Ignoring ankle pain now could hurt later

Dr. Christopher Bock

For The Courier-Herald

Healthy ankles are strong and flexible – they bear your body weight and the impact of your activities. But the demands you place on your ankle joints every day make them prone to injury and pain.

Almost everyone will experience ankle pain at some point. It is usually temporary and requires nothing more than home treatment, including RICE: Rest, Ice, Compression and Elevation. However, pain lasting more than a week should be a cause for concern. If you ignore severe ankle injury or pain, you could be setting yourself up for chronic ankle pain.

The source of the pain

Ankle sprains are, by far, the most common ankle injuries in the adult population. Some studies estimate that at least one million ankle sprains occur every year in the United States.

Though the term “sprain” is used generally to describe any non-bone ankle injury, it specifically refers to an injury to ligaments, which connect bones to each other. When an ankle is twisted inward or outward, tears to the ankle’s small, supporting ligaments often occur, which then leads to swelling, bruising and potential joint instability.

An article, published in the May 2009 issue of the Journal of the American Academy of Orthopaedic Surgeons, reports that approximately 40 percent of those who suffer an ankle sprain will later experience chronic ankle pain, even after being treated for their initial injury. The research found that tendon injuries to the ankle are a possible cause for this chronic pain. In cases where the condition is untreated, the pain – and the problem – often don’t go away.

The good news is, those who seek medical care soon after their sprain occurs can be prescribed physical therapy or other treatment to help ensure proper healing, which improves the likelihood that they’ll avoid long-term problems.

Other causes

While ankle pain is most commonly caused by sprain, there are other causes, including:

• Arthritis of the ankle joint

• A fracture in one of the joint bones

• Synovitis, or inflammation of the synovial lining of the ankle joint, which provides cushioning for joint movement. Synovitis occurs most often with repeated injury to the ankle joint and poor muscle conditioning.

• Osteochondral bone defects in which pieces of bone and cartilage within the joint are damaged or separated from the underlying bone.

• Nerve injury can occur when the nerves that run through the ankle become stretched, torn, injured or pinched under pressure.

• Scar tissue can form when a sprain goes untreated. It puts pressure on the ligaments.

• Torn or inflamed tendons

• Gout

• Infection

Ankle instability

Often described by patients as a feeling of “looseness” in the ankle joint, ankle instability is a common result of a severe sprain that does not heal adequately. An unstable ankle may feel like it could “give way” on uneven terrain.

Ankle instability may be quite painful and is associated with early onset of degenerative arthritis, but it is treatable. A specialist (either a podiatric foot and ankle surgeon or an orthopedist) can best assess your condition and treat any issue. Treatment can range from conservative modalities, such as physical therapy and orthotics, to the latest surgical interventions, such as lateral ankle stabilization techniques and more complicated deformity correction including total ankle replacement.

Protect yourself

Since ankle sprains are so common, people tend to underestimate their potential for causing long-term damage. The injury may not seem very serious at first; and even when the pain lingers, some people don’t seek medical attention because they expect it to heal on its own.

If you believe you have a sprain, try the RICE (rest, ice, compression, elevation; see insert) regimen for 24 hours. If you’re still in pain three to five days after your injury, you should see a physician who specializes in foot and ankle disorders such as a podiatrist or an orthopedic surgeon. You’ll get the best long-term results if your treatment begins soon after your injury.

Podiatrist and foot and ankle surgeon Christopher Bock practices at Enumclaw Medical Center-Cole Street, a part of the Franciscan Medical Group.

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