Ankle pain is a common symptom that can be caused by an array of conditions and injuries. The ankle is where 3 bones meet (the tibia, the fibula, and the talus). This area also includes several ligaments and tendons that connect the leg to the foot. Ankle pain can be experienced as a result of an injury from a slip or fall, a sports injury, or from an underlying medical condition such as arthritis. The most common cause of ankle pain is a sprain. A sprain is an injury to the ligaments, the bands of tissue that hold the ankle bones together. Twisting the ankle can tear the ligaments and lead to a sprain. Over 70% of British people will suffer from ankle pain at some point in their lives. The symptoms of ankle pain can vary depending on the cause of the pain. If the pain is the result of an injury, the symptoms will be apparent quickly. For a sprained ankle, the symptoms are pain, bruising, swelling, stiffness, and difficulty putting weight on the affected foot. If the pain is due to a medical condition, the symptoms may develop more slowly and become more severe. It is important to ensure that ankle pain is diagnosed properly before undergoing treatment because the more accurate the diagnosis, the more direct the treatment enabling a speedier recovery and a reduction in pain.
Understanding Ankle Pain
The ankle joint is composed of three bones: the tibia, the fibula, and the talus, which are articulated together by multiple ligaments that provide stability to the ankle joint. The most common cause of ankle pain is an ankle sprain. When the ankle is sprained, the foot turns inwards damaging the ligaments on the outside of the ankle. Depending on the severity of the sprain, the ligament can be stretched, partially torn or completely torn. Another common cause of ankle pain is damage to the articular cartilage that lines the joint surfaces of the tibia, fibula, and talus. Articular cartilage can be damaged from an acute injury/dislocation or from chronic injuries such as ankle impaction injuries and ankle sprains. Osteoarthritis involving the ankle joint is less common than arthritis of the hip or knee, but can also be a cause of ankle pain. Osteoarthritis is usually a primary, idiopathic, slowly progressive, and degenerative disorder of the synovial joint, but it can also occur secondary to traumatic injuries to the ankle joint, including those of an intra-articular nature. Ankle pain can also be caused by systemic diseases, such as diabetes, which can lead to damage of the ankle joint. Finally, ankle pain not associated with any injury can be referred from damage of the surrounding joints, such as the subtalar joint. In order to determine the cause of ankle pain, a healthcare provider may use a detailed history to pinpoint the pain and any pain referral, followed by a physical examination and diagnostic imaging.
Importance of Seeking Treatment
Ankle pain treatment Singapore is very important for ankle pain. Ignoring symptoms and medical advice can lead to chronic pain and instability. Pain and instability may make walking on uneven ground or participating in sports difficult. Damage done to the joint from a bad sprain or an injury and improper or delayed treatment can cause chronic arthritis and pain. Recurrent and chronic pain often limits movement and the ability to walk or take part in activities he or she would otherwise enjoy. This can lead to increased pain, as well as further limitation in movement and participation in activities – a downward spiral. For example, an athlete may adapt to chronic ankle pain by limping, which then causes problems in the opposite leg or back. This can result in pain and dysfunction all over the body. Ankle pain left untreated can also affect the way a person walks. This can cause problems in the knees, hips, or back over time. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, an injury such as a fracture or a severe sprain may lead to the development of osteoarthritis. When people develop osteoarthritis, it leads to activity restrictions. People who are not able to engage in usual daily activities may become depressed or may develop chronic health conditions. Ideally, it is best to avoid these types of secondary problems by seeking treatment for an ankle sprain or injury.
Common Causes of Ankle Pain
Tendinitis is inflammation of a tendon, and this condition can affect various parts of the body. With ankle tendinitis, the most common form is the inflammatory changes of the Achilles tendon. Symptoms include pain in the lower leg or back of the ankle, swelling, and stiffness, especially in the morning. If there is any doubt about symptoms of pain and swelling, it is recommended that a medical professional is consulted to rule out the possibility of a tear in the tendon.
Arthritis, though often associated with the elderly, can affect people of all ages. The symptoms will generally present as time goes on and the condition worsens. Pain and stiffness around the joint affected are common symptoms of arthritis, as is the case with ankle arthritis. The pain is usually worse after use of the affected joint, and arthritis has the potential to make the joint change shape, thus impairing movement.
A sprain is the most common cause of ankle pain, often occurring when the ankle is twisted inward. This causes damage to the ligaments, which in turn results in inflammation usually with bruising and swelling. This is a strain or minor tear of the affected ligament. Strains, while similar, affect muscles and/or the tendons connecting muscle to bone. Symptoms can range from mild to severe. Sometimes it isn’t until weight is put on the affected ankle/leg that the severity is noticed. As with many musculoskeletal ankle injuries, R.I.C.E. (rest, ice, compression, elevation) is the recommended self-treatment to reduce swelling and minimize movement or weight bearing on the ankle.
Sprains and Strains
The most common symptoms of a sprained ankle are pain and swelling. The patient will often not be able to put weight on the affected foot, and there may be some bruising on the skin. If a ligament has been partially torn, the joint may feel unstable or “wobbly”. This is known because the muscle action can’t be coordinated to the structure of the joint due to pain inhibition. It may also occur in a joint that has developed arthritis following a severe sprain.
Ankle sprains and strains occur frequently during physical activity. It is not uncommon for an athlete or dancer to sprain their ankle, and people who play sports that involve running and jumping are at greater risk compared to those who take part in less dynamic activities. Events like a sudden trip or slip can cause an ankle sprain for just about anyone.
One of the most common causes of ankle pain is a sprain or strain of the ankle. This usually occurs when the ankle is moved out of its usual range of movement, causing the ligaments to be overstretched or torn. A sprain is an injury to a ligament. The sprain is graded 1, 2, or 3 depending on the severity of the tear.
Arthritis
Rheumatoid arthritis is an inflammatory system condition that is damaging to the joints and other organs. The body’s immune system is designed to destroy foreign cells such as viruses and bacteria. In a person with rheumatoid arthritis, the immune system has gone awry in some way. For reasons that are unclear, the immune system begins to attack the body’s own tissues. In the case of an arthritic, the target is the synovial membrane, a thin tissue that lines the joints. Damage to the synovial membrane causes the release of chemicals that damage both the membrane itself and the cartilage it is supposed to protect. If inflammation persists, the joint’s ligaments, capsule, and bone may be affected.
Osteoarthritis is a degenerative joint disease. This is the most common chronic joint condition that mainly affects the elderly. It may also affect younger people as a result of injury. It is a slowly progressive disease that is characterized by the breakdown of joint cartilage. New bone forms at the margins of the joint and this extra bone growth is referred to as spurs. Osteoarthritis is a subtle disease that develops over time.
Arthritis is a general term for inflammation of a joint. Pain, swelling, stiffness, and decreased range of motion can be the symptoms of arthritis. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. They are very different conditions, but the effects are the same in terms of pain and swelling in the joints.
Achilles Tendinitis
Symptoms of Achilles tendinitis include swelling, pain, and warmth of the back of the leg. These symptoms are usually worse during activity and can become severe. If the problem persists, the local area can begin to change in color and appear to be nodular. Chronic tendinitis can lead to a weakening of the tendon and increase the risk of a tear.
Insertional Achilles tendinitis: This type of tendinitis affects the fibers where they insert into the heel bone. Often times there is a bone spur that has formed with this type of tendinitis. This type is more commonly associated with Haglund’s deformity.
Noninsertional Achilles tendinitis: Fibers that are located in the middle portion of the tendon begin to thicken, swell, and develop disarray. This type of tendinitis is more common in younger people.
Achilles tendinitis is a common cause of ankle pain. The Achilles tendon is the largest tendon in the body, connecting your calf muscles to your heel bone. It is used when you walk, run, and jump. The tendon can withstand great stresses from running and jumping, but it is also prone to tendinitis. The term tendinitis means inflammation of the tendon. Inflammation is the body’s natural response to injury or disease, and often causes swelling, pain, or irritation. There are two types of Achilles tendinitis, based upon which part of the tendon is inflamed.
Fractures
Symptoms: An ankle fracture can be very painful and can cause the ankle to look deformed, making it difficult to move the ankle. A painful, swollen and bruised ankle is also common. It is important to seek medical care at the first sign of a fracture, as the symptoms may be similar to those of a sprain. The telltale sign of an ankle fracture is an inability to put any weight on the foot. Immediate swelling of the ankle after an injury usually indicates a fracture. A fracture is also diagnosed by x-ray.
An ankle fracture is a break in one or more bones in the ankle and often occurs during sports, a fall or from a motor vehicle accident. There are several different types of ankle fractures, each with different severities and symptoms. A fracture can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may be so severe that you are unable to put any weight on your foot.
Treatment Options for Ankle Pain
Orthotics are any external devices applied to the body to modify structural and functional characteristics. In terms of the treatment of ankle sprains, an orthosis can be as simple as an ankle stirrup or as complicated as a custom-fit AFO. The most common form of bracing comes from taping, and there is moderately strong evidence that taping pre-sport or pre-exercise will limit the incidence of ankle sprains in both athletic and at-risk populations. A review article suggests that students with a previous ankle injury should be treated with an air stirrup brace for 1-3 months to reduce the risk of re-injury. A custom-fit AFO has shown to be more effective in the prevention of recurrent ankle sprains in those with chronic ankle instability.
Physical therapy is crucial in the treatment of ankle sprains as it helps increase strength and mobility and identifies any deficits in the lower leg or foot that may cause reinjury. In the initial acute phase, PRICE protocol is employed, and manual therapy may also be utilized. As the patient progresses, physical therapy can incorporate therapeutic exercise and functional training to improve strength, range of motion, and proprioception. A systematic review revealed that therapeutic exercise is beneficial for an increased rate of return to usual activities, for decreasing pain and re-injury, and for increased functional and muscle strength. High-grade evidence demonstrates that the use of wobble boards to improve proprioception is useful for chronic ankle instability and the prevention of recurrent ankle sprains.
Direct comparison studies showing the efficacy of any specific analgesic drugs in acute ankle sprain are not present. Recommendations are largely based on expert opinion and consist of mild to moderate use of acetaminophen, NSAIDs, and COX-2 inhibitors. Research from a systematic review failed to provide strong evidence for short-term efficacy of these drugs but did show that, in general, patients who use NSAIDs have a lower rate of re-injury or residual symptoms after an ankle sprain.
Medications and Pain Relief
Taking medication is a common way of dealing with ankle pain and can be effective. It is not normally a long-term method, but can be used to break the cycle of pain. Acetaminophen (Tylenol) is an over-the-counter pain reliever that is recommended as first-line treatment of ankle pain. It is effective and relatively safe, but should not be used by individuals with liver disease or alcohol dependence. Nonsteroidal anti-inflammatory drugs (NSAIDs) are another option and these include ibuprofen (Advil, Motrin) and naproxen (Aleve). These types of medications not only help with pain relief but also reduce inflammation and are safe and effective when used as directed. Topical pain relievers are useful for pain that is localized to one specific area. These include preparations that contain salicylates or capsaicin. Salicylates are used to relieve pain and inflammation and capsaicin diminishes the amount of a chemical known as substance P which is a pain transmitter to the brain. There are other measures of pain relief such as steroid injections and acupuncture. This is something that should be discussed with a doctor to weigh the risks and benefits. Be cautious that steroidal injections can cause damage to ligaments and tendons with overuse. Step one in ridding your ankle pain is to choose what type of medication is right for you.
Physical Therapy and Rehabilitation
Iontophoresis and phonophoresis are ways of administering anti-inflammatory drugs to specific areas underneath the skin by using electrical stimulation and ultrasound waves. This can be helpful for patients who have stomach irritation from oral anti-inflammatory medications. Once the patient has relaxed, the therapist will then begin active treatments focused on increasing a patient’s strength, flexibility, and function. This is often done through an exercise program that fits the patient’s specific condition, which should be maintained between visits and after discharge from physical therapy. Exercises for patients with ankle pain can include those to increase balance, range of motion and flexibility, strength, and overall conditioning. The therapist may also perform manual therapy which consists of mobilization of soft tissue and joint articulation and manipulation to and around the ankle. This is to help improve the mobility of the ankle, foot, and surrounding tissues.
Physical therapy is often a staple in healthcare plans for treating ankle pain. A physical therapist will devise a treatment plan aimed at reducing pain, which will include both passive and active treatments. Passive treatments help to relax the patient and prepare them for the exercises that are to come. They can include hot and cold therapy, iontophoresis, phonophoresis, and electrical stimulation.
Orthotic Devices and Bracing
Orthotic and bracing devices are occasionally urged for patients to apply to support their ankle and help remove stress from the wounded tendon. The use of a brace or orthotic device has been confirmed to be an efficient approach of furnishing exterior support in patients with a variety of musculoskeletal circumstances. These devices are constructed from a range of stuffs such as elastic, synthetic, metal, leather, and foam and are fashioned in either an inflexible or semi-rigid plan. The bracing and orthotic devices are accessible in various patterns including lace-up, boot, stirrup, and air-cast with each yielding different degrees of support. There have been some concerns that the use of a brace or orthotic device can lead to enfeeblement of the ankle and an raised risk of re-injury. However, a systematic review by Karlsson et al found that the utilization of an orthotic device in patients with an earlier ankle sprain was efficient in reducing the risk of re-injury to the same ankle. This was due to precluded supination of the ankle from the closed kinetic chain engendered by the exterior support from the brace. Recent advances in orthotic and bracing devices such as the “air-stirrup” brace have been designed to simulate the mechanical restrict incurred by the Brostrom procedure and can be an option for patients requiring non-surgical treatment. Overall, the utilization of an orthotic or bracing device is a secure and efficient method of treatment for patients with ankle pain, potentially reducing the risk of further injury and providing relief of symptoms.
Surgical Interventions
Ankle pain Singapore surgery aims to treat forms of ankle pain that do not respond to non-surgical treatment. There are many different types of ankle pain and each type may have a specific surgery or a surgery that can be utilized in severe cases. The type of surgery that is selected is based on the degree of damage and the specific type of ankle pain. Any decision to proceed with surgical interventions should be undertaken in collaboration with your GP and/or a surgeon who specializes in foot and ankle surgery and who can determine the best procedure for the individual based on examination and diagnostic imaging such as X-ray, CT or MRI. Ankle pain comes from different sources including degenerative arthritis, inflammatory arthritis, acute fractures and post-traumatic sequelae, instability secondary to ligament rupture and ankle impingement. Static and progressive deformity and malalignment can also be a cause of ankle pain. Due to the wide diversity of the sources of ankle pain, effective surgical management can only be achieved in specific cases and treatment of some conditions may be best managed non-surgically.
Preventing Ankle Pain
Regular treatment and monitoring of an ongoing ankle injury should involve the use of a brace or strapping and the continuation of this until the injury has resolved and function has returned to normal. A physiotherapist can guide you as to the correct method of strapping and/or bracing at different stages of your rehabilitation program.
Protective strapping is a very effective way of preventing ankle injuries, particularly in individuals with a history of previous ankle injuries or with ankle joint instability. Strapping can help to stabilize the ankle joint and provide proprioceptive feedback to the brain, thus reducing the likelihood of the ankle rolling and an injury occurring. Research has demonstrated that ankle taping can reduce the incidence of ankle injury in high-risk sports and activities. It is important for the tape job or any ankle brace to be applied correctly, and if you are unsure about how to do this, then visit a physiotherapist for a demonstration.
Ankle sprains and other ankle injuries can usually be prevented by paying close attention to the following aspects of the body and its surroundings. Some of these are common sense but it takes an injury to happen before these measures are taken into account. The damage and the occurrence of ankle injuries can be lessened significantly by addressing these predisposing factors.
Strengthening Exercises and Stretching
The goal behind using therapeutic exercise is to derive the benefits of the positive aspects of exercising, while minimizing the exacerbation of the patient’s injury or condition. The initial response to an acute injury is to decrease the inflammation in the ankle. This can be accomplished by elevating the leg, using ice, and using a compression bandage. Isometric exercises can be started once the pain has subsided, and can later be advanced to isotonic and isokinetic exercises. They are initiated in a non-weight bearing position, and can later be advanced to weight bearing activities. This will provide a basis for the progression to strength and functional exercises. Static and proprioceptive neuromuscular facilitation (PNF) stretching exercises may also be introduced in the initial phase to maintain flexibility in the uninjured portions of the ankle and in the muscles and tendons surrounding the ankle. This will depend on the comfort of the patient, and the severity of the injury on the injured ankle. A patient with a fracture in an ankle would not perform PNF exercises on the ankle, but may perform them in the other leg to maintain symmetry.
Proper Footwear and Support
Proper foot care is extremely important in preventing ankle injury. Wearing the right footwear can help to prevent injury. Assess your feet and gait and choose the correct footwear for you. If you are flat-footed, you will require a shoe with good arch support and a slightly rigid sole to limit motion and support your foot. If you have a high arch, you will require a cushioned shoe with a soft midsole to absorb shock and allow for proper foot motion. Ankle stability may be improved with the use of a custom orthotic. Studies have shown that high-top shoes may help to prevent inversion ankle injuries. This is because the boot restricts the motion of the ankle, which in turn prevents the ankle from rolling over. There may also be added protection for the Achilles tendon. Step-slip shoes should be avoided at all costs as they are a major cause of falls and can lead to serious ankle injury. Injury can also be prevented by wearing a preventative brace. Bracing has been shown to be very effective in both the prevention and the rehabilitation of ankle injuries. An ankle brace with heel-lock strapping is the most supportive and provides the best protection. The brace works by immobilizing the Achilles tendon and preventing the talus bone from dropping, thus preventing the ankle from rolling. Supporting the ankle can also relieve pain caused by an ongoing condition. Simple elastic supports can be used for minor pain. For moderate to severe pain, a more advanced brace such as an Aircast can be used. The Aircast works by inflating an airbag around the ankle, which compresses and conforms around the joint. This provides maximum support and protection while maintaining a good amount of comfort for the user. Try your best to avoid taping the ankle. While taping does help to prevent injury by restricting the range of motion, it can have a detrimental effect on the strength of the ankle joint. This is because the joint becomes reliant on the tape for support and as a result, the muscles do not develop properly. This can lead to a decrease in the stability of the ankle joint and an increase in the likelihood of future injury.
Avoiding High-Impact Activities
Jumping activities such as basketball have been shown to produce peak ground reaction forces of up to 5.8 times body weight. High jumping, lay-ups, and the action of coming down from a jump are times when a basketball pla
Ankle pain is a common symptom that can be caused by an array of conditions and injuries. The ankle is where 3 bones meet (the tibia, the fibula, and the talus). This area also includes several ligaments and tendons that connect the leg to the foot. Ankle pain can be experienced as a result of an injury from a slip or fall, a sports injury, or from an underlying medical condition such as arthritis. The most common cause of ankle pain is a sprain. A sprain is an injury to the ligaments, the bands of tissue that hold the ankle bones together. Twisting the ankle can tear the ligaments and lead to a sprain. Over 70% of British people will suffer from ankle pain at some point in their lives. The symptoms of ankle pain can vary depending on the cause of the pain. If the pain is the result of an injury, the symptoms will be apparent quickly. For a sprained ankle, the symptoms are pain, bruising, swelling, stiffness, and difficulty putting weight on the affected foot. If the pain is due to a medical condition, the symptoms may develop more slowly and become more severe. It is important to ensure that ankle pain is diagnosed properly before undergoing treatment because the more accurate the diagnosis, the more direct the treatment enabling a speedier recovery and a reduction in pain.
Understanding Ankle Pain
The ankle joint is composed of three bones: the tibia, the fibula, and the talus, which are articulated together by multiple ligaments that provide stability to the ankle joint. The most common cause of ankle pain is an ankle sprain. When the ankle is sprained, the foot turns inwards damaging the ligaments on the outside of the ankle. Depending on the severity of the sprain, the ligament can be stretched, partially torn or completely torn. Another common cause of ankle pain is damage to the articular cartilage that lines the joint surfaces of the tibia, fibula, and talus. Articular cartilage can be damaged from an acute injury/dislocation or from chronic injuries such as ankle impaction injuries and ankle sprains. Osteoarthritis involving the ankle joint is less common than arthritis of the hip or knee, but can also be a cause of ankle pain. Osteoarthritis is usually a primary, idiopathic, slowly progressive, and degenerative disorder of the synovial joint, but it can also occur secondary to traumatic injuries to the ankle joint, including those of an intra-articular nature. Ankle pain can also be caused by systemic diseases, such as diabetes, which can lead to damage of the ankle joint. Finally, ankle pain not associated with any injury can be referred from damage of the surrounding joints, such as the subtalar joint. In order to determine the cause of ankle pain, a healthcare provider may use a detailed history to pinpoint the pain and any pain referral, followed by a physical examination and diagnostic imaging.
Importance of Seeking Treatment
Ankle pain treatment Singapore is very important for ankle pain. Ignoring symptoms and medical advice can lead to chronic pain and instability. Pain and instability may make walking on uneven ground or participating in sports difficult. Damage done to the joint from a bad sprain or an injury and improper or delayed treatment can cause chronic arthritis and pain. Recurrent and chronic pain often limits movement and the ability to walk or take part in activities he or she would otherwise enjoy. This can lead to increased pain, as well as further limitation in movement and participation in activities – a downward spiral. For example, an athlete may adapt to chronic ankle pain by limping, which then causes problems in the opposite leg or back. This can result in pain and dysfunction all over the body. Ankle pain left untreated can also affect the way a person walks. This can cause problems in the knees, hips, or back over time. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, an injury such as a fracture or a severe sprain may lead to the development of osteoarthritis. When people develop osteoarthritis, it leads to activity restrictions. People who are not able to engage in usual daily activities may become depressed or may develop chronic health conditions. Ideally, it is best to avoid these types of secondary problems by seeking treatment for an ankle sprain or injury.
Common Causes of Ankle Pain
Tendinitis is inflammation of a tendon, and this condition can affect various parts of the body. With ankle tendinitis, the most common form is the inflammatory changes of the Achilles tendon. Symptoms include pain in the lower leg or back of the ankle, swelling, and stiffness, especially in the morning. If there is any doubt about symptoms of pain and swelling, it is recommended that a medical professional is consulted to rule out the possibility of a tear in the tendon.
Arthritis, though often associated with the elderly, can affect people of all ages. The symptoms will generally present as time goes on and the condition worsens. Pain and stiffness around the joint affected are common symptoms of arthritis, as is the case with ankle arthritis. The pain is usually worse after use of the affected joint, and arthritis has the potential to make the joint change shape, thus impairing movement.
A sprain is the most common cause of ankle pain, often occurring when the ankle is twisted inward. This causes damage to the ligaments, which in turn results in inflammation usually with bruising and swelling. This is a strain or minor tear of the affected ligament. Strains, while similar, affect muscles and/or the tendons connecting muscle to bone. Symptoms can range from mild to severe. Sometimes it isn’t until weight is put on the affected ankle/leg that the severity is noticed. As with many musculoskeletal ankle injuries, R.I.C.E. (rest, ice, compression, elevation) is the recommended self-treatment to reduce swelling and minimize movement or weight bearing on the ankle.
Sprains and Strains
The most common symptoms of a sprained ankle are pain and swelling. The patient will often not be able to put weight on the affected foot, and there may be some bruising on the skin. If a ligament has been partially torn, the joint may feel unstable or “wobbly”. This is known because the muscle action can’t be coordinated to the structure of the joint due to pain inhibition. It may also occur in a joint that has developed arthritis following a severe sprain.
Ankle sprains and strains occur frequently during physical activity. It is not uncommon for an athlete or dancer to sprain their ankle, and people who play sports that involve running and jumping are at greater risk compared to those who take part in less dynamic activities. Events like a sudden trip or slip can cause an ankle sprain for just about anyone.
One of the most common causes of ankle pain is a sprain or strain of the ankle. This usually occurs when the ankle is moved out of its usual range of movement, causing the ligaments to be overstretched or torn. A sprain is an injury to a ligament. The sprain is graded 1, 2, or 3 depending on the severity of the tear.
Arthritis
Rheumatoid arthritis is an inflammatory system condition that is damaging to the joints and other organs. The body’s immune system is designed to destroy foreign cells such as viruses and bacteria. In a person with rheumatoid arthritis, the immune system has gone awry in some way. For reasons that are unclear, the immune system begins to attack the body’s own tissues. In the case of an arthritic, the target is the synovial membrane, a thin tissue that lines the joints. Damage to the synovial membrane causes the release of chemicals that damage both the membrane itself and the cartilage it is supposed to protect. If inflammation persists, the joint’s ligaments, capsule, and bone may be affected.
Osteoarthritis is a degenerative joint disease. This is the most common chronic joint condition that mainly affects the elderly. It may also affect younger people as a result of injury. It is a slowly progressive disease that is characterized by the breakdown of joint cartilage. New bone forms at the margins of the joint and this extra bone growth is referred to as spurs. Osteoarthritis is a subtle disease that develops over time.
Arthritis is a general term for inflammation of a joint. Pain, swelling, stiffness, and decreased range of motion can be the symptoms of arthritis. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis. They are very different conditions, but the effects are the same in terms of pain and swelling in the joints.
Achilles Tendinitis
Symptoms of Achilles tendinitis include swelling, pain, and warmth of the back of the leg. These symptoms are usually worse during activity and can become severe. If the problem persists, the local area can begin to change in color and appear to be nodular. Chronic tendinitis can lead to a weakening of the tendon and increase the risk of a tear.
Insertional Achilles tendinitis: This type of tendinitis affects the fibers where they insert into the heel bone. Often times there is a bone spur that has formed with this type of tendinitis. This type is more commonly associated with Haglund’s deformity.
Noninsertional Achilles tendinitis: Fibers that are located in the middle portion of the tendon begin to thicken, swell, and develop disarray. This type of tendinitis is more common in younger people.
Achilles tendinitis is a common cause of ankle pain. The Achilles tendon is the largest tendon in the body, connecting your calf muscles to your heel bone. It is used when you walk, run, and jump. The tendon can withstand great stresses from running and jumping, but it is also prone to tendinitis. The term tendinitis means inflammation of the tendon. Inflammation is the body’s natural response to injury or disease, and often causes swelling, pain, or irritation. There are two types of Achilles tendinitis, based upon which part of the tendon is inflamed.
Fractures
Symptoms: An ankle fracture can be very painful and can cause the ankle to look deformed, making it difficult to move the ankle. A painful, swollen and bruised ankle is also common. It is important to seek medical care at the first sign of a fracture, as the symptoms may be similar to those of a sprain. The telltale sign of an ankle fracture is an inability to put any weight on the foot. Immediate swelling of the ankle after an injury usually indicates a fracture. A fracture is also diagnosed by x-ray.
An ankle fracture is a break in one or more bones in the ankle and often occurs during sports, a fall or from a motor vehicle accident. There are several different types of ankle fractures, each with different severities and symptoms. A fracture can range from a simple break in one bone, which may not stop you from walking, to several fractures, which forces your ankle out of place and may be so severe that you are unable to put any weight on your foot.
Treatment Options for Ankle Pain
Orthotics are any external devices applied to the body to modify structural and functional characteristics. In terms of the treatment of ankle sprains, an orthosis can be as simple as an ankle stirrup or as complicated as a custom-fit AFO. The most common form of bracing comes from taping, and there is moderately strong evidence that taping pre-sport or pre-exercise will limit the incidence of ankle sprains in both athletic and at-risk populations. A review article suggests that students with a previous ankle injury should be treated with an air stirrup brace for 1-3 months to reduce the risk of re-injury. A custom-fit AFO has shown to be more effective in the prevention of recurrent ankle sprains in those with chronic ankle instability.
Physical therapy is crucial in the treatment of ankle sprains as it helps increase strength and mobility and identifies any deficits in the lower leg or foot that may cause reinjury. In the initial acute phase, PRICE protocol is employed, and manual therapy may also be utilized. As the patient progresses, physical therapy can incorporate therapeutic exercise and functional training to improve strength, range of motion, and proprioception. A systematic review revealed that therapeutic exercise is beneficial for an increased rate of return to usual activities, for decreasing pain and re-injury, and for increased functional and muscle strength. High-grade evidence demonstrates that the use of wobble boards to improve proprioception is useful for chronic ankle instability and the prevention of recurrent ankle sprains.
Direct comparison studies showing the efficacy of any specific analgesic drugs in acute ankle sprain are not present. Recommendations are largely based on expert opinion and consist of mild to moderate use of acetaminophen, NSAIDs, and COX-2 inhibitors. Research from a systematic review failed to provide strong evidence for short-term efficacy of these drugs but did show that, in general, patients who use NSAIDs have a lower rate of re-injury or residual symptoms after an ankle sprain.
Medications and Pain Relief
Taking medication is a common way of dealing with ankle pain and can be effective. It is not normally a long-term method, but can be used to break the cycle of pain. Acetaminophen (Tylenol) is an over-the-counter pain reliever that is recommended as first-line treatment of ankle pain. It is effective and relatively safe, but should not be used by individuals with liver disease or alcohol dependence. Nonsteroidal anti-inflammatory drugs (NSAIDs) are another option and these include ibuprofen (Advil, Motrin) and naproxen (Aleve). These types of medications not only help with pain relief but also reduce inflammation and are safe and effective when used as directed. Topical pain relievers are useful for pain that is localized to one specific area. These include preparations that contain salicylates or capsaicin. Salicylates are used to relieve pain and inflammation and capsaicin diminishes the amount of a chemical known as substance P which is a pain transmitter to the brain. There are other measures of pain relief such as steroid injections and acupuncture. This is something that should be discussed with a doctor to weigh the risks and benefits. Be cautious that steroidal injections can cause damage to ligaments and tendons with overuse. Step one in ridding your ankle pain is to choose what type of medication is right for you.
Physical Therapy and Rehabilitation
Iontophoresis and phonophoresis are ways of administering anti-inflammatory drugs to specific areas underneath the skin by using electrical stimulation and ultrasound waves. This can be helpful for patients who have stomach irritation from oral anti-inflammatory medications. Once the patient has relaxed, the therapist will then begin active treatments focused on increasing a patient’s strength, flexibility, and function. This is often done through an exercise program that fits the patient’s specific condition, which should be maintained between visits and after discharge from physical therapy. Exercises for patients with ankle pain can include those to increase balance, range of motion and flexibility, strength, and overall conditioning. The therapist may also perform manual therapy which consists of mobilization of soft tissue and joint articulation and manipulation to and around the ankle. This is to help improve the mobility of the ankle, foot, and surrounding tissues.
Physical therapy is often a staple in healthcare plans for treating ankle pain. A physical therapist will devise a treatment plan aimed at reducing pain, which will include both passive and active treatments. Passive treatments help to relax the patient and prepare them for the exercises that are to come. They can include hot and cold therapy, iontophoresis, phonophoresis, and electrical stimulation.
Orthotic Devices and Bracing
Orthotic and bracing devices are occasionally urged for patients to apply to support their ankle and help remove stress from the wounded tendon. The use of a brace or orthotic device has been confirmed to be an efficient approach of furnishing exterior support in patients with a variety of musculoskeletal circumstances. These devices are constructed from a range of stuffs such as elastic, synthetic, metal, leather, and foam and are fashioned in either an inflexible or semi-rigid plan. The bracing and orthotic devices are accessible in various patterns including lace-up, boot, stirrup, and air-cast with each yielding different degrees of support. There have been some concerns that the use of a brace or orthotic device can lead to enfeeblement of the ankle and an raised risk of re-injury. However, a systematic review by Karlsson et al found that the utilization of an orthotic device in patients with an earlier ankle sprain was efficient in reducing the risk of re-injury to the same ankle. This was due to precluded supination of the ankle from the closed kinetic chain engendered by the exterior support from the brace. Recent advances in orthotic and bracing devices such as the “air-stirrup” brace have been designed to simulate the mechanical restrict incurred by the Brostrom procedure and can be an option for patients requiring non-surgical treatment. Overall, the utilization of an orthotic or bracing device is a secure and efficient method of treatment for patients with ankle pain, potentially reducing the risk of further injury and providing relief of symptoms.
Surgical Interventions
Ankle pain Singapore surgery aims to treat forms of ankle pain that do not respond to non-surgical treatment. There are many different types of ankle pain and each type may have a specific surgery or a surgery that can be utilized in severe cases. The type of surgery that is selected is based on the degree of damage and the specific type of ankle pain. Any decision to proceed with surgical interventions should be undertaken in collaboration with your GP and/or a surgeon who specializes in foot and ankle surgery and who can determine the best procedure for the individual based on examination and diagnostic imaging such as X-ray, CT or MRI. Ankle pain comes from different sources including degenerative arthritis, inflammatory arthritis, acute fractures and post-traumatic sequelae, instability secondary to ligament rupture and ankle impingement. Static and progressive deformity and malalignment can also be a cause of ankle pain. Due to the wide diversity of the sources of ankle pain, effective surgical management can only be achieved in specific cases and treatment of some conditions may be best managed non-surgically.
Preventing Ankle Pain
Regular treatment and monitoring of an ongoing ankle injury should involve the use of a brace or strapping and the continuation of this until the injury has resolved and function has returned to normal. A physiotherapist can guide you as to the correct method of strapping and/or bracing at different stages of your rehabilitation program.
Protective strapping is a very effective way of preventing ankle injuries, particularly in individuals with a history of previous ankle injuries or with ankle joint instability. Strapping can help to stabilize the ankle joint and provide proprioceptive feedback to the brain, thus reducing the likelihood of the ankle rolling and an injury occurring. Research has demonstrated that ankle taping can reduce the incidence of ankle injury in high-risk sports and activities. It is important for the tape job or any ankle brace to be applied correctly, and if you are unsure about how to do this, then visit a physiotherapist for a demonstration.
Ankle sprains and other ankle injuries can usually be prevented by paying close attention to the following aspects of the body and its surroundings. Some of these are common sense but it takes an injury to happen before these measures are taken into account. The damage and the occurrence of ankle injuries can be lessened significantly by addressing these predisposing factors.
Strengthening Exercises and Stretching
The goal behind using therapeutic exercise is to derive the benefits of the positive aspects of exercising, while minimizing the exacerbation of the patient’s injury or condition. The initial response to an acute injury is to decrease the inflammation in the ankle. This can be accomplished by elevating the leg, using ice, and using a compression bandage. Isometric exercises can be started once the pain has subsided, and can later be advanced to isotonic and isokinetic exercises. They are initiated in a non-weight bearing position, and can later be advanced to weight bearing activities. This will provide a basis for the progression to strength and functional exercises. Static and proprioceptive neuromuscular facilitation (PNF) stretching exercises may also be introduced in the initial phase to maintain flexibility in the uninjured portions of the ankle and in the muscles and tendons surrounding the ankle. This will depend on the comfort of the patient, and the severity of the injury on the injured ankle. A patient with a fracture in an ankle would not perform PNF exercises on the ankle, but may perform them in the other leg to maintain symmetry.
Proper Footwear and Support
Proper foot care is extremely important in preventing ankle injury. Wearing the right footwear can help to prevent injury. Assess your feet and gait and choose the correct footwear for you. If you are flat-footed, you will require a shoe with good arch support and a slightly rigid sole to limit motion and support your foot. If you have a high arch, you will require a cushioned shoe with a soft midsole to absorb shock and allow for proper foot motion. Ankle stability may be improved with the use of a custom orthotic. Studies have shown that high-top shoes may help to prevent inversion ankle injuries. This is because the boot restricts the motion of the ankle, which in turn prevents the ankle from rolling over. There may also be added protection for the Achilles tendon. Step-slip shoes should be avoided at all costs as they are a major cause of falls and can lead to serious ankle injury. Injury can also be prevented by wearing a preventative brace. Bracing has been shown to be very effective in both the prevention and the rehabilitation of ankle injuries. An ankle brace with heel-lock strapping is the most supportive and provides the best protection. The brace works by immobilizing the Achilles tendon and preventing the talus bone from dropping, thus preventing the ankle from rolling. Supporting the ankle can also relieve pain caused by an ongoing condition. Simple elastic supports can be used for minor pain. For moderate to severe pain, a more advanced brace such as an Aircast can be used. The Aircast works by inflating an airbag around the ankle, which compresses and conforms around the joint. This provides maximum support and protection while maintaining a good amount of comfort for the user. Try your best to avoid taping the ankle. While taping does help to prevent injury by restricting the range of motion, it can have a detrimental effect on the strength of the ankle joint. This is because the joint becomes reliant on the tape for support and as a result, the muscles do not develop properly. This can lead to a decrease in the stability of the ankle joint and an increase in the likelihood of future injury.
Avoiding High-Impact Activities
Jumping activities such as basketball have been shown to produce peak ground reaction forces of up to 5.8 times body weight. High jumping, lay-ups, and the action of coming down from a jump are times when a basketball player is at the greatest risk of experiencing an ankle injury. Again, wearing shoes with greater support around the ankle can help to prevent injury. A less harmful alternative activity for basketball players might be swimming. This is a non-weight bearing activity that offers a great workout with reduced stress on the lower limbs.
High-impact activities usually involve running and jumping. Running has been shown to produce a ground reaction force that is equal to 2.5 times body weight. Competitive runners often experience lower limb injuries due to the repetitive stress on the joints. These injuries can range from mild to severe and can be enough to force someone to give up running as a sport. The most common running-related ankle injury is an ankle sprain. This can be reduced by wearing shoes that have greater support around the ankle joint. Ankle sprains can also be reduced by being mindful of foot placement while running.
Avoiding high-impact activities is another common approach that is used when trying to reduce ankle pain. High-impact activities place unnecessary stress on the joints of the body, particularly the lower limbs. By reducing the amount of stress placed on these joints, the likelihood of developing ankle pain is reduced. Although avoiding high-impact activities may not always be possible, there are often less harmful alternative activities that can be used instead.
yer is at the greatest risk of experiencing an ankle injury. Again, wearing shoes with greater support around the ankle can help to prevent injury. A less harmful alternative activity for basketball players might be swimming. This is a non-weight bearing activity that offers a great workout with reduced stress on the lower limbs.
High-impact activities usually involve running and jumping. Running has been shown to produce a ground reaction force that is equal to 2.5 times body weight. Competitive runners often experience lower limb injuries due to the repetitive stress on the joints. These injuries can range from mild to severe and can be enough to force someone to give up running as a sport. The most common running-related ankle injury is an ankle sprain. This can be reduced by wearing shoes that have greater support around the ankle joint. Ankle sprains can also be reduced by being mindful of foot placement while running.
Avoiding high-impact activities is another common approach that is used when trying to reduce ankle pain. High-impact activities place unnecessary stress on the joints of the body, particularly the lower limbs. By reducing the amount of stress placed on these joints, the likelihood of developing ankle pain is reduced. Although avoiding high-impact activities may not always be possible, there are often less harmful alternative activities that can be used instead.
