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Active Without Ankle Pain

Causes and Treatment Options

This article originally appeared in Kane County Magazine.

The ability to get outside after a long winter motivates many to start new exercise programs. If chronic ankle problems are halting your new goals, you may want to see specialist to root out the cause before summer is in full swing.

Ankle pain can be caused by a variety of factors.

Ankle instability, due to a history of sprains or joint laxity —loose ligaments — can cause the ankle to be fatigued or achy. In turn, this can cause recurrent sprains. Often ankle instability occurs because of inadequate rehabilitation after a previous injury, which inhibits the muscles around the ankle from reacting fast enough to prevent further injury. This can result in chronic pain, swelling and weakness. Once examinations and X-rays rule out other causes of pain, physical therapy can be effective to help rebuild ankle stability. If physical therapy doesn’t help, the instability may be from overstretched ligaments. In this case, surgery to repair the ligaments can be effective to improve balance and stability.

Ankle impingement is another cause of ankle pain. This typically causes swelling and occasionally limited flexion of the ankle due to scar tissue from previous injuries or bone spurs in the front of the ankle. People with ankle impingement often feel motion restriction and pain during flexing, driving and squatting. Physical therapy, footwear modifications and occasionally a cortisone injection can be helpful in relieving pain. If these conservative measures are not effective, minimally invasive arthroscopic surgery can often successfully remove the spurs and inflammatory tissue from the joint to solve the problem.

Ankle pain can also be caused by cartilage damage or loose bodies — fragments of bone or cartilage —in the ankle. This is often a result of prior injuries or early arthritis in the ankle joint, and typically presents as deep ankle pain that is hard to pinpoint, catching in the ankle, or even locking up in the joint. Swelling and instability are other symptoms of cartilage damage or loose bodies. After an examination and X-rays are performed, an MRI is often used to confirm the diagnosis. Arthroscopic surgery is often the treatment of choice, allowing removal of loose fragments from the ankle and correction of any cartilage damage. If the injured area is too large, cartilage grafting can be done to restore function.

Tendinitis (inflammation) of the tendons on the outside of the ankle, or tears in these tendons, can cause pain, swelling and weakness. This type of injury typically is caused by overuse or recurrent ankle injuries or sprains. Treatment can include anti-inflammatory medications, wearing a brace, rest and cross training. Sometimes orthotics or arch supports can help balance out your weight on your foot and ankle. Surgical repair or reconstruction is an option if these treatments fail to restore strength and function.

After any surgical procedure, physical therapy is a vital part of getting you back to full function as soon as possible. Northwestern Medicine offers personalized physical therapy — including gait analysis — at multiple locations and performance centers. A dedicated team of orthopaedic experts will work with you to get you back on the trails making progress toward your fitness goals.

Jeffrey A. Senall, MD
Jeffrey A. Senall, MD
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