ANKLE PAIN
There are many causes of pain in the ankles. One of the commonest problems is recurrent ankle sprains. In the ankle joint, the talus bone fits snugly under the tibia and the fibula which hold it in place on either side with the medial and lateral malleoli. These bone pro-eminences are linked with strong ligaments, in particular the deltoid ligament in the middle and the lateral collateral ligament on the side. The commonest form of ankle sprain causes the foot to twist inwards which stretches and may tear the lateral collateral ligament on the side of the ankle. If the ligament is torn or stretched too much, it cannot recover and you will get recurrent ankle sprains and have an unstable ankle. At times during a sprain, the ankle bone, the talus gets fractured (osteochondral fracture of the talar dome). If this happens, you may have ankle pain, deep in the ankle on an ongoing basis and the fracture will be seen on x-rays or detected with a bone scan.
In older people, one of the commonest ankle problems is osteoarthritis. Osteoarthritis will cause pain, stiffness, and at times swelling of your ankle. For more information, go to osteoarthritis.
Tibialis posterior tendinitis can cause pain behind the ankle’s medial malleolus. It is due to a straining or overstretching of the tendon of the tibialis posterior muscle which attaches on the tibia, travels down behind the medial malleolus and attaches on the medial cuneiform. The tibialis posterior muscle moves the foot down and in. If your foot is overpronated it has to work much harder to do this, and you are more likely to develop tendinitis of this muscle.
We will deal with Achilles tendonitis in a separate section.
How can you treat these ankle problems?
Recurrent sprains can be treated with physiotherapy to strengthen the leg muscles and exercises on a balance board to make you react more quickly to changes in the terrain underneath your feet. This will help prevent you twisting your foot unexpectedly. Unfortunately, this will not strengthen the ligaments that hold your ankle steady and weakness of your ankle ligaments is the basic cause of current ankle sprains. The only procedure which can strengthen the ligaments of your ankle is prolotherapy.
If you have a fracture of the talar dome, you need to rest your ankle. This means using crutches, or even putting your ankle in a cast. Severe cases may require surgery. Afterwards, you will need physiotherapy to strengthen your muscles improve your range of motion and your balance. If you fractured your talar dome, you probably very badly damaged the ligaments that hold your ankle steady on either side. You may benefit from prolotherapy to strengthen these ligaments and stabilize your ankle.
If you have posterior tibial tendinitis, you may want to rest your ankle. A physiotherapist can teach you stretching and strengthening exercises. One of the best ways to prevent this tendinitis is to wear orthotics which support the arch of your foot and prevent it from pronating. That way your posterior tibial muscle doesn't have to pull your foot in so much whenever you take a step. Some people recommend a cortisone injection may be required to reduce inflammation and pain, but this can weaken the tendon and make it more likely to rupture. Please read the section on Nonsteroidal anti-inflammatory references to find out why this might be counterproductive
The treatment for arthritis of the ankle is similar to that which is explained in the osteoarthritis section. As other forms of arthritis, it responds well to prolotherapy. Orthotics also help the ankle joint to track straight. Dr. Bertrand can fit you with a guaranteed pair of orthotics.
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