It is estimated that 2 million Americans suffer from ankle injuries each year. 20% of all sports injuries are ankle injuries. The causes of ankle pain can be endless, but most ankle pain is caused by some form of injury to the ankle. The most common causes of ankle pain include ankle sprains, ankle instability, and ankle fractures. Severe ankle sprains can eventually lead to ankle instability and arthritis of the ankle joint. Ankle sprains can be graded as I, II or III and the higher the grade the more severe the injury. Ankle sprains usually do not require surgical fixation and are often treated with a period of non-weight bearing, resting, elevating, icing and applying a compression wrap to the ankle for a period of time along with medication therapy to alleviate the pain and swelling associated with the injury.
Did You Know?
Did you know that people with higher arches tend to sprain their ankles more? People with higher arches tend to have ankle instability because of the position of the heel bone when walking, standing, and running that puts more stress on the tendons and ligaments on outside of the ankle.
Ankle sprains can sometimes also cause tendon pain, inflammation, damage and sometimes tearing and rupture. Tendons are anatomical structures that connect muscles to bones. Sometimes during an ankle sprain, the tendon can detach from the bone it inserts on and cause what’s known as an avulsion injury of the bone. If someone has a chronic history of spraining their ankle throughout their life, they may have ankle instability and laxity or tearing of the ligaments that surround the ankle joint. Once ankle ligaments become stretched or torn from an injury, they sometimes are no longer able to keep the ankle in an optimal alignment when putting weight on the foot and therefore the ankle will begin to be very unstable and can cause severe pain, damage to the cartilage of the ankle joint that can lead to arthritis, and a tendency for the person to twist and roll their ankle more and more. Typically we see these patients with synovitis of the ankle joint also known as inflammation of the ankle as well as partially torn, thickened or even absent ankle ligaments. At Next Step Foot and Ankle Clinic we are able to provide tremendous relief of chronic ankle pain and instability by performing minimally invasive arthroscopic surgery of the ankle joint to clean up the joint of all inflammatory tissue, loose bone fragments, and repair and augment the damaged ligaments and often times we re-create these ligaments with special non-absorbable suture and bone anchors. This is a day surgery usually done through 3 small, 1 cm skin incisions and the patient is able to go home shortly after the surgery. Usually people report significant improvement in their symptoms and are able to get back to running, marching, hiking, walking without pain or instability.
Ankle fractures or breaking of one or more bones that make up the ankle joint (tibia, fibula, talus) can result from a fall, a motor vehicle accident, a work related injury, sports injury, or pathologically from a systemic disease process the patient has had chronically. Usually if displaced or significantly out of alignment or compromising circulation to the foot, the ankle fracture will need to be surgically repaired to realign the ankle and create a functional foot and ankle for weight bearing. Fixing the ankle joint usually involves use of plates and screws and sometimes external pins and fixation. This procedure is usually not performed right away after the injury but soon after all skin swelling and blisters have resolved. Patients with ankle fractures are acutely advised to remain off of the affected foot/ankle, ice, elevate, wear compression dressings and take pain medication.
People who have ankle fractures are more susceptible to developing ankle joint arthritis down the road and may require more surgery to alleviate pain from the arthritis including ankle joint synovectomy, cartilage repair, fusion or ankle joint replacement. At Next Step Foot and Ankle, we offer a variety of ankle joint surgeries to alleviate ankle pain from arthritis. Patients who choose to undergo ankle joint fusion usually have a severely narrowed ankle joint that is almost already fused on its own but that small amount of motion that they do have is very painful. Fusing the ankle completely rids the patient of the pain but their ankle basically functions the same if not better than it did prior to the surgery. It is often difficult to recognize if a person has an ankle fusion just by watching them walk amongst a crowd. Ankle replacement surgery is usually reserved for older patients with BMI <30 who want to be community ambulators and perform activities of daily life without pain. These patients will not wear out the prosthetic joint as fast as a younger, more active individual would. If you are not a surgical candidate or simply do not want to have your ankle surgically corrected, we can offer you a variety of custom ankle braces that will allow you to walk without significant pain or worsening of the ankle deformity. These braces are usually partially or totally covered by your health insurance carrier. If you would like to discuss ankle bracing or ankle surgical options for your painful ankle, give us a call today!