Diagnosing and Treating Ankle Pain
If you experience pain, stiffness, or swelling in the ankle, book an appointment as soon as possible. We will begin with an exam and may order imaging tests such as X-rays, MRIs, or CT scans. Ankle pain is typically caused by sprains, arthritis, posterior tibial or peroneal tendinitis or tears, OCD or fractures but could also indicate Achilles tendinitis.
Osteochondritis Dissecans of the Ankle (Ankle OCD)
OCD is a condition that occurs when a portion of the cartilage and potentially its underlying supporting bone begins to separate from the dome of the talus, causing cracking and loosening of the bone and cartilage nearby. It may be caused by injury to the ankle similar to an ankle sprain. In some cases, the condition heals on its own and the OCD is seen on x-rays but does not cause pain. However some OCDs are symptomatic and cause pain, tenderness, possible swelling, stiffness or instability. Diagnosis involves a physical examination, X-ray, and sometimes an MRI or ultrasound. Treatment begins with observation, rest, and avoiding vigorous sports and may involve crutches, splinting, or casting. In most cases, this prescription heals OCD within 2 – 4 months. If this treatment fails to relieve pain and swelling, or if the lesion is large, separated, or detached, surgery in the form of arthroscopy may be considered. Generally, crutches will be used for 4-6 weeks after the procedure, physical therapy will be prescribed for 2 – 4 months, and patients can gradually return to sports in 4 – 6 months.
Chronic Ankle Pain
Chronic ankle pain can develop after an injury. Pain is usually on the lateral (outside) part of the ankle. When pain lasts longer than 6 weeks further evaluation is often necessary. Causes of chronic ankle pain include instability of the ankle or subtalar joint, peroneal tendinitis or tearing, scar tissue which causes impingement, nerve injury, osteochondral lesions, synovitis or inflammation of the subtalar joint or subtalar arthritis. Diagnosis will begin with a history of any injury and physical examination. X-rays of the ankle and foot if appropriate will be ordered. MRI, CT, bone scan or electromyographic and nerve conduction studies may be needed for evaluation. Treatment depends on the specific cause of the pain and can range from nonsteroidal anti-inflammatory medications, immobilization in protective footwear or cast to surgery. Surgery is determined by the cause of the pain and may include arthroscopy (placing a small camera in the joint to see the injury and using small instruments to repair it will remove scar tissue) or open repair of torn tendons or ligaments.
