What hurts?
Some possible conditions • Ankle Pain – Ankle – Front
-
Sprain/Strain -
Extensor Tendinitis -
Arthritis
Some possible conditions • Ankle Pain – Ankle – Front
Ankle sprains and strains have similar symptoms, causes and risk factors, but they also have some differences. Ankle sprains are usually a result of a traumatic or acute injury, while ankle strains can be acute or chronic. Acute injuries of the ankle occur suddenly and are caused by a single episode, whereas a chronic injury tends to develop after a period of time with repetitive movement or overuse. The ankle joint is formed by the tibia in the lower leg and the talus bone in the foot. There are dozens of ligaments to support the ankle and several muscles and tendons to provide strength and stability. If any of the ligaments are overstretched or disrupted, an ankle sprain may result. When the muscles or tendons are affected, a strain can occur.
The main difference between a sprain and strain is the onset of the pain, swelling, redness and reduced range of motion at the ankle. When an ankle sprain occurs, there may be an audible pop or a popping feeling, followed by bruising at the site and intense pain at the time of the injury. A strain will typically occur over time and can also result in weakness and instability around the ankle joint. A strain can also occur from a one-time injury or possibly at the same time as a sprain. Sprains and strains are graded from 1 to 3 and based on severity. Severity ranges from minor tearing to complete tearing of the soft tissues. Symptoms will be worse the higher the grade.
Ankle sprains and strains have similar risk factors including overtraining causing ligament or muscle fatigue, poor athletic conditioning, being overweight, not warming up sufficiently before training, poor and unsupportive footwear and history of a previous ankle injury. Another ankle injury is much more likely to occur after it has already been injured due to a sprain or strain. Additionally, women over the age of 30 and young men between the ages of 15 and 24 tend to be more at risk for ankle sprains. Activities and sports carried out on uneven terrain or involving pivoting on the spot or side-to-side movement may also increase a person’s risk for injury at the ankle.
Healing after an ankle sprain can be lengthy as ligaments have little to no blood supply and knowing if ankle pain is a result of a sprain or strain is imperative for proper treatment and avoiding re-injury. Mild ankle sprains and strains can be treated at home with R.I.C.E, the age old application of rest, ice, compression and elevation. Ankle joint instability is common after injury. Ankle braces and taping can be effective for increasing stability, as are custom foot orthotics and appropriate footwear. Stretching and strengthening exercises will help to support and stabilise the weakened ankle joint. More severe injuries may also require immobilisation of the joint with traditional plaster casts or an air cast/boot. Surgery to repair the injured structures is only required if the first-line of treatment and rehabilitation is ineffective.
Extensor tendonitis refers to inflammation of the extensor tendons, which run past the front of the ankle and along the top of the foot inserting into the toes. It is an overuse injury that is common in active individuals, especially if your shoes do not fit properly, or are laced too tight.
The main symptom of extensor tendonitis is pain on the top of the foot. It is often described as an aching pain or soreness, which increases with wearing shoes or exercise, in particular, running. Symptoms are likely to develop gradually over time, becoming progressively worse.
You may have some swelling over the top of your foot. And very rarely, some mild redness from shoe irritation. Curling the toes may trigger pain because this places stress on the tendons by stretching them.
Extensor tendonitis refers to the inflammation of the extensor tendon and implies a more acute injury. Overuse or repetitive strain is likely the cause. Repetitive strain causes the tendons to become inflamed and eventually degenerate. However, there are a number of factors that may increase your chances of injury. These include:
- Tying shoes too tightly or having a high instep where shoes fit tightly
- Running uphill or on a treadmill incline for extended periods
- Running on slippery surfaces
- Pathological biomechanics
The term extensor tendinopathy is probably a more accurate description of most injuries. This is because it also describes the degeneration of the tendon.
Pain from most long-term, chronic injuries is likely to be degeneration from wear and tear, not tendonitis. Studies have shown that long-term injuries usually do not have inflammatory cells present.
The best treatment is to cease the behaviour that caused the concern, while you let the tendons heal. If you were tying your laces too tightly or incline/uphill running, you’ll want to stop. Training can continue once the inflammation has subsided and you begin to feel better. But easing back into training must be slow. Additionally, ice and anti-inflammatory medications can help when it is acute and newly painful. Once the pain subsides, heat is a better option than ice. Elastic laces may be a great investment as they expand with walking and take the pressure off. Finally, if you are active or walk or stand throughout your day, having a Certified Pedorthist or Registered Chiropodist examine your lower limb mechanics is important. You may be at further risk for injury if a biomechanical condition is contributing to your problem.
Arthritis is a common inflammatory condition that affects bony joints. The most common type of arthritis is Osteoarthritis (OA). It occurs when the cartilage, which acts as a cushion between the bones of the lower limb wears down over time. As the cartilage deteriorates, the bones begin to rub against each other causing pain and inflammation. While it is most common in older adults, osteoarthritis can occur at a younger age. Other types of ankle joint disease/arthritis include gout, septic arthritis and charcot.
The most common symptom of ankle arthritis is pain, which can range from mild to severe. Along with pain, people with ankle arthritis may also experience stiffness, as well as decreased range of motion or a change in ankle alignment. These symptoms may be worse after sitting or standing for long periods of time, or with physical activity. Gout can be acute or chronic, but when it first presents, pain, swelling and redness of the joint are the primary indicators. These are also the same symptoms you would find with septic arthritis, which indicates an infected joint. Any quick onset joint redness, or swelling needs to be investigated immediately.
Osteoarthritis is caused by a combination of genetic and environmental factors. With age comes the natural breakdown of the cartilage. Biomechanics plays a significant role in the development of osteoarthritis because of the daily wear and tear on our ankle joint and bearing the weight of the body daily in walking or activities. Previous ankle injuries or surgeries can cause damage to overall joint structure/cartilage, which can be another factor. Overuse of the joint (e.g. avid gymnast or runner) is another cause of ankle osteoarthritis as the more we work our joints, the faster cartilage breaks down. This is why jobs that involve a lot of walking and kneeling will have higher rates of workers with osteoarthritis. Gout is primarily precipitated by diet but ultimately, is a by-product of faulty handling or producing of uric acid by the body. These crystals build up within a joint and are very painful. Septic arthritis is caused by an infectious agent being introduced into/seeding the joint space. Finally, charcot neuro-arthropathy is a joint disease in individuals with neuropathy, and most typically diabetes. The exact cause is largely inconclusive.
Treatment for ankle arthritis begins with non-surgical approaches, such as medication, physical therapy, weight loss, bracing/splinting, orthotics and well-fitted shoes. Physical therapy can help to reduce pain and improve function by strengthening the muscles around the joints. Weight loss is also an important aspect of treatment as it can help to reduce the pressure on the ankle joints. Often a brace, splint, orthotic or shoe with a forefoot rocker may be recommended to offer support and aid in pain reduction and improve range-of-motion.
