Ankle problems can present themselves in several different ways. Persistent swelling and low pain in and around your ankle after a mild-to-moderate injury can linger for months or be resolved in several weeks if addressed early. If you have pain and weakness on the inside of your ankle when you rise up onto your toes, that’s your warning of a smoldering tendon problem that will eventually rage into a 3-alarm fire. If, after an ankle sprain, there is point tenderness and swelling just in front of the outside/lateral ankle bone, expect this to continue for months. When ankle pain and issues are present, they are not something you want to drag your feet on.
Your ankles are some of the most valuable joints in your entire body. Without them, you wouldn’t be able to walk, run, jump, or even operate the gas and brake pedals in your car. When your ankles are healthy, they allow you to stay mobile and independent.
It’s easy to take your ankles for granted, but if a common ankle problem results in pain, swelling, or stiffness, you will certainly become well-aware of how much you rely on them in daily life. The good news is that we can find a way to address the problem for you, whether by changing the environment or changing the foot. We’ll discuss what those terms mean in the context of treatment, but first let’s take a look at how your ankle is structured and some of the more common injuries we see.
It is not uncommon for people to think about their ankles as having only one joint. The truth of the matter is there are actually two joints. The “true ankle joint” is the one people often think about, and this is found where the lower leg bones (tibia and fibula) meet the ankle bone (talus). There is a second joint on the bottom of the talus, where it meets the heel bone (calcaneus). We call that the subtalar joint.
The true ankle joint allows the foot to move up and down, whereas the subtalar joint enables side-to-side movement.
These bones are all connected and supported by various ligaments, which are connective tissues that hold bones together. (The other common connective tissue—tendons—connect bones and muscles.) Muscles provide further support and mobility. Nerves, of course, are used by your brain and spine to signal when muscles should contract or elongate to move the foot in an appropriate manner.
Common Ankle Problems
As with any area of your body, there are numerous ankle injuries and conditions that can develop, but some are more likely than others. When we discuss common ankle issues, we are talking about ones such as:
Quite possibly the most common injury humans experience anywhere in the body, ankle sprains and strains are too frequently dismissed as being “not a big deal.” This is a real mistake – left untreated, a sprained ankle can ultimately lead to a condition of chronic ankle instability. Also, an ankle sprain can share many symptoms with an ankle fracture. We can properly diagnose your injury to ensure you receive the right treatment.
A sprain is an injury wherein a ligament is stretched beyond its intended range of motion. This injury can happen when your foot twists excessively. Sprains are commonly thought of as being sports injuries, but it really only takes a slight misstep on a stair or curb, or a high heel breaking, for this injury to occur.
There is an 80% chance of better healing of an ankle sprain if you address the problem right away. The best way to do so is with the PRICE technique. (No, this does not entail spending a lot of money!).
- Protection. Your starting point for this treatment is to protect the affected area from sustaining further injury. This means putting the old “walk it off” or “it’s merely a flesh wound” mindset to rest.
- Rest. Speaking of rest, this is the second part of the PRICE protocol. Your body has remarkable abilities to repair damaged tissue. To do so, however, you need to rest. This also will help you avoid further injury.
- Ice. Controlling inflammation is absolutely huge for optimal healing. Putting ice on the injured ankle as soon as possible is a great starting point. Keep the ice on for about 15-20 minutes. Do this multiple times during the day, but wait about an hour between icing sessions.
- Compression. Compression is another measure for reducing swelling. Use a compression wrap, but if you start to feel tingly below the wrap, loosen it a bit. A major problem with Ace wraps is that one area can be compressed/strangled more than another and block fluid form escaping.
- Elevate. Keeping your leg elevated above heart level is an approach used to prevent the area from becoming swollen with excessive fluid. Since you have to rest anyhow, prop your leg up on a couple of pillows while you relax on your couch or bed. Gravity is a tremendous force that can either work for you or against you.
Sinus Tarsitis/Sinus Tarsi Syndrome
When people hear the word “sinus,” the first thing that probably comes to mind are the sinuses in your head that are often affected by allergies and illness. Yet your body has various other sinuses in it as well. The word simply means a cavity in a body tissue or organ.
In the case of your sinus tarsi, this is an opening found on the outside of your foot, between the ankle bone (talus) and heel bone (calcaneus). Sinus tarsitis is a secondary injury to an ankle sprain (further proof those common injuries should not be overlooked!). It often develops when there is excessive and localized pressure on the outer ankle. This is a common secondary issue following an ankle sprain.
Posterior Tibial Tendonitis
Given the intricate nature of your foot structure, there are numerous connective tissues keeping everything together and allowing natural movement. Your posterior tibial tendons are extremely important for holding up your arches and supporting your feet when you walk.
Now, anytime you see an “-itis” at the end of a medical term, it means inflammation (swelling). So in the case of posterior tibial tendonitis, your posterior tibial tendon(s) has become inflamed. This injury can arise during an acute incident (a sudden event) or overuse. In either case, you will likely experience pain along the inside of your foot and ankle. The pain tends to worsen during physical activities. This is associated with your foot rolling in too much (pronation).
As with any bones in your body, the ones forming your ankle—the tibia, fibular, calcaneus, and tarsus—are at potential risk for fracturing when subjected to enough force. This includes cumulative forces from overuse that can cause stress fractures. There are many different kinds of fractures you can potentially sustain. Treatment is typically centered on keeping the injured area stable so your damaged bone tissue will be able to mend correctly.
A fracture that is often overlooked in an emergency room setting occurs at the base of the 5th metatarsal. If there is persistent pain and swelling in the lateral foot (not the ankle) you may be the proud owner of this problem. This is a notoriously poor area to heal in the best circumstances and delay in treatment will require surgery.
Treatment for Ankle Problems
Naturally, the treatment for whichever ankle problem you are experiencing will depend on several variables, including the nature of the injury itself. Our aim is always to “change the environment” (nonsurgical care), instead of “changing the foot” (surgery).
We touched on using the PRICE method for ankle sprains, but other nonsurgical options we might use in your treatment plan include corticosteroid injections, physical therapy, and orthotic devices. Now, these are not all applicable for all conditions. Case in point, we do not use steroid injections for posterior tibial tendonitis, since they can weaken the collagen in connective tissues.
Our hope, as always, is that we will be able to treat your ankle injury conservatively. In some cases, however, surgery does become a recommended option. If this is what Dr. Leibovitz determines would be best, he will discuss it with you so you are able to make the best possible decision for your healthcare.
If you have any questions about common ankle problems and injuries, or are ready to schedule an appointment with our Indianapolis office, simply give us a call at (317) 545-0505 and our staff will be glad to help you.