Arthritis is often the cause of chronic ankle pain, but other conditions such as osteochondral lesions of the talus can certainly be the reason a patient suffers from the condition. People who are involved in sports are at risk of ankle instability and peroneal tendon injuries, although the conditions can also be the result of repeated injuries over time.
While a sprained ankle is not usually viewed by patients with great alarm, if the cartilage does not heal properly, the damage can be long lasting. The top of the dome-shaped ankle bone (talus), which is completely covered with cartilage, forms the ankle joint where it meets the shin bone (tibia). When this tough, rubbery tissue is injured by a sprain, for example, it must be allowed to heal completely otherwise it can soften and separate from the rest of the cartilage, causing chronic pain.
Although conservative treatment, such as immobilizing the ankle in a cast on a strictly non-weight-bearing basis, tends to resolve the situation with young patients, adults usually require surgery. The surgical options for this condition vary from arthroscopic minimally invasive techniques to open cartilage transplant procedures.
Chronic ankle instability is a condition that often develops after repeated ankle sprains. In addition to causing persistent pain, it may cause a cycle of re-injury, leading to a general weakening of the ligaments, which in itself results in greater instability. Treating the initial sprain correctly and then rehabilitating the muscles and tissues in the ankle for strength and balance is crucial.
Similarly, a peroneal tendon injury, such as a tear, subluxation or a case of tendonitis, can become chronic and should be evaluated by a foot and ankle surgeon as soon as the patient feels pain and experiences swelling and/or the back of the ankle is warm to the touch. If non-surgical treatments are not an option, the post-operative recovery period will generally include six weeks of non-weight-bearing immobilization followed by physical therapy.
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How do you recommend treating chronic ankle pain?
As explained by Dr. Anand Vora.
Chronic ankle pain is something that truly does require physician work on. Chronic foot pain oftentimes can be addressed by just a first step of home remedies, shoewear modifications, and changing activities and changing things up so that activities are varied. Ankle pain, generally speaking, can be more concerning. It requires more significant medical evaluation and workup to identify the underlying causes of the ankle pain. The real issue is understanding what’s causing the pain so that we can treat it appropriately because the causes of ankle pain can vary. They can be localized to the foot or ankle, but also can be from systemic causes throughout the body. Patients can get swelling in their ankles from even non-orthopedic conditions, such as heart-related problems or kidney-related problems.
Ankle pain is something that requires further evaluation, extensive diagnostic workup, and making sure that we can identify the cause. Most often, what we’re treating in our practice stems from either instability or weak ligaments around the ankle that we can address both conservatively or surgically. If it’s related to the tendons or other soft tissues, oftentimes we can rehab those patients and allow the tendons or ligaments to heal. Oftentimes conservatively, and in some scenarios, surgically. Lastly, if the ankle pain is caused by ankle arthritis or degeneration and loss of the normal cartilage surfaces, that can be treated with cortisone injections or bracing. Sometimes we have to treat that with surgical intervention, including minimally invasive surgeries such as arthroscopy, or surgeries such as ankle replacement, to try to preserve the motion and function of the ankle while still providing pain relief.