Chronic Lateral Ankle Pain
The ankle is the joint that forms between the tibia and the ankle. This joint is located in the lower part of the lower limb and connects the tibia to the foot.
The bones are connected to each other and fixed with connective tissue strips, which are called ligaments. The ligaments guide the movements of the joints and do not allow the bones to move too far apart. The joints are normally very elastic and when stretched they return to their normal length without any other problems. However, when due to a violent movement the bones are significantly separated from each other then the ligaments are significantly stretched and it is possible to cut. In this case the patient feels intense discomfort.
In the ankle joint there are ligaments on the outside and on the inside. On the outside of the ankle there are 3 tapered ligaments and on the inside there is a flattened ligament, the medial lateral ligament. The 3 ligaments on the outside of the ankle have different names depending on the area of protrusion and bulge. The more severe the sprain, the more joints have been injured.
Recurrent or permanent (chronic) pain in the outside of the ankle often develops after an injury such as a sprained ankle. However, many other conditions can also cause chronic ankle pain.
The ankle shows swelling (swelling) almost immediately after turning the foot. The swelling is usually more severe on the outside of the ankle and may be accompanied by hematoma. At the same time charging the limb is painful or even impossible.
The symptoms concern:
- Pain usually on the outside of the foot (the pain may be so severe that the patient has difficulty walking, in some cases the pain is a permanent, hazy pain)
- Difficulty walking on uneven ground or toes
- Feeling of instability
- Repetitive ankle sprains
The most common cause of a persistently sore foot is inadequate healing after an ankle sprain. When you get a sprained ankle, the ligaments between the bones stretch. Without a complete recovery, the ligaments and surrounding muscles may remain weak, leading to recurrent instability. As a result, you may experience further ankle injuries.
Other causes of chronic pain include:
- Injury to the nerves that penetrate the ankle. The nerves can be stretched or injured by a direct hit or by constant pressure while the foot is trapped.
- Cut or inflamed tendon.
- Ankle arthritis.
- Fracture of one of the bones that make up the ankle joint.
- Inflammation of the synovial membrane.
- Development of scar tissue in the ankle after a sprain. The scar tissue takes up space in the joint, squeezing the ligaments.
Ankle x-rays are usually requested by a specialist. An x-ray of the other leg may also be needed so that the doctor can compare the injured to the non-injured ankle. In some cases, additional tests may be needed, such as a bone scan, CT scan, or MRI scan.
The treatment will depend on the final diagnosis and should be individualized to the needs of the individual. Both conservative and surgical methods are used.
The conservative method includes:
- Anti-inflammatory drugs such as aspirin or ibuprofen to reduce swelling.
- Physiotherapy, which includes natural means (Diagnostic pump, TECAR, currents, LASER etc) & exercises (on a balance disc, with the aim of strengthening the muscles, restoring range movement, and increase the perception of the position of the joint.)
- Ankle splint or other support.
- Injection of a steroid medication.
- In the event of a fracture, immobilize to allow the bone to heal.
Harmon K.G., (2007). Which support is best for first-time ankle sprains? Clin J Sport Med, 17 (4): 333 – 334.
Weber J.M., & Maleski R.M., Conservative treatment of acute lateral ankle sprains, Clin Podiatr Med Surg, 19 (2): 309 – 318.