At Pioneer Podiatry, we treat a wide range of problems associated with ankle pain and instability. Ankle problems can be divided usually into two types: acute (sudden) ankle injury, or chronic (long-term) ankle pain.
Acute Ankle injury
Acute, or sudden, ankle injuries are very common. They are most common in athletes, however then can occur suddenly
A sprained ankle is when your ankle rolls out (or inverts) and the lateral ankle ligaments are stretched too much, or torn. This is also called an "ankle inversion injury". Severity can vary from a mild "rolled ankle" all the way to complete rupture of tendons or broken bones.
What can cause a Sprained Ankle?
At its most simple, sprained ankles occur when the ankle rolls out too much suddenly. Often this can happen while doing something energetically or quickly, such as sport or exercise, however some people find they are prone to rolling their ankles very frequently while just walking.
What does a Sprained Ankle feel like?
When you do the initial injury, you may hear a popping sound, and you will usually notice swelling and bruising and pain.
If you've had a severe injury, it might be hard to walk or stand. You might even need crutches or other help to walk.
In more severe injuries, deep pain into the ankle suggest bone injury, which could include talar dome fracture, avulsion fracture, tibial or fibular fracture. Pain higher up in the the ankle could indicate a high ankle strain.
How is a Sprained Ankle Diagnosed?
Podiatrists are the most highly trained doctors for foot problems. Depending on your symptoms and clinical examination, we may need X-rays or CT scans or an MRI to determine exactly which structures are injured, and to plan your rehab and return to normal activities.
What are the most commonly injured lingaments?
The lateral ankle ligaments on the outside (little toe side) of the foot are the most commonly injured. These are the anterior talo-fibular ligament (ATFL), the calcaneofibular ligament (CFL), and the posterior talo-fibular ligament (PTFL). The most commonly injured is the ATFL.
Nowdays we use MRI a lot more, and we have become aware of the significant injury that often happens to the ligaments on the inside (big toe side) of the ankle. It is common to get medial foot and ankle pain after an ankle sprain, often due to damage to the deltoid ligament.
A High Ankle Sprain is when the inferior tibiofibular ligament and syndesmosis is injured. These are important to recognise and treat accordingly.
How do we treat a Sprained Ankle?
Once you've sprained your ankle, your chance of re-injury is very high, with an average of about 60% of people going on to sprain the ankle again after the first time. The 3 main steps when treating an ankle sprain are...
Initial phase - Pain relief and Inflammation Control
Second phase - Regain full movement of joint, full muscle strength, and joint awareness (proprioception)
Third phase - Return to normal function (including work and sports activities)
Our foot doctors at Pioneer Podiatry are trained to diagnose and treat all causes of acute ankle pain, and we can develop a treament and rehab plan to get you back on track as fast as possible.
Many acute ankle injuries can progress to become chronic or long-term in duration, and if you have received initial treatment for an ankle sprain (from a physiotherapist or podiatrist or otherwise) that is not getting better, you should get in touch with us to arrange a full specialist assessment of your injury. We are familiar with the common causes of long term post-inversion injury pain and disability. We are registered with Workcover if your injury has occurred while working.
Chronic Ankle Pain
Chronic Ankle Instability
Chronic ankle instability is a condition characterised by a recurring ‘giving way’ of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Many athletes, as well as others, suffer from chronic ankle instability.
What are the signs & symptoms of Chronic Ankle Instability?
- A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
- Persistent (chronic) discomfort and swelling
- Ankle pain or tenderness
- The ankle feeling wobbly or unstable
What causes this?
Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is then affected.
How is it treated?
Treatment for chronic ankle instability is dependent on the severity and the patient’s level of activity. A treatment plan may include:
- Physical therapy to strengthen the ankle, improve balance and range of motion, and retrain your muscles
- Foot mobilisation therapy, to restore normal function of the joints and bones of the foot and ankle.
- Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning (racing also helps prevent additional ankle sprains)
- Improved footwear
- Customised foot supports (orthotics) if the underlying foot mechanics are contributing to the instability
- Surgery if conservative treatment fails – surgery involves repair or reconstruction of damaged ligaments.
Tarsal Tunnel Syndrome
The Tarsal Tunnel is a narrow space that lies on the inside of the ankle next to the ankle bone. The tunnel is covered with a thick ligament that protects and maintains the structures contained within the tunnel (arteries, veins, tendons and nerves).
Tarsal Tunnel Syndrome is a compression, or squeezing, of the posterior tibial nerve which runs within the tarsal tunnel. Compression of the posterior tibial nerve can produce symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.
Tarsal Tunnel Syndrome is similar to Carpal Tunnel Syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.
What causes Tarsal Tunnel Syndrome?
Caused by anything that produces compression on the posterior tibial nerve:
- Flat feet or collapsing arches cause the heel to tilt inwards which places increased strain in the region of the tarsal tunnel, sometimes causing compression of the nerve and therefore ankle pain.
- An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve and cause ankle pain. Some examples may include an arthritic bone spur, ganglion cyst, a varicose vein, ganglion cyst and swollen tendon.
- An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
- Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve.
What are the symptoms?
Patients with Tarsal Tunnel Syndrome experience one or more of the following symptoms:
- Burning or a sensation similar to an electrical shock
- Ankle pain – sometimes shooting pain.
Symptoms are typically felt on the inside of the ankle and/or on the underside of the foot. Sometimes the symptoms appear suddenly, often brought on by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.
How is it treated?
Correct diagnosis and early treatment of Tarsal Tunnel Syndrome is very important. If left untreated, the condition progresses and may result in permanent nerve damage.
Non-surgical treatment may include:
- Initial rest and applying ice packs
- Oral NSAIDs medication to help reduce pain and inflammation
- Injection of local anaesthetic and corticosteroid may be useful in reducing inflammation
- Padding and strapping to support the arch which, in turn, reduces the tension and compression of the nerve – to provide initial short term relief for the nerve
- Supportive footwear and customised foot supports (orthotics) to support the arch and provide long term relief for the nerve.
If the symptoms are not addressed early, the nerve can be severely damaged and may require surgery to decompress the nerve.
Sinus tarsi syndrome
This is a common cause of pain in the lateral ankle. It can occur after a sprained ankle, but is also very common in people with flat feet. If you have this condition, you will feel pain on the outside of the ankle (little toe side). Most people with this condition also feel very unstable on their feet, particularly on uneven surfaces.
How do we diagnose Sinus Tarsi Syndrome?
When you see us in clinic, we will be able to easily test for this using a few simple clinical tests. It is particularly painful when the foot in inverted and everted, and it is very painful to push into the sinus tarsi, which is a gap between the ankle bone (talus) and the heel bone (calcaneus). Sometimes we may take X-rays, CT scans, or MRIs to get a closer look, or to exclude other causes of pain in this area.
How do you fix this problem?
This condition responds very well to custom orthotic therapy to correct foot function and remove tissue stress to the sinus tarsi. Usually we do this, and have great results. Surgery is very rarely needed for this condition.