Tag Archives: ankle pain

Sinus Tarsi Syndrome

Summary

  • The sinus tarsi is a small cavity located on the outside of the ankle. This cavity contains numerous anatomical structures including ligaments and joint capsule. These structures may be injured following an ankle sprain or due to the repetitive strain associated with an excessively pronated (flat) foot. When this occurs, the condition is known as sinus tarsi syndrome. Patients with sinus tarsi syndrome typically experience pain over the outside of the ankle. There may also be swelling and tenderness in the region. Symptoms are typically worse in the morning and may present as pain and stiffness that slowly improves as the patient warms up. Symptoms may also be aggravated during walking or running especially on slopes or uneven surfaces.

How did I get this?

  • Sinus tarsi syndrome usually occurs following an ankle sprain or due to the repetitive strain associated with walking or running on an excessively flat foot.

What can I do about it?

  • Rest sufficiently from any activity that increases your pain.
  • Icing and short term anti-inflammatory medication (e.g. Ibuprofen) may help to significantly reduce inflammation.
  • Elevation of the affected foot to decrease inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe an ankle brace, appropriate footwear, and orthotics, along with strengthening exercises.
  • Your doctor may prescribe a steroid injection.

When will it get better?

  • Most patients with this condition heal well with an appropriate treatment program. This can be a lengthy process and may take several months in patients who have had their condition for a long period of time. Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Early treatment is vital to hasten recovery and ensure an optimal outcome.

Cuboid Dysfunction Pain

Summary

  • The Cuboid is a square shaped bone which lies between your heel and the 5th metatarsal.
  • Cuboid dysfunction pain can result if this bone and the surrounding joints are subject to repeated trauma and cause intermittent pain.

How did I get this?

  • The way that you walk, or if you have a high arched, or excessively flat foot can cause cuboid dysfunction. There is not usually a specific injury. The joints around the cuboid become inflamed and cause the pain.

What can I do about it?

  • Rest, ice packs, and soft cushioning footwear may be helpful.
  • Short term antiinflammatory drugs such as ibuprofen may relieve symptoms.

What help can I get for this?

  • A podiatrist will assist with footwear advice or modification, strapping, padding, orthotics, or joint mobilisation.

When will it get better?

  • With the correct support and reduction in activity you can expect an improvement over 6-8 weeks.

Tarsal Tunnel Syndrome

Summary

  • The tarsal tunnel is located inside the ankle next to the ankle bones. Its job is to protect veins, arteries, tendons and nerves. When this tibial nerve is squeezed, or compressed, it results in a condition called tarsal tunnel syndrome (TTS). Many patients experience a tingling or burning sensation inside the ankle or in the sole of the foot while others experience pain in the ankle, heel, toes, arch, and even up the calf.

How did I get this?

  • There is no one specific cause for tarsal tunnel syndrome, but inflammation is the most recognized reason for TTS. Since the tibial nerve is encased in the tarsal tunnel, anything that takes up extra room like inflammation causes swelling in the tissues and puts pressure on the nerve.

What can I do about it?

  • Rest may be suggested to control the symptoms initially.
  • Ice or heat treatment.
  • Activity modification.
  • Anti-inflammatory medications help reduce the inflammation and swelling of the tissues around the tibial nerve.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may prescribe padding or strapping, specialized orthotics to relieve the symptoms, and give footwear advice.
  • Orthopedic surgeon for surgical management if nonoperative approach fails.
  • Physical therapy for specialized strengthening exercise for up to eight weeks after surgery.

When will it get better?

  • An improvement in your symptoms may take about 2-3 months.
  • Surgery causes release of pressure on the nerve, so by the time the sutures are removed you may already have had relief of your symptoms.

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Tarsal Coalition

Summary

  • A tarsal coalition is an abnormal connection that develops between two bones in the back of the foot (the tarsal bones). This abnormal connection, which can be composed of bone, cartilage, or fibrous tissue, may lead to limited motion and pain in one or both feet. While many people who have a tarsal coalition are born with this condition, the symptoms generally do not appear until the bones begin to mature, usually around ages 9 to 16. Sometimes there are no symptoms during childhood. However, pain and symptoms may develop later in life. Symptoms include Pain (mild to severe) when walking or standing, tired or fatigued legs, muscle spasms in the leg causing the foot to turn outward when walking, flatfoot (in one or both feet), walking with a limp, and stiffness of the foot and ankle.

How did I get this?

  • Most often, tarsal coalition occurs during foetal development, resulting in the individual bones not forming properly. Less common causes of tarsal coalition include infection, arthritis, or a previous injury to the area.

What can I do about it?

  • Rest from activities that cause the pain.
  • Short term nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be helpful in reducing the pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may prescribe orthotic devices for distributing weight away from the joint, limiting motion at the joint and relieving pain. Footwear modification such as a stiff rocker sole may be effective.
  • Podiatrist may consider immobilization to give the affected area a rest. The foot is placed in a cam walker, and crutches may be used to avoid placing weight on the foot.
  • Your doctor may give steroid injections to reduce the inflammation and pain.
  • Foot and ankle surgeon for surgical management if symptoms are not adequately relieved with nonsurgical treatment.

When will it get better?

  • Treatment by a podiatrist may result in symptom relief within 6-8 weeks.
  • Depending upon the type and location of your surgery, a cast will be required for a period of time to protect the surgical site and prevent you from putting weight on the foot. Although it may take several months to fully recover, most patients have pain relief and improved motion after surgery.

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Stress Fracture

Summary

  • Stress Fracture occurs when excessive repetitive force is applied to a localized area of bone. Activities such as walking, running, and repeated jumping can subject the bones of the foot to large forces that often lead to microscopic cracks in the bone.

How did I get this?

  • Generally, it is repetitive stress (i.e. running, marching, sport etc.) although some bone diseases can pre-dispose to thin bones which therefore fracture more easily. In people with osteoporosis (thinning of the bone) there is an increased risk of stress fracture.

What can I do about it?

  • Rest the area and stop sporting activity.
  • Wear good fitting shoes with adequate support and cushioning.
  • Avoid high heels.
  • You can try a protective pad.
  • See a podiatrist.

What help can I get for this?

  • Podiatrist may advise appropriate shoes, consider prescribing orthotics, consider immobilisation, and advise on surgery.

When will it get better?

  • In the majority of cases, conservative care allows the bone to heal and normal activity can then be resumed. Surgery is sometimes necessary to stabilise the fracture site which allows longer time to resume activity.

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Posterior tibial tendon dysfunction

Summary

  • Posterior tibial tendon dysfunction (PTTD) is an injury involving overstretching or rupturing of the posterior tibial tendon, leading to tendon inflammation, weakness, foot deformity and arthritis. The posterior tibial tendon extends from the deep layer of muscle at the back of your leg. It runs along the inside of your ankle and down the inside of your foot to underneath your arch. This tendon, along with some strong stabilising ligaments, is one of the major supporting structures of the foot. In PTTD, the tendon’s ability to perform that job is impaired, often resulting in a collapsed arch or ‘flat foot’. PTTD is the most common type of flat foot developed during adulthood, and is also known as adult-acquired flat foot.
  • Symptoms include pain and swelling on the inside of your ankle which grows worse with increasing activity, tenderness over the midfoot especially during activity, weakness or an inability to stand on your toes, a collapsed arch and development of a flat foot, and gradually developing pain on the outer side of your ankle.

How did I get this?

  • Often occurs in women over 50 years of age and may be due to an inherent abnormality of the tendon. But there are several other risk factors which include obesity, diabetes, hypertension, previous surgery or trauma, inflammatory diseases, and arthritis. The tendon may also become inflamed if excessive force is placed on the foot, such as when running on a banked track or road.

What can I do about it?

 

  • Rest.
  • Short term nonsteroidal anti-inflammatory drugs such as ibuprofen.

What help can I get for this?

  • Podiatrist may advise immobilization of the foot for six to eight weeks with a removable boot to prevent overuse.
  • Podiatrist may prescribe shoe inserts such as a heel wedge or arch support.
  • Podiatrist may recommend that you use a custom-made orthotic or support.
  • Foot and ankle surgeon for surgical management such as tendon repair or ankle joint fusion if conservative treatments don’t work.
  • A program of exercises and therapy to help rehabilitate the tendon and muscle following immobilization.

When will it get better?

  • The success of nonoperative treatment first requires the assessment of the flexibility of the flatfoot deformity. It is common for a patient to take 4-6 months to achieve much of their recovery and 12-18 months before they reach their point of maximal improvement after surgery.

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Peroneal Tendon Injury

Summary

  • The peroneal tendons are two tendons that lie immediately behind the outside bone of the ankle. These two tendons are responsible for moving the foot outwards. They balance the ankle and the back of the foot and prevent the foot from turning inwards repetitively. These tendons can be injured due to overuse or acute injury. In preoneal tendon injury there is pain behind the ankle, swelling over the tendons, and tenderness of the tendons.

How did I get this?

  • It usually occurs because these tendons are subject to excessive repetitive forces during standing, walking, and running. History of ankle injury (e.g. blow to the ankle or ankle sprain) which can displace the peroneal tendons. Certain foot shapes such as a higher arched foot predispose to the development of injury as well.

What can I do about it?

  • Rest is key, often helped by supportive footwear such as a hiking boot or jogger.
  • Applying ice to the area can help to reduce swelling and help to control pain.
  • Short term use of anti-inflammatories and can reduce the swelling around the tendon.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist for footwear modification, strapping, bracing, orthotics or other measures to reduce stress on the tendons and allow for rest and inflammation to subside.
  • Orthopaedic surgeon for possible surgical repair if there are large tendon tears.

When will it get better?

  • Minor cases of this condition that are identified and treated early can usually settle within a few weeks. Recovery after surgery involves several weeks of restricted weight-bearing and immobilization, depending on the type of surgery performed. Following immobilization, therapy can begin. Total time for recovery is usually 6-12 weeks, depending on the extent of surgery.
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OsTrigonum Syndrome

Summary

  • Ostrigonum syndrome refers to pain in the back of the ankle. The Ostrigonum is an extra (accessory) bone that sometimes develops behind the ankle. The presence of an Ostrigonum in one or both feet is congenital (present at birth). It becomes evident during adolescence. Pain in the back of the ankle is the first indicator of Ostrigonum syndrome. The area in front of the Achilles tendon is sore to touch and the bony prominence may even be palpable. The diagnosis can usually be confirmed by x-ray views of the ankle from the side.

How did I get this?

  • Ostrigonum syndrome is usually triggered by an injury, such as an ankle sprain. The syndrome is also frequently caused by repeated downward pointing of the toes, which is common among ballet dancers, soccer players and other athletes.

What can I do about it?

  • Rest to stay off the injured foot to let the inflammation subside.
  • Applying a bag of ice covered with a thin towel to the affected area decreases inflammation process.
  • Short term nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may consider immobilization using a walking boot or splint to restrict ankle motion to allow healing.
  • Your doctor may prescribe cortisone injection into the area to reduce the inflammation and pain.
  • Foot and ankle surgeon for possible removal of Ostrigonum.

When will it get better?

  • Most patients’ symptoms improve quickly with non-surgical treatment. However, in some patients, surgery may be required to relieve the symptoms. There is usually persistent swelling and discomfort after the surgery so limiting activities is required until these symptoms settle.

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Jones Fracture

Summary

  • The Jones fracture is a fairly common fracture of the fifth metatarsal (The long bone connecting your little toe to the rest of the foot).
  • Jones fractures sometimes disrupt blood supply and can result in the permanent failure of a bone to heal.
  • Symptoms include pain, swelling, bruising, severe and pain while walking.

How did I get this?

  • Overuse, repetitive stress, and trauma are the leading causes of Jones fractures. Jones fracture is attributed to a twisting inversion injury to the foot. Inversion injuries happen when the foot or ankle twists inward.

What can I do about it?

  • Rest and stay off the injured foot (walking may cause further injury).
  • Apply an ice pack to the injured area, placing a thin towel between the ice and the skin. Use ice for 20 minutes and then wait at least 40 minutes before icing again.
  • An elastic wrap should be used to control swelling.
  • Elevation of foot should slightly above the level of your heart to reduce swelling.
  • Seek podiatry consultation.

What help can I get for this?

  • Podiatrist may consider immobilization in a cam walker depending on the severity of the injury (crutches may also be needed to avoid placing weight on the injured foot).
  • Foot and ankle surgeon for surgical approach if the injury involves a displaced bone, multiple breaks, or has failed to adequately heal.

When will it get better?

  • In most cases, rehabilitation can begin once the cast is removed, and you will gradually be able to resume your normal activities. Rehabilitation may take an additional two to three weeks. Your age may also play a role in healing time. Younger people are known to heal faster from bone injuries.

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Ankle Sprain

 

Summary

  • An ankle sprain is a condition where there is partial or complete tear of the ligaments of the
    ankle due to sudden stretching. 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.

How did I get this?

  • This typically occurs when the ankle is suddenly “twisted” in a sports activity or by stepping off an uneven surface.

What can I do about it?

  • Ice packs.
  • Rest – Limiting the amount of walking and weight bearing on the injured ankle.
  • Elevate to reduce swelling.
  • Apply compression bandage.

What help can I get for this?

  • Seek the advice of a podiatrist for further assessment and strapping, bracing or immobilisation.
  • In case of severe injuries you may need immobilization in a cam walker.
  • Orthopedic surgery if there is complete tear.

When will it get better?

    • Recovery depends on the severity of the injury.
    • For minor injuries, people can usually return to normal activities within several days.
    • For very severe sprains it may take longer, possibly up to several weeks.

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