ANKLE PAIN
Conditions
Overview
ANKLE PAIN
The ankle joint is one of the most commonly injured joints in the human body.
Ankle pain refers to any kind of discomfort within the ankle. Ankle pain can affect either or both ankles, any age group and can severely affect one’s ability to walk.
There are a variety of causes but the most common cause of ankle pain is a sprain, an injury resulting in a partial or significant tear of the supportive ligaments that connect the ankle bones.
The Ankle Joint
The ankle joint is essentially a complex hinge joint that allows the body to move over the foot when it is planted on the ground, during walking or running.
Common Issues
- Sprains – ligament injuries resulting from the ankle being twisted out of its normal position
- Fractures – the fibula is the most commonly fractured bone
- Arthritis – ankle sprains, fractures and significant trauma break down the cartilage
- Tendon injuries – affect the movement and alignment of the ankle
- Misalignment – creates uneven strain on ligaments, tendons and uneven pressure on joints
Symptoms & Signs
•Swelling, sometimes bruising
•Pain with movement or weight bearing
•Unable to put weight on it
•Redness and heat
•Instability – feeling unsteady
Treatment
- R.I.C.E. – rest, ice compression, elevation is the best course of action for immediately after a sprain
- Bracing – we carry the best solutions in ankle bracing for sprains
- Custom Bracing – for degenerative arthritis and tendon failures
- Foot orthotics – often foot orthotics are integral to treating the chronic painful ankle
- Footwear – proper shoes can complement the orthotics or improve ankle stability
- Exercises – we can guide you with recommendations or suggest physiotherapy
POSTERIOR TIBIALIS TENDON DYSFUNCTION (ADULT ACQUIRED FLATFOOT)
Common Issues
- The posterior tibialis muscle becomes irritated and loses function
- The inner part of the ankle gives way causing excessive overpronation, and a flattening of the long arch of the foot occurs
- The outer ankle collapses onto itself and the heel shifts from under the ankle
- An inability to rise up on tiptoes with the affected foot
- A history of trauma does not need to be present as the condition can occur spontaneously
- Most common in middle aged adults, particularly women
- When the foot posture dramatically changes, the failure of the posterior tibialis tendon and the resultant flat foot deformity is usually permanent
Symptoms & Signs
- The tendon becomes inflamed and possibly strained or elongated (attenuated)
- Pain behind your inner ankle (malleolus) with walking or standing
- Often accompanied with significant swelling, warmth, redness and tenderness to the touch, around the malleolus
- Pain and tenderness may carry into your arch
- Pain and tenderness may carry into your inner shin and feel like shin splints
- Stiffness and tenderness around the malleolus when you first step out of bed
Treatment
- Initial treatment should consist of rest, ice and physiotherapy to strengthen the muscle – consult your physician or we will gladly direct you to one of the many qualified physiotherapy clinics in the area
- Custom foot orthotics are integral to recovery as they are very effective, and the benefits are often immediate
- We cast using plaster almost exclusively to capture the foot in the most ideal and functional position
- Supportive ankle bracing – we carry the best off the shelf bracing solutions
- Custom Ankle Bracing (gauntlet AFO) – we provide custom ankle braces in the more extreme cases
- In addition to fitting you with the most effective foot orthoses, we will guide you with appropriate exercises
ACHILLES TENDINITIS
Common Issues
- The Achilles tendon, the largest and strongest tendon in the body, becomes irritated due to excessive load or overuse
- The condition can occur in the midtendon or at the very back of the heel where it attaches to the calcaneus (heel bone)
- Overuse activities such as sports requiring pushoff are the most common causes
- It can also occur shortly after taking on a new job, again as a reaction to overuse
Symptoms & Signs
- The tendon becomes inflamed and swollen
- Pain and stiffness in the back of the ankle, close to the heel
- Irritated with walking or standing
- Often accompanied with significant swelling, warmth, redness and tenderness to the touch
- Stiffness and tenderness when you first step out of bed
- Chronic pain lasting more than 6 weeks could indicate a break down in the health of the tendon and lead to rupture
Treatment
- Initial treatment should consist of rest, ice and physiotherapy to strengthen the muscle – consult your physician or we will gladly direct you to one of the many qualified physiotherapy clinics in the area
- Custom foot orthotics are integral to recovery as they are remarkably effective in addressing biomechanical factors that contribute to the injury
- Stretching – as the pain lessens, stretching is very important
- Strengthening – exercises help to restore strength, tendon strength and capacity to handle loads from activity
- In addition to fitting you with the most effective foot orthoses, we will guide you with appropriate exercises
- Supportive ankle bracing – we carry the best off the shelf bracing solutions
- Walking boot – we provide Aircast walking boots to eliminate the strain on the healing tendon
ANKLE ARTHRITIS
Common Issues
- The most common form is osteoarthritis, typically associated with aging
- However, severe or repetitive injuries to your ankle can lead to osteoarthritis
- Other factors that contribute include obesity and poor joint alignment
- The (talocrural) joint where your shin (tibia) meets the top bone of your foot (talus) and the (subtalar) joint between the talus and your heel (calcaneus) are the 2 major ankle joints affected by arthritis
Symptoms & Signs
- Severe pain with motion
- Stiffness, and swelling, even in the morning
- Reduced ability to move or walk
- An inability to tolerate walking on uneven surfaces (an example is cutting the grass)
Treatment
- Custom foot orthotics are integral to improving comfort and function
- Custom Ankle Bracing (gauntlet AFO) – We custom fit the Arizona AFO to stabilize the ankle and subtalar joints
- Orthopaedic or custom made footwear – made from a cast of your feet, these footwear stabilize the arthritic joints and improve heel to toe walking
Common Ankle Issues and Solutions
How does it work?
Adult-acquired flatfoot deformity (from PTTD), Achilles tendonitis and ankle arthritis are common and often debilitating chronic foot and ankle conditions.
Brad will formulate a proper treatment course by performing a thorough musculoskeletal evaluation, accounting for deformity and poor alignment, and sites of pain and sensitivity. Ultimately, the management goal is to remove or reduce forces that have robbed you of normal function.
Step 1
Book An Assessment
- Call us or book a pedorthic assessment on line
- An ankle assessment typically takes 30 to 45 minutes
- If you have shorts, bring them(we also have shorts at the clinic)
- Bring 2 or 3 pairs of the shoes you wear most often, for work and play
- Bring your prescription if you have one, your x-ray CD and/or reports from an x-ray or MRI
step 2
During Your Assessment
- Review of your condition and history of injury and discuss your x-ray or MRI results
- Examine your muscle strength, structural alignment, joint ranges of motion and how you walk (gait assessment)
- Answer any questions you may have relating to your foot or lower limb condition
- Discuss the various orthotic or bracing options, fit you with an over the counter brace or cast your feet for either a pair of orthotics or a custom ankle brace
- Recommend or fit footwear
- Provide strengthening exercises, stretches or referral to complementary health professionals
step 3
ENJOY A BETTER QUALITY OF LIFE
- Typically, you will receive your orthotics in about 2 weeks
- A custom gauntlet brace takes about 4 weeks to make
- Within a few weeks, your feet or ankle should be feeling less pain
- If necessary, we’ll have you come back for a follow up
- Follow ups are for further modifications, and/or to review exercises and stretches, and footwear recommendations
- At any point in the future, we encourage you to return for any necessary adjustments and service the orthotics or custom brace if necessary
Frequently Asked Questions
Custom gauntlet braces cost $1200
Many insurance companies cover much of the cost
Custom ankle bracing can aid in the relief of pain and instability associated with arthritis. If your ankle is painful with activity or you easily roll your ankle on uneven ground(chronic instability), a custom ankle brace may help you.
Gauntlet braces work like a stabilizing cast around your ankle so they make your ankle a little larger in circumference. Typically, quality athletic footwear and work boots will easily accommodate this brace.
Ready to Get Started
Request An appointment
Assessments are typically 30 to 60 minutes. Bring your footwear you work in and what you wear after work, bring shorts, and the prescription from your referring medical professional if you have one.