Ankle Pain

By Jay Herrera, DPT
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A leg tensor bandage being applied outdoors

Ankle Pain 

The  ankle joint AKA talocural is  comprised from three bones, the tibia and fibula (  long bones of the leg)  and the talus ( top bone of the foot). Functionally, it is a hinge type joint, permitting dorsiflexion and plantar flexion and slight rotation of the foot.  The bones of ankle joint are connected by supportive ligaments. Various muscle at the back, top and bottom of the foot function as joint movers.

Ankle pain occurs from: a) trauma  such as sprain, strain, or fractures or b)  a variety of joint arthritis including osteoarthritis the most common or from, gout or rheumatoid. Osteoathritis is most often due to prolonged wear and tear on the joint structures.

Traumatic foot Injuries may occur from specific event  e. g. tripping or falling,  repetitive activities including walking, running or competitive  sports including, soccer, tennis, football, or basketball. 

Ankle Injury may result in pain and dysfunction of any of the soft tissue structures i.e. ligaments, muscles and their tendons. Poor fitting shoes or prolonged wearing of high-heal shoes (see picture below,)  coupled with  or poor biomechanics may also cause foot pain disorders.

Methods of injury prevention include: proper warm up exercise before activity, proper fitting shoes for walking or sports, and cooling down after sport is also advisable.

Pain is often the result of an inflammatory processes due to direct or repetitive trauma.

Common Ankle Injuries:

Sprain/strain: a sprain refers to injury stretching or tears of ligaments. A strain is injury to muscles or tendon.

Most common ankle sprain/strains occur from a twist during a misstep or improper landing during a jump or planting hard playing sports. Tendonitis is inflammation of them muscles including the Achilles or Peroneal.

Many sprain/strain type of  injuries are self-limiting. If pain persist treatment options include.

Treatment: Acute (fresh) vs. Chronic (lasting 90 + days):

Acute treatment:  Remember RICE:  R-est, I-ce, C-ompression (soft bracing e.g. ace bandage wrap), and E-levation . The RICE method should be the first approach in the treatment of recent foot injuries.  Once the sharp pain improves applications of heat, e.g. warm baths provides relief.

Conservative care as done by a licensed chiropractor includes, patient education, joint mobilization or manipulation, massage,  use of braces or supports, as well as therapeutic and rehabilitative exercises. 

Physical medicine modalities include ultrasound ; TENS – transcutaneous electro-muscle stimulator; or laser light device- to help reduce inflammation and promote healing.

Sports medicine chiropractic providers also employ kinesiology  taping methods which have been shown to be effective.

Acupuncture:  Acupuncture has been shown to be effective in treating joint and muscle inflammation and adjust the muscular tone/tension.

Chronic care:  Conditions which last longer than 90 days or become recurrent.  Over time or due to repeated injuries, some patients develop   ankle joint osteoarthritis (OA).  OA may affect different joints of the foot and toes. OA may be, slight to advanced and adversely affect activities of daily living e.g. walking or stair climbing.

Conservative Treatment options may include strengthening exercises, or a combination of land and water based exercises. Tai-chi as a light force exercise has been shown to be helpful including in help in restoring balance.

More serious injuries or longer lasting injuries may require surgery.

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