What hurts?
Some possible conditions • Ankle Pain – Ankle – Inside
-
Sprain/Strain -
Arthritis -
Adult Acquired Flat Foot
Some possible conditions • Ankle Pain – Ankle – Inside
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.
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.
Adult acquired flatfoot, also known as Posterior Tibial Tendon Dysfunction (PTTD), is characterized by a fallen arch and outward pointed toes. This condition is a gradual progression in most cases, as the posterior tibialis tendon becomes weakened and loses the ability to maintain the height of the arch. Adult acquired flatfoot is different from a flatfoot condition in children. Adults with flatfeet remain permanently flat without surgical intervention, while children usually outgrow the condition on their own with or without treatment.
People typically present with pain along the course of the Posterior Tibial (PT) tendon which is on the inside of the foot and ankle. Pain is usually worse with activities, especially high impact like running and jumping. The heel bone can shift toward the outside of the foot putting more pressure on the outside ankle bone. People that develop arthritis and joint spurring may have nerve impingement (trapping/pinching of the nerve), which can lead to numbness, tingling or burning in the arch and toes of the foot. Diabetic patients may notice swelling or a bump on the bottom of the foot if the condition progresses. Due to the presence of diabetic neuropathy (numbess) in some patients, pain is not always an indicator of this condition.
The most common cause of adult acquired flatfoot is damage to the posterior tibial tendon. This tendon starts at the calf and travels down to the inside of the foot. If the tendon becomes swollen, irritated or torn, the arch will begin to collapse due to lack of support and strength from the tendon. Studies have shown that women over 40 years of age are the most likely to develop an issue with the PT tendon. Risk factors that can increase the chances of PT tendon dysfunction include but are not limited to obesity, diabetes and high blood pressure. There is a small population of patients with inflammatory arthritis, such as rheumatoid arthritis, that develop a painful flatfoot condition. Inflammatory arthritis typically causes dysfunction of the tendon, ligaments and joints leading to a more severe flatfoot.
Patients with adult acquired flatfoot deformity are often treated with orthotics, supportive footwear and braces. Assessment by a Footcare Clinician is recommended in these cases due to the complex nature of the deformity. Often patients require anti-inflammatory medication due to pain and swelling, which can limit mobility. People with PTTD also benefit from physical therapy to help treat and prevent further injuries with the tendon involved. Patients that do not respond to conservative therapy may require surgical intervention.
