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Getting To The Bottom Of Ankle Pain

  • Category: Foot & Ankle
  • Posted On:
  • Written By: Andrew P. Gerken, MD

The ankle is a complex structure that, when injured, can lead to pain and swelling, restricted movement, and mild to moderate instability. The most common ankle injuries are sprains, but breaks, stress fractures and the effects of arthritis can also cause these and other symptoms.

The ankle joint consists of three bones: the shinbone, the fibula, and the anklebone. The knobby bumps on either side of the ankle are the very ends of the lower leg bones. The bump on the outside of the ankle is part of the fibula; the smaller bump on the inside of the ankle is part of the shinbone. This configuration allows the foot to bend up and down.

Right below the ankle joint is another joint, where the anklebone connects to the heel bone. This joint enables the foot to rock from side to side. Three sets of fibrous tissues, called ligaments, connect the bones and provide stability to both joints.

A sprained ankle means one or more ligaments on the outside of the ankle were stretched or torn. If it is not treated properly, there could be long-term problems. Physical therapy is necessary. A broken ankle can involve one or more bones, as well as affect the surrounding ligaments. Initially, a cast may be applied, which can later be replaced by a short walking cast. It takes at least six weeks for a broken ankle to heal. Sometimes, surgical repair of the broken bones is required.

Sometimes, despite treatment, the pain and instability may not resolve. The most common cause of persistent ankle pain is incomplete healing after an ankle sprain. There may be a specific spot of tenderness in the front of the ankle that won’t go away. Without thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. As a result, the ankle may be prone to additional injuries.

When is it time to seek additional treatment? If the injury is not at least 80-90 percent recovered two to three months following treatment, it’s time to seek a second opinion. This is especially true if the ankle is loose, or keeps twisting and turning. Ankle arthroscopy may be necessary to stabilize the joint or remove scar tissue, followed by additional rehabilitation.