Chronic Ankle Pain

Did you know that, depending on severity of past injuries, 80% of chronic ankle pain sufferers can find relief from pain? Most chronic ankle pain results from an ankle sprain/strain or from more severe injuries such as fractures or nerve injury. The feeling of constant aching, sharp pain when the ankle moves or bears any weight, and instability when stepping on the smallest crack in the sidewalk are all common to chronic, post-traumatic ankle injury. Different treatments are available, and all have different results.

Signs and Symptoms of Chronic Ankle Pain

The most common location of chronic ankle pain is on the outside (lateral) part of the ankle. Pain can range from a constant, mild aching to intense pain that keeps you from doing your daily activities. Symptoms can be constant or flare up when running or walking. Chronic ankle pain symptoms include:

• Stiffness of the heel bone  - A feeling like you need to pop your ankle joint
  
  
• Instability - Uncertainity when walking or stepping down whether the ankle will twist. Repeated twists lead to greater instability
  
  
• Swelling and tenderness - A swollen and puffy area just below the ankle bone due to continued trauma to the joint and soft tissue (ligaments and tendons).

Causes of Chronic Ankle Pain

The primary causes of chronic ankle pain and instability are ankle sprain injuries and improper treatment after an ankle sprain injury.

• Mild and moderate ankle sprains seem to cause more chronic problems than severe ankle sprains because of the lack of attention to adequate treatment. Mild to moderate injuries that go untreated tend to be the nagging ankle pains of the future that potentially can develop degenerative arthritis and limited motion due to joint displacement and scar tissue production.
  
  
• Most severe ankle sprains that undergo appropriate rehabilitation can actually turn out to be fairly stable joints.
  
  

The other key factors for causing chronic ankle pain are fractures and breaks, and nerve injury or compression. 

Evaluating Chronic Ankle Pain

• Ankle X-ray
• Visual Inspection of the ankle
• Orthopedic tests to reveal type of injury and tissues that were injured

• Talus Range of Motion Test - A flex test to determine whether the talus bone, located at the top and front of the ankle, is misaligned. When misaligned, chronic ankle pain and degeneration will follow unless proper realignment occurs.
  
  
• Calcaneous Range of Motion Test - A test stabilizing all joints in the ankle except the calcaneous (heel) bone to evaluate its range of motion. Realignment treatment promotes healing.
  
  
• Arch Range of Motion and Evaluation - Ankle joints cannot function properly when the arch has collapsed. Even though there may not have been injury to the arch, problems of the arch need to be evaluated to ensure that the injured ankle joint heals appropriately. Four joints need to be tested for proper motion and function and possible orthotic devices may be required.
  
  
• Blood tests, MRIs or CT scans  - Arthritis and other inflammatory diseases can affect the ankle. When there has been no trauma to the ankle, these tests may be required by a physician.

Other Treatments for Chronic Ankle Pain

• Ankle Ice Packs can reduce inflammation which causes pain. Icing the ankle 1-2 times per day for up to 20 minutes is recommended. Always place a towel between you and the source of ice to protect the skin from frost-bite.
  
  
• Ankle Hot Packs  is effective in bringing blood to the area to enhance healing. If in doubt whether to use heat or ice, always choose ice. Ice reduces pain and inflammation more than heat.
  
  
• Ankle Exercises  using a tilt board or balance board help retrain the nerve "balance" cells within the joint. This type of exercise should be performed even with the mildest of ankle sprains.
  
  
• Ankle Bracing helps support chronic ankle instability. A brace that is flexible, allowing a limited range of motion, is vital. Never completely restrict ankle motion unless there is a severe injury that requires ankle immobility; consult your physician. For immobility of the ankle, use an ankle support with intense support
  
  
• Anti-inflammatory drugs are helpful in reducing inflammation but should not be used for an extended time.
  
  
• Ankle surgery may be necessary in extreme circumstances to stabilize or repair the ankle.
  
  
• Refrain from activities, such as athletics, until the ankle heals.