ANKLE PAIN

The Pain

Ankle pain is a common problem for people who are active, whether it is from hiking, running, playing basketball or any number of fun weekend sports.  This pain typically comes from several different sources in your ankle – tendons, ligaments and cartilage being the most common.

The Causes

The most common problem to cause ankle pain is what is called a lateral ankle sprain and it is mostly typically caused by “turning” your ankle from landing funny while jumping  or from running and hitting an uneven part of the pavement.  This problem effects the anterior talofibular ligament – the one on the front/lateral part of the ankle bone – and the injury is classified by a “grade” – I, II or III.  The higher the number, the worse the sprain / injury.

You can also have ankle pain from inflammation in the tendons around the ankle, called tendonitis, and this can effect the inside or outside part of the ankle.  This problem is usually from overuse of the muscles in the lower leg which have their tendons extending down into the ankle.

The last common cause of ankle pain is arthritis.  This is a breakdown of the cartilage inside the joint and causes swelling and pain from the inflammation that is caused.  This problem is not normally caused by trauma – it develops gradually over time.  Pain, swelling, stiffness and warmth are common to this condition.

The Treatment

1.)   Sprains

a.     The initial treatment for a sprain is RICE – Rest, Ice, Compression and Elevation.  Rest allows the tissues to heal; Ice helps to decrease the inflammation, swelling and pain; compression helps to decrease the swelling; and Elevation also helps to decrease swelling by using gravity to pull the swelling out of the joint and toward the heart, where it is re-absorbed back into the system.

b.     As far as Physical Therapy goes, there are multiple things that are done in treatment at a facility like ours.  These include:

i.     Joint mobilizations to make sure the joint is moving correctly again after the injury and soft tissue mobilization if there are muscle spasms present after the injury.

ii.     Taping to the ankle.  There are a number of possible tapings that can be done.  The first is a classic stabilization taping for the ankle to “lock” the ankle in place and prevent reinjury.  The second is a taping geared toward the lateral malleolous (the outside ankle bone) which is focused on repositioning it in the proper place to allow it to function normally.   Finally, a taping can be done to help decrease the swelling in the ankle.

iii.     A therapist make treat an ankle sprain with modalities such as electrical stimulation to help decrease the swelling and compression units to help push the swelling out of the ankle.

iv.     Exercises to help strengthen the muscles around the joint and to retrain balance so they don’t re-injure themselves.  We find that the most common cause of recurrent ankle sprains is not a weakness problem – it is that the joint was never retrained correctly to stop another sprain before it happens.  We do a lot of balance / proprioceptive training with ankle patients.

2.)   Tendonitis

a.     The key for treatment here is to stop the overuse of the muscles/tendons that caused them to get irritated in the first place.  All of the tendons in the ankle have muscles that are located in the lower leg.  The tendons have their lower attachment in the foot and control the foot and ankle movements.  The place to start, then, is to decrease the work done at the foot/ankle.  Two easy ways to do this are to use arch supports / orthotics to help the feet (primarily the arch) and an ankle brace to support the ankle.

b.     Once you have stopped the overworking of the muscles and tendons, it is a good idea to ice, rest for a short time if needed and use anti-inflammatory medicine such as Ibuprofen if your doctor okays it.

c.     Physical Therapy treatment for this is geared toward joint and soft tissue mobilization to make sure that the joints and muscles are working properly, along with orthotic fabrication, taping of the foot (to support the arch) or ankle (to reposition the lateral malleolus) and, when needed, modalities such as ultrasound to decrease the inflammation.  (Clinics such as ours rarely use modalities for things like this but it is a common treatment approach for many PT clinics.)

d.     Lastly, it is a good idea to do stretches of the calf muscle to make sure that it is not limiting motion at the ankle and placing increased stress on the foot and ankle tissues.

3.)   Arthritis

a.     The best treatment for arthritis is rest, arch supports / orthotics and anti-inflammatory medicine if your doctor okays it.

b.     Surgery is a last-resort option if the arthritis gets too bad.  The typical surgical procedures for this are arthroscopic surgery to “clean” out the joint, or an ankle replacement.  Replacements are normally not done unless a person has significant difficulty with walking or has extreme pain.

Summary

While ankle problems are fairly common, treatment is very straight forward and people typically improve well in the long run.  The key is to make sure to get early treatment – a good rule is that the faster you get in to therapy, the faster you get better and get out of therapy!