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Chronic Ankle Pain Causes And Treatment

Authored by Jyoti Shah in Diseases
Published on 05-15-2009

  • Though ankle injuries can heal fast, severe injuries can be the cause of pain in later life. Most athletes at some time or the other injure or sprain their ankles. Injuries can occur on force landing, particularly on a rough uneven surface. At such times the ligaments can be stretched unnaturally into awkward positions causing injury or sprain. Sometimes the pain may vanish only to resurface when the injury is almost forgotten! This can happen especially if healing has remained incomplete at the time of the injury. A single injury to the ankle increases risk of repeated injury, which in turn increases the vulnerability of the ankle to pain. The most common causes of ankle pain are:
    • Torn tendons or tendonitis. This can occur when the tendons are overused because of vigorous sports or athletic activity causing inflammation of the tendons. Injury and arthritis can also cause tendonitis. The ankle may become weak and tender, causing swelling and pain. Rest and immobilization along with anti-inflammatory medicines and application of local analgesic creams can help.
    • Inflammation of the joint lining or synovitis. The synovium is the lining that cushions the ankle joint and allows it to move smoothly. Injury to the ankle can cause inflammation resulting in swelling, heat and pain. Repeated injuries to the ankle and poor muscle tone can trigger this condition. History of injury helps diagnosis. X-rays may help detect a fracture. Treatment involves rest and immobilization. A cortisone shot may be required for severe pain.
    • Ankle sprain accompanied by looseness (instability) of the ankle joint. Can happen after a severe injury to the ankle, particularly when the ankle has twisted inward or outward at the time of injury when there is every chance of rupture of the supporting ligaments. This can cause pain and lead to premature degenerative arthritis.
    • Inflammation of the nerve along the ankle joint, also called neuritis. Neuritis causes pain and can also affect muscle function. The ankle has bundles of nerves that traverse the inner and outer portion of the joint. When there is injury to the ankle these get inflamed. Sometimes ankle instability or ‘looseness’ can be an indirect cause. Scar tissue formed during injury may be compressing a nerve that only an MRI will reveal.

    Treatment After Ankle Injury

    Treatment after an ankle injury will involve giving rest by keeping the leg and foot elevated with a pillow. Cold packs of ice for 15 minutes, every hour or two will help reduce swelling and numb the pain. Hot fomentation can increase swelling and is not recommended. An aspirin is avoided because it prolongs bleeding time. A crepe bandage or ankle stir-up will help. If injury is severe, a cast may be needed. Sometimes crutches are suggested so as to avoid putting weight on the injured ankle. Immobilization for too long can be erroneous. If mobilization starts early, it helps collagen bundle orientation, which helps restore the motion range of the ankle and promotes healing.

    Treatment after an injury must be proper, followed by a thorough check up so that pain does not recur in future. If rehabilitation is incomplete or improper it can cause instability and increase the risk of being injured again. Fitness can be ascertained when:

    • The person walks normally without a limp.
    • Can hop on the injured foot without pain.
    • The injured ankle has regained about 90% of its original strength. This can be judged by comparing with the normal ankle.
    • There is full range motion of the ankle.
    • The patient can resume normal activity: he can walk and jog at least 50% of what he did before, without pain.

    If the treatment is incomplete the patient will always feel pain while climbing stairs or walking on an uneven surface. When the ankle remains lax for a long period is needs to be rehabilitated by exercises to help improve and restore stability and strength and help mobility to return to normal range. Here are some:

    • Try to stand on a step with your heels just a little off the step and then slowly raise yourself on the ball of your foot holding for about 3-4 seconds. Slowly lower your heels to original position. Repeat about 20 times, several times a day.
  • Try to move your ankle to determine its entire range of motion with up and down, in and out and circle movements, without moving the leg. Trying writing the alphabet in the air using your toes.
  • Stand on the floor and try to raise one foot off the floor while balancing your body on the other foot to a count of 15. Gradually increase the count to 20 and then 30. Repeat with the injured foot on the floor.

  • Other therapies

    Sonotron Therapy is non-invasive and drugless. A device called a Sonotron is used. It utilizes low power modulated radio frequency and audio energy. Dr. Alfonso Di Mino invented it in 1987 in the US. It has no side effects and is considered safe for treating acute and chronic pain in joints and soft tissues. For more details see:

    http://www.sonotron-therapy.com/srcweb-JUNE99/SWM99-What/What-Is-Sonotron-Therapy.htm
    Alternative therapies like Pranic healing, hands-on healing, Reiki, can relieve pain, if done regularly.

    It is imperative for any ankle injury to be properly treated with medication, rest and exercise following an injury, so that risk of future injury is reduced and chronic pain can be avoided later in life.

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