Ankle Pain Complete Overview

Ankle Pain Complete Overview

There are many structures present at the anterior aspect of the ankle. These structures are often susceptible to injury. There are many common injuries and conditions around the ankle. Anterolateral impingement is a painful limitation of full range of motion of the ankle due to soft tissue or osseous (bony) pathology. Soft tissue thickening is commonly seen in athletes with prior trauma that extends into the ankle joint. Tibial bone spur impinging on the talus can become a source of chronic ankle pain and limitation of ankle motion in athletes. Osseous (bony) is a spur on the anterior lip of the tibia contacting the talus during dorsiflexion. Arthritis of the ankle joint is commonly the result of a prior injury or inflammation to the ankle joint. It can usually be diagnosed with an examination and x-ray. Osteochondritis Dissecans of the Talus is a chip-type fracture that usually occurs with severe ankle sprains. It causes pain, swelling, and stiffness of the ankle joint. X-rays, CT scan, or MRI are commonly used for the diagnosis. Tibialis Anterior Tendonitis is an overuse condition common in runners. It is a common injury that usually accompanies anterior shin splints. If this tendon is strained, pain and tenderness will be felt upon active dorsi-flexion or when the tendon is touched.

There are many structures present at the medial aspect of the ankle. These structures are often susceptible to injury. There are many common injuries and conditions around the medial ankle. Posterior tibial tendonitis or rupture can occur from overuse activities, degeneration, or trauma. The posterior tibial tendon is one of the major supporting structures of the foot. The tendon helps to keep the arch of the foot in its normal position.

When there is insufficiency or rupture of the tendon, the arch begins to sag, and a flatfoot deformity can occur with associated tight Achilles tendon. The posterior tibial tendon rupture occurs in a hypovascular zone. This occurs distal to the medial malleolus. It will present as painful swelling on the posteromedial aspect of the ankle. The patient will be unable to perform a single leg toe raise, the too many toes sign will be present, the patient will be flatfoot, and there will be a fixed deformity of the hind foot. There are four stages of posterior tibial tendon rupture. Rupture of the posterior tibial tendon could be missed. Tarsal tunnel syndrome is compression of the tibial nerve in the tarsal tunnel. The flexor retinaculum covers the nerve. Tarsal tunnel syndrome is similar to compression of the median nerve in the carpal tunnel. It can be caused by ganglia, accessory muscles, or soft tissue mass. Tarsal tunnel syndrome can be differentially diagnosed as a herniated disc, a stress fracture of the calcaneus, or plantar fasciitis. Tarsal tunnel syndrome will present as pain on the medial side of the foot. The patient will have pain worse with dorsiflexion due to tension on the nerve. There will be paresthesia and numbness of the foot and a positive tinel’s sign behind the medial malleolus. Flexor hallucis tendonitis is pain, swelling, and weakness posterior to the medial malleolus. Dorsiflexion of the big toe may be reduced when the ankle is placed in dorsiflexion. Triggering and pain along the tendon sheath may also occur with toe flexion. Flexor hallucis tendonitis often occurs in activities such as ballet dancing, in which plantar flexion is necessary. The deltoid ligament is the primary stabilizer of the ankle joint. The deltoid ligament provides support to prevent the ankle from everything. An isolated eversion sprain with a tear of the deltoid ligament is a rare injury.

There are many structures present at the posterior aspect of the ankle. These structures are often susceptible to injury. There are many common injuries and conditions around the posterior ankle. Posterior ankle impingement (os trigonum) is a posterior talar impingement of the os trigonum or large process of the talus (stieda syndrome). This is a non-united piece of accessory bone seen posterior to the talus. It is common in athletes such as ballet dancers. There will be tenderness in the posterolateral aspect of the ankle posterior to the peroneal tendon especially with passive plantar flexion. It may be seen in association with flexor hallucis longus tenosynovitis. Flexor hallucis longus tenosynovitis is a condition associated with ballet dancing, in which extreme plantar flexion is necessary. It is characterized by swelling and pain posterior to the medial malleolus. It is triggered by toe flexion. Dorsiflexion of the big toe is less when the ankle is dorsiflexed. Achilles tendonitis is irritation and inflammation that occurs due to overuse. It is characterized by pain, swelling, and tears within the tendon. It is usually treated with therapy and injection. Do not inject inside the tendon. It is rarely treated with surgery. Achilles tendon can become prone to rupture with age, lack of use, or by aggressive exercises. Rupture is diagnosed by the Thompson test and MRI. It is treated by conservative treatments without surgery by using a cast or a boot. However, rupture rate may be high if the patient is treated conservatively. Surgery is done by approximation of the torn tendons. The risk of surgery is infection or skin and wound complications.

There are many structures present on the lateral side of the ankle. These structures are often susceptible to injury. Diagnosis of these injuries can be confusing and many of these injuries can be missed. Diagnosis of a sprained ankle may be the wrong diagnosis. A high ankle sprain is a syndesmotic injury that may require surgery. Other injuries to the lateral side of the ankle include peroneal tendon subluxation, rupture of the peroneus longus tendon, peroneal tendonitis, anterior process of the calcaneus fracture, lateral process of the talus fracture, and Achilles tendonitis.