Ankle Pain and Tendinitis (cont.)
What injuries can cause ankle pain?
Ankle sprains & fractures
Ankle sprains are one of the most common musculoskeletal
injuries. Sprains are injuries to the ligaments of the ankle, causing
them to partially or completely tear as a result of sudden stretching.
They can occur on either or both of the inner and outer portions
of the ankle joint. Ankle sprains more commonly happen when there
is a preexisting muscle weakness in the ankle area or a history
of previous ankle injuries. The typical injury occurs when the
ankle is suddenly "twisted" in a sports activity or
by stepping off an uneven surface. The pain is initially severe
and can be associated with a "popping" sensation. Immediate
swelling over the area of injury often occurs as the injured blood
vessels leak fluid into the local tissue. Examination of the area
may cause severe pain when the ankle is moved. The degree of pain
may not necessarily indicate the degree of damage to the ligament(s).
Ligament injuries are often graded from I to III, ranging from
partial to complete tears. Partial tears retain some ankle stability,
whereas complete tears lose stability because the strapping ligaments
no longer brace the ankle joint. After an examination, significant
ankle sprains are commonly evaluated with an x-ray test. X-rays
can determine whether there is an accompanying break ( fracture)
of the bone.
Acute ankle sprains are initially treated with ice,
rest, and limiting the amount of walking and weight-bearing on
the injured ankle. The leg can be elevated to reduce swelling,
and crutches are often recommended to avoid further trauma to
the injured ligaments. Anti-inflammatory medications can be given
to reduce local inflammation. Ice packs help decrease further
swelling of the area and can reduce pain. Patients with severe
injuries are placed in immobilization casts. Surgical repair of
grade III injuries is considered, especially for those patients
contemplating future athletic participation. Physical therapy
programs are part of the rehabilitation process, incorporating
strengthening exercises of the lower leg muscles. Fractures are
repaired with casting to immobilize the bone for healing. Depending
on the severity, fractures can require orthopedic casting, surgical procedures
including pinning, and open repair of the fractured bone.
Tendinitis
Tendinitis (also referred to as tendonitis) is an inflammation of the tendon. Tendinitis of the ankle can involve the Achilles
tendon, the posterior tibial tendon, or the peroneal tendon. This condition usually
results from trauma but can result from underlying inflammatory
diseases or illnesses such as reactive arthritis (formerly called Reiter's syndrome), rheumatoid arthritis,
and ankylosing spondylitis. All forms of tendinitis cause pain,
swelling, and tenderness in the tendon area involved. The onset
may be rapid, such as with an athletic injury. Immediate treatment
involves immobilizing the area, elevation, and limiting weight-bearing, applying
ice, and using nonsteroidal antiinflammatory drugs (NSAIDs) to
decrease inflammation. NSAIDs such as naproxen (Naprosyn) or
ketoprofen (Orudis) are commonly used for this purpose. More severe inflammation
can require orthopedic casting. Athletic participation should
be limited when the tendon is still inflamed, as there is a
significant
risk of rupturing or tearing the tendon, especially in the Achilles
area, with continued athletic activity. A rupture of the Achilles
tendon more frequently occurs in patients who have had previous
Achilles inflammation. When the Achilles tendon ruptures, it usually
requires orthopedic surgical repair.
Next: What diseases and conditions can cause ankle
pain, and how are they treated? »
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