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Ankle Pain

At Foundation Podiatry Townsville we treat a wide range of problems associated with ankle pain and instability. Below are two problems in detail:

Tarsal Tunnel Syndrome

The tarsal tunnel is a narrow space that lies on the inside of the ankle next to the ankle bone. The tunnel is covered with a thick ligament that protects and maintains the structures contained within the tunnel (arteries, veins, tendons, and nerves).

Tarsal tunnel syndrome is a compression, or squeezing, of the posterior tibial nerve which runs within the tarsal tunnel. Compression of the posterior tibial nerve can produce symptoms anywhere along the path of the nerve running from the inside of the ankle into the foot.

Tarsal tunnel syndrome is similar to carpal tunnel syndrome, which occurs in the wrist. Both disorders arise from the compression of a nerve in a confined space.

Causes

Caused by anything that produces compression on the posterior tibial nerve:

  • Flat feet or collapsing arches cause the heel to tilt inwards which places increased strain in the region of the tarsal tunnel, sometimes causing compression of the nerve and therefore ankle pain.
  • An enlarged or abnormal structure that occupies space within the tunnel can compress the nerve and cause ankle pain. Some examples may include an arthritic bone spur, ganglion cyst, a varicose vein, ganglion cyst and swollen tendon.
  • An injury, such as an ankle sprain, may produce inflammation and swelling in or near the tunnel, resulting in compression of the nerve.
  • Systemic diseases such as diabetes or arthritis can cause swelling, thus compressing the nerve.

Symptoms

Patients with tarsal tunnel syndrome experience one or more of the following symptoms: tingling, burning, or a sensation similar to an electrical shock; numbness; ankle pain – sometimes shooting pain. Symptoms are typically felt on the inside of the ankle and/or on the underside of the foot (region where the nerve supplies). Sometimes the symptoms appear suddenly, often brought on by overuse of the foot, such as in prolonged standing, walking, exercising, or beginning a new exercise program.

Treatment

Correct diagnosis and early treatment of tarsal tunnel syndrome is very important. If left untreated, the condition progresses and may result in permanent nerve damage.

Non-surgical Treatment may include:

  • Initial rest and applying ice packs
  • Oral NSAIDs medication to help reduce pain and inflammation
  • Injection of local anaesthetic and corticosteroid may be useful in reducing inflammation
  • Padding and strapping to support the arch which in turn reduces the tension and compression of the nerve – to provide initial short term relief for the nerve
  • Supportive footwear and Customised Foot Supports (Orthotics) to support the arch and provide long term relief for the nerve

If conservative treatment fails, often because the symptoms are not addressed soon enough and the nerve is too damaged, surgery to decompress the nerve maybe be necessary.

Chronic ankle instability

Chronic ankle instability is a condition characterised by a recurring ‘giving way’ of the outer (lateral) side of the ankle. This condition often develops after repeated ankle sprains. Many athletes, as well as others, suffer from chronic ankle instability.

Signs & Symptoms

  • A repeated turning of the ankle, especially on uneven surfaces or when participating in sports
  • Persistent (chronic) discomfort and swelling
  • Ankle pain or tenderness
  • The ankle feeling wobbly or unstable

Causes

Chronic ankle instability usually develops following an ankle sprain that has not adequately healed or was not rehabilitated completely. When you sprain your ankle, the connective tissues (ligaments) are stretched or torn. The ability to balance is then affected.

Treatment

Treatment for chronic ankle instability is dependent on the severity of instability and on patient’s level of activity.

  • Physical therapy to strengthen the ankle, improve balance and range of motion, and retrain your muscles.
  • Bracing. Some patients wear an ankle brace to gain support for the ankle and keep the ankle from turning. Bracing also helps prevent additional ankle sprains.
  • Improve Footwear
  • Customised Foot Supports (Orthotics) if the underlying foot mechanics are contributing to the instability
  • Surgery if conservative treatment fails. Surgery involves repair or reconstruction of damaged ligaments.

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