Ankle Problems (Pathology)

Acute Ankle Sprain

A sprain is a stretching or tearing of one or more ligaments, the tough fibrous bands that hold the ankle bones in place. Sprains can be caused by a sports injury, accident or stepping on an uneven surface. Symptoms may include pain, swelling, stiffness and bruising. There may be a popping sound when the ankle is moved. The ankle may be unstable or unable to hold weight.

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Chronic Ankle Instability

Chronic ankle instability is a condition in which the outer portion of the ankle constantly “gives way.” It typically occurs after walking or running, although it may also occur while standing still. Chronic ankle instability results from an ankle sprain that has not healed properly. A sprained ankle tears or stretches connective tissues, affecting your balance. The most common symptom is a wobbly, unstable feeling within your ankle but there also may be pain or tenderness, swelling and discomfort present.

Most cases of chronic ankle instability can be treated through non-surgical measures including physical therapy, painkillers or ankle bracing. Severe cases may require surgical correction, which involves repairing or reconstructing the damaged ligaments.

Osteochondral Lesion of the Talus (OLT, OCD, Osteochondritis Dissecans)

The talus is the uppermost bone in the foot that is completely covered with cartilage to allow for smooth movement of the ankle joint. When the ankle joint is injured, the cartilage may be torn, leading to an osteochondral lesion. Symptoms tend to develop gradually and include:

• Chronic pain in the ankle
• Clicking or catching when walking
• Feeling that the ankle will give out
• Swelling

Treatment for osteochondral lesions usually begins with conservative methods including nonsteroidal anti-inflammatory drugs, immobilization, physical therapy and ankle bracing. If these methods fail to relieve the symptoms, surgery may be needed. Surgery involves removing the loose cartilage or bone within the joint.

Avascular Necrosis of the Talus

Avascular necrosis of the talus (AVN) refers to a cutoff of the blood supply to the talus, which is a bone of the ankle. It typically results from a fracture in the area that damages the blood vessels. When AVN takes place, the bone may soften and begin to break down. If the blood flow is not restored, arthritis will often develop, severe pain occurs and joint function is reduced.

There are several surgical options available to treat AVN. Depending upon the progression of the condition, your doctor may consider ankle fusion, decompression of the talus, a muscle flap to restore blood flow or a bone graft.

Peroneal Tendon Injury

Peroneal tendon injuries take place when the tendons running through the outer, rear portion of the ankle are damaged. The injury is typically due to repetitive strain during normal activity such as walking or standing.

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Tarsal Tunnel Syndrome

Tarsal tunnel syndrome causes chronic pain in the ankle, foot and toes due to abnormal pressure on nerve roots. The specific cause of tarsal tunnel syndrome is not known, but it can be a result of inflamed tissues around the tibial nerve or injury to the area. The main symptom of tarsal tunnel syndrome is tingling or burning pain while standing or walking that starts in the ankle and spreads to the toes. Pain is usually relieved during rest.

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Posterior Tibial Tendon Dysfunction

Posterior tibial tendon dysfunction, also known as acquired adult flatfoot deformity, is a condition that results in a weakening of this tendon, rendering it unable to provide arch support. A repetitive injury that often occurs during walking, standing or climbing stairs, it is generally accompanied by pain and a limp.

Posterior tibial tendon dysfunction may be treated successfully with a combination of physical therapy to strengthen the tendons and muscles and use of an ankle brace to restrict mobility. In more severe cases, surgery may be required to repair the damaged tendons and realign the structure of the foot.