes up too far) and eversion (pointing the toes out). With this sort of injury the signs and symptoms are:
    • Positive tests for front/back ligament laxity and severe swelling (possibly fracture) in the lower leg
    • Pain and swelling over the front/back ligaments and the lower leg space.
    • Specific X-ray may show abnormal joint space in the lower leg.
    • Recovery time is longer compared to other sprains.
    • Need to rule out fracture and avulsion.

Ankle sprains are graded from Grade 1 (mild) through Grade 2 (partial ligament tear) to Grade 3 (complete tear and joint instability). To diagnose and gauge the severity of an ankle sprain, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programmes that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

This will vary according to severity/grade of sprain. With milder Grade 1 sprains, you may be able to return to activity within a few days, with the help of a brace or strapping. Grade 2 sprains may take closer to 2-3 months before strength and stability is regained. Grade 3 sprains may require some form of immobilization lasting several weeks, with recovery taking as long as 4 months.

Once your injury has been graded, we will discuss with you the best plan of treatment. This may involve a combination of a walker boot (moonboot), ice, rest, strapping and padding, western medical acupuncture/dry needling, shockwave therapy, supportive footwear and orthotics. An exercise programme to restore strength and balance is particularly important with ankle sprains, and will also reduce the likelihood of chronic ankle instability and recurrent sprains.

Coming Soon: 

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).
Sinus tarsi syndrome

Overview

The sinus tarsi is a canal type structure on the outside of the ankle. The structures within the sinus tarsi can become damaged or compressed with acute ankle sprains. If this occurs, you may experience:

  • Pain at the lateral (outside) ankle, which is aggravated by weight-bearing activity
  • Swelling
  • Feeling of instability
  • Increased pain on uneven ground.

To identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programmes that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.) which will also rule out differential diagnoses.

Treatment

A number of treatments and solutions may be used to help overcome this condition, including:

  • Activity modification if acutely irritated
  • Temporary strapping and/or brace
  • Supportive footwear
  • Foot orthoses to stabilise the rear-foot and reduce pronation will help reduce compression forces at the sinus tarsi.

If symptoms remain, we may refer on for guided injection of local anaesthetic into the sinus tarsi or to our orthopaedic colleagues for discussions around other exploratory surgery.

Posterior tibial tendon dysfunction

Overview

Tendonitis in the foot is a common problem because we use our feet continuously. It is a common example of an overuse injury. One of the most frequently affected tendons is the posterior tibial tendon, a structure that is normally hard at work, helping to hold the arch up and prevent over-pronation or rolling in of the foot.

The symptoms of tendonitis of the posterior tibial tendon include pain in the instep area of the foot and swelling along the course of the tendon. You may also experience pain and swelling right behind the inner ankle bone. There may also be burning, shooting, tingling, stabbing pain, because the nerve is inflamed inside the tarsal tunnel.

You may experience significant pain:

  • When walking, steadily worsening toward the end of the day
  • When inverting the foot
  • Upon passive stretching of the posterior tibial tendon
  • On eversion or flattening of the foot.

In some cases, the tendon may actually rupture or tear due to weakening of the tendon by the inflammatory process. Rupture of the tendon leads to a fairly pronounced flatfoot deformity that is easily recognisable.

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Once confirmed through a series of tests with your podiatrist, the following treatments may help. When the foot is acutely painful:

  • Rest and ice
  • Non-steroidal anti-inflammatory drugs like Advil are recommended, and
  • A compressive dressing may be applied.

Once the pain has eased, you may also need:

  • A custom orthoses or brace fitted to help immobilise the foot during the rehabilitation period
  • Special shoes with external additions to the heel side (i.e. medial heel wedge) to support the foot and prevent arch collapse
  • A custom foot orthotic based on the flexibility of the foot.

If the condition becomes severe and chronic, or the tendon has ruptured, surgery may be required.

Haglund's Deformity and Retrocalcaneal Exostoses

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

Tarsal Coalition

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

Accessory Bones

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

Ankle Osteoarthritis

Overview

To read about Osteoarthritis click here

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

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Sural Nerve Entrapment

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

Charcot Neuropathy of the Ankle

Overview

Click Here 

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

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Anterior Ankle Impingement

Overview

Coming Soon

To diagnose this condition and identify the painful structure and likely causative factors, we will conduct an in-depth assessment, including:

  • Thorough history
  • Strength and range of motion testing
  • Biomechanical and gait assessment
  • Evaluation of work, leisure activities and training programs that may exacerbate the condition
  • Evaluation of footwear
  • Referral for appropriate imaging (x-ray, ultrasound, MRI, CT etc.).

Treatment

Coming soon

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