Ankle Problems
Equinus
Equinus is a condition in which the motion of the ankle is limited. There is a lack of flexibility in the ankle preventing motion in the upward direction. This can often happen and cause the foot and leg to compensate for this limitation in motion. This can then cause flattening of the arch, toe walking or pain in the ankle, knee, hip or back. There are several causes of this disorder. The list is quite long but is often due to tightness of the Achilles tendon or calf muscles (gastrocnemius or soleus muscle). It can occur at birth or later in life. Treatments can vary widely from stretching, physical therapy, casting, shoe modifications, or even surgery in rare cases. This is very common in diabetes as there are changes to the fibers as diabetes progresses. On occasion there are bony spurs or fragments which can cause this to happen. Several neurologic conditions are related to equines including stroke, Cerebral palsy and more. Equinus can also cause heel pain or planar fasciitis.
Ankle Fractures
Ankle fracture is a partial or complete fracture (break) in one or more of the bones of the ankle. This can range in severity from a small crack to a large dislocation of the tibia or fibula bones. Sometimes this may be mistaken for a simple sprain. Usually there is severe ligament injury which also occurs during the traumatic event. Ankle fractures should always be evaluated quickly to prevent further damage. If an emergency you should got to the hospital right away and then follow up as instructed by the ER staff. Not every ankle fracture will require surgery. Base on the severity and amount of shifting or displacement that has occurred will help determine treatment. X-rays are very helpful in determining what treatment is right for you
Ankle Sprain
Ankle sprains are a very common injury to the soft tissues, tendons, and ligaments of the ankle. These usually occur to the lateral (outside) part of the ankle. These ligaments are like rubber bands that connect the bones together and keep the ankle stable. Sometimes a stumble or fall can cause these ligaments to tear causing pain, swelling, bruising, and difficulty walking. There are various types of sprains, and can cause long term problems if left untreated. This can cause the ankle to feel weak, unsteady, or wobbly. Treatments often include immobilization, bracing, or therapy. Prompt evaluation may help prevent long term problems. In some rare cases surgery is required to repair the ligaments.
Ankle Swelling
Foot and ankle swelling is also known as edema or lymphedema. In this condition there is a buildup of fluids in the ankle or leg tissues. Usually this is painless and causes no problems, but not always. There are certain instances where this can cause pain, skin changes, ulceration, difficulty wearing shoes, or difficulty walking. Common causes are injuries, surgery, heart problems, kidney problems, allergies, medications, or disorder of the veins, arteries or lymph vessels. Treatments can range widely from medication, compression garments, massage, or air powered leg sleeves. Gravity can cause fluid to collect in the legs and elevation of the legs to the level of the heart is often very important to reduce swelling. Occasionally labs, ultrasound, or other imaging is necessary to help understand the cause of swelling of the legs.
Chronic Ankle Instability
Chronic ankle instability is a condition in which the ankle will “give way” or “roll” without much warning. This often occurs while walking or standing. There is usually some history of an injury to the ankle but usually has pain and swelling. This will often make it difficult to walk on uneven surfaces. Usually an x-ray is required and a thorough exam. Other problems are commonly associated with this condition such as talar dome lesions or peroneal tendonitis. Treatment options include physical therapy to help strengthen the ankle and improve balance. In other cases bracing is preferred to help regain support and stability of the ankle. In some cases surgery is required to repair the ligaments and treat other associated problems.
Chronic Ankle Pain
Ankle pain can halve several causes. The list is quite extensive but it is often characterized by pain or instability while walking. There may be swelling, redness, or clicking. History of fractures, arthritis, ankle sprains can often be associated to ankle pain. X-rays are required to accurately assess the ankle joint. An MRI is occasionally necessary to view the structures that surround the ankle. Treatments vary from shoes, orthotics, braces, injections, physical therapy, and medications. Depending on the cause of the pain, surgery is sometimes required and may include an arthroscopic evaluation (ankle scope), fusion or even replacement.
Subtalar Joint Pain
The subtalar joint is often overlooked but important joint in the foot. This joint allows side to side motion of the foot and is important in walking on uneven or sloped ground. The subtalar joint can become inflamed or arthritic causing severe pain. Subtalar joint problems can also lead to issues with flat feet or pronation. Treatments vary and include changes or modifications to shoes, orthotics, injections, medications, bracing or physical therapy. Surgery is rare but occasionally necessary to treat the problem.
Ankle Arthritis
Ankle arthritis is the wearing or destruction of the joint surface of the ankle. This can vary in severity from mild to severe. Irregularity or changes occasionally happen and cause pain swelling or difficulty walking. The ankle may feel stiff, sore and radiate pain into the leg. The causes are extensive but frequently happen due to injuries, fractures, sprains, wear and tear, age, genetics, or rheumatoid conditions. Once damage has happened to the cartilage covering of the ankle bones this may be permanent. Inflammation of the soft tissues is also common surrounding the ankle, known as synovitis. There are several treatment aimed at treating arthritis and pain in the ankle, hopefully improving pain. This includes shoes, orthotics, braces, injections, medication physical therapy. Surgery is sometimes required to remove spurs, loose fragments of cartilage, treat cystic changes. In severe cases the ankle is sometimes fused or replaced in order to provide pain relief.
Tarsal Tunnel Syndrome
The tarsal tunnel in the ankle is located near the medial (inside) part of the ankle. This is where several arteries and nerves enter the foot. There are ligaments and other structures which can cause the nerves of the ankle to become compressed. Compression of the posterior tibial nerve can cause symptoms which include tingling, burning, shocking sensations, numbness, shooting pain or heel pain. These are usually experienced along the medial foot (inside part). It can be caused by over use, pronation or flat feet, cysts or tumors, varicose veins, injuries or diabetes. Diagnosis occasionally requires a special study called an EMG or NCV to better understand the condition. Treatments often include modifications to the shoe, orthotics, immobilization, injections, bracing or physical therapy. Occasionally a surgical procedure called a tarsal tunnel release is required to reduce pressure along the nerves.
Joint Stiffness
Joint stiffness is characterized by limitation in range of motion of a joint in the foot or ankle. Sometimes bones are connected by a bridge of bone or tissue which is called a tarsal coalition. These bones become fused together causing significant stiffness and occasionally pain. This can be treated with orthotics, injections, or medications but sometimes requires surgery to remove the tarsal coalition and restore motion. Other causes of joint stiffness may include ankle arthritis, inflammation or swelling.
Talar Dome Lesion - Osteochondral defect
A talar dome lesion is an injury to the joint surface of the talus at the ankle joint. The talus is similar to the skin of an apple with a tough skin and a softer interior. When an injury occurs there is a piece bruised or broken off leading to pain, swelling, clicking, catching or locking of the ankle. MRI of the ankle can often identify the size and severity of the lesions. Treatment can include immobilization, bracing and injections. In some cases surgery is required to remove loose pieces, and clean out any bone fragments which prevent proper healing. Occasionally drilling or micro fracturing is required to relieve pain and edema of the bone beneath the cartilage. Many times this can be done using ankle arthroscopy (ankle scope).