ANKLE PAIN      

Many people complain of ankle pain. The very young can experience ankle pain, active/sporting people often damage the ankle & the elderly experience various forms of ankle pain. Being such a broad area, we will discuss only the most common ankle problems.

Ankle pain can will generally affect either the back of the ankle, or either side of the ankle. The 3 most common ankle problems are :

• achilles tendonitis (located at the back of the ankle)

• posterior tibial tendonitis (located along the inside of the ankle)

• ankle sprains (located along the outside of the ankle)

1. Achilles tendonitis (rear ankle pain) This type of ankle pain is commonly seen in athletes/active people, but also anyone who maybe has commenced an exercise program such as walking. The pain is generally located in the middle portion of the achilles tendon (the thick band of tissue just above the back of the heel bone). In the initial stages, the pain may be more a dull ache. It generally worsens with more activity & generally ceases upon finishing the walk or activity. The pain may continue as an ache for some time after.

2. Posterior tibial tendonitis (inside ankle pain) Posterior Tibial Tendonitis is a strain of the Posterior Tibial Tendon which runs along the inside of the ankle and the foot. When there is Posterior Tibial Tendon dysfunction the tendon does not hold up the arch resulting in flat feet. This can lead to heel pain, arch pain, Plantar Fascitis and/orHeel Spurs. With Posterior Tibial Tendonitis pain will be more severe upon weight bearing especially while walking or running. Posterior Tibial Tendonitis occurs when the muscle is over used and the tendon (soft tissue) that connects the muscle to your bone is strained. Years of over-pronation (flat feet) can also lead to Posterior Tibial Tendon dysfunction. If you keep over using the muscle, damage to the tendon builds up and Tendonitis develops. At first the pain or swelling may come and go quickly but eventually the problem may become more permanent, eventually leading to foot collapse. A serious complication of this condition in that if left untreated the tendon may rupture leading to disability. Early treatment of this condition is indicated to prevent serious problems. This includes the use of orthoses to support the foot and relieve tension on the tendon allowing the body to heal the area. In severe cases options include the use of plaster of Paris casts or orthopaedic walkers to immobilise the foot and ankle. In the case of tendon rupture surgical intervention is inevitable and post surgery most will require foot orthosis.

3. Ankle sprains (outside ankle pain) Anything that makes the ankle 'tip over' increases the chance of an ankle sprain - this can occur in sport (eg jumping and landing on someone's else's foot), walking on uneven surface, twisting motions etc. Sprains are classified into three types, based on how severe the injury is: Type 1 - the ligaments have been stretched but are still intact. There will be pain and a small degree of swelling but no difficulty moving the ankle. Type 2 - a more severe injury, involving a partial tear of a ligament. Pain will be moderate to severe, the ankle will be swollen and difficult to move and there will be some bruising. Weight bearing will be painful. Type 3 - a complete tear through a ligament. There will be severe pain, swelling, loss of joint motion and inability to walk. The ankle is often unstable and bruising is more extensive.

Self Treatment

The sooner treatment starts for a sprained ankle, the greater chance to prevent chronic pain and long term instability.

SYMPTOMS of a Sprain include:

• a sensation of the ankle "giving way" at the time of injury
• pain at or near the injury site
• difficulty in moving the joint
• swelling
• bruising

Self treatment:

• Rest your ankle - do not walk on it.
• Ice - this helps to keep the swelling down. Use ice on the injury several times a day for 15-20 minutes (more than 20 minutes is not advised)
• Compressive bandages are needed to immobilize the ankle sprain and to support the injury.
• Elevate the ankle above your heart level for as much as you can for 48 hours.

If the sprain is a 2nd or 3rd degree ankle sprain, seek professional advice immediately.

Podiatric Treatment

Sprained ankle treatment

If the ankle sprain is a 2nd degree sprain, then in addition to the R.I.C.E. principle, a more effective means of immoblising the ankle (splints) may be needed. Anti-inflammatory medication may also be used to help.

If the ankle sprain is a 3rd degree sprain, cast immoblisation is needed for at least 2-3 weeks. Surgery to repair the ruptured ligament is often needed.

Physical therapy modalities (such as ultrasound) and manual therapy modalities (such as friction massage) are often used when the acute phase is over.

As soon as treatment is instigated, consideration must be given to adequate rehabilitation:

* exercises to increase proprioception

* ankle braces and strapping to facilitate activity

* muscle strengthening and flexibility exercises

* gradual return to any sporting activities

* maintain fitness by doing alternative activities

Exercises for sprained ankle rehabilitation

Exercises after the first 48 hours play a major role in the in the rehabilitation of the sprained ankle and the prevent of ankle sprains.

lising the ankle (splints) may be needed. Anti-inflammatory medication may also be used to help.

If the ankle sprain is a 3rd degree sprain, cast immoblisation is needed for at least 2-3 weeks. Surgery to repair the ruptured ligament is often needed.

Physical therapy modalities (such as ultrasound) and manual therapy modalities (such as friction massage) are often used when the acute phase is over.

As soon as treatment is instigated, consideration must be given to adequate rehabilitation:

* exercises to increase proprioception

* ankle braces and strapping to facilitate activity

* muscle strengthening and flexibility exercises

* gradual return to any sporting activities

* maintain fitness by doing alternative activities