What causes ankle pain?

There are many causes of pain in the ankles. One of the commonest problems is recurrent ankle sprains. In the ankle joint, the talus bone fits snugly under the tibia and the fibula which hold it in place on either side with the medial and lateral malleoli. These bone pro-eminences are linked with strong ligaments, in particular the deltoid ligament in the middle and the lateral collateral ligament on the side. The commonest form of ankle sprain causes the foot to twist inwards which stretches and may tear the lateral collateral ligament on the side of the ankle. If the ligament is torn or stretched too much, it cannot recover and you will get recurrent ankle sprains and have an unstable ankle. At times during a sprain, the ankle bone, the talus gets fractured (osteochondral fracture of the talar dome).
If this happens, you may have ankle pain, deep in the ankle on an ongoing basis and the fracture will be seen on x-rays or detected with a bone scan. In older people, one of the commonest ankle problems is osteoarthritis. Osteoarthritis will cause pain, stiffness, and at times swelling of your ankle. For more information, go to osteoarthritis. Tibialis posterior tendinitis can cause pain behind the ankle’s medial malleolus. It is due to a straining or overstretching of the tendon of the tibialis posterior muscle which attaches on the tibia, travels down behind the medial malleolus and attaches on the medial cuneiform. The tibialis posterior muscle moves the foot down and in. If your foot is overpronated it has to work much harder to do this, and you are more likely to develop tendinitis of this muscle. We will deal with Achilles tendonitis in a separate section.
Nerve damage can also cause ankle pain. Sometimes the nerves that supply the skin of the ankle can be injured through a sudden jolt or a sprain, or through prolonged exercise (a marathon, for example). The nerves that supply the skin of your ankle have to cross the fascia, the fibrous sheath covering the muscles of the legs through tiny holes. A jolt, or a sprain or excessive exercise distorts these holes, which become slits. These slits squeeze the nerves and cause them to swell. Once swollen, the nerves are trapped in these holes and cannot slim down, as they keep re-injuring themselves on the walls of these holes. As long as they remain swollen, these nerves will send pain messages to the brain. This pain can spread down to the foot and can last for many years. Pain due to loose ligaments or tendons or arthritis only comes when you move the ligaments or tendons or the joints. Nerve pain, on the other hand, can be severe and happen at any time even when you are not moving at all. If you press lightly on an area with nerve pain, the pain gets worse. Can nerve blocks help your ankle pain? Perineural injection therapy (nerve blocks), is likely to help if your pain is coming from the nerves that supply the skin of your ankle. Many people suffering from ankle pain have been successfully treated with perineural injection therapy (nerve blocks). Because this treatment is very safe, it is worth trying at least once, particularly if your pain has not been helped by other treatments.

Ankle pain treatments

Recurrent sprains can be treated with physiotherapy to strengthen the leg muscles and exercises on a balance board to make you react more quickly to changes in the terrain underneath your feet. This will help prevent you twisting your foot unexpectedly. Unfortunately, this will not strengthen the ligaments that hold your ankle steady and weakness of your ankle ligaments is the basic cause of current ankle sprains. The only procedure which can strengthen the ligaments of your ankle is prolotherapy.

If you have a fracture of the talar dome, you need to rest your ankle. This means using crutches, or even putting your ankle in a cast. Severe cases may require surgery. Afterwards, you will need physiotherapy to strengthen your muscles improve your range of motion and your balance. If you fractured your talar dome, you probably very badly damaged the ligaments that hold your ankle steady on either side. You may benefit from prolotherapy to strengthen these ligaments and stabilize your ankle.
If you have posterior tibial tendinitis, you may want to rest your ankle. A physiotherapist can teach you stretching and strengthening exercises. One of the best ways to prevent this tendinitis is to wear orthotics which support the arch of your foot and prevent it from pronating. That way your posterior tibial muscle doesn’t have to pull your foot in so much whenever you take a step. Some people recommend a cortisone injection to reduce inflammation and pain, but this can weaken the tendon and make it more likely to rupture. Please read the section on steroid references to find out why this might be counterproductive

The treatment for arthritis of the ankle is similar to that which is explained in the osteoarthritis section. As other forms of arthritis, it responds well to prolotherapy. Orthotics also help the ankle joint to track straight. Dr. Bertrand can fit you with a guaranteed pair of orthotics.

Prolotherapy References