Spence Rehabilitation Center
1650 45th Ave. Suite 2C
Munster, IN 46321
Visit our Porter County location!
1620 Country Club Rd. Ste E
Valparaiso, IN 46383
Phone : (219) 513-2267
What are some potential sources of ankle pain?
1. Ankle Sprain:
Usually results from an inversion injury (turning the
ankle inward).
2. Sinus Tarsus Syndrome:
Irritated synovial tissue in the ankle that can result
from recurrent ankle sprains. The patient can complain
of a recurrent sense of instability and diffuse pain in
the outer ankle particularly when walking on uneven
3. Osteochondritis Dessicans:
Separation of a piece of cartilage from the surrounding
4. Stress fractures:
Usually caused by repetitive trauma such as running. If
the activity continues, the bone is not allowed to heal
and arthritis can develop.
5. Peroneal tendon injuries:
Tendons located on the outer foot and ankle that
evert (turn out) the foot. The tendons can be
inflamed (Peroneal Tendonitis) or torn which is
sometimes associated with swelling and bruising.
If completely torn, a snap can even be heard.
6. Os peroneum:
An extra piece of bone near the peroneus longus
muscle. This bony piece can irritate the nearby
peroneus longus resulting in tendinitis which is
usually experienced as outer ankle pain.
7. Flexor hallucis longus injuries:
Irritation can result in Flexor hallucis longus tendonitis
which is also known as dancer's tendonitis because it
is common among classical ballet dancers, also occurs
in runners, soccer players, and other athletes. The
pain is usually in the back of the inner ankle and can
be associated with clicking.
8. Os tibiale externum:
Is an extra piece of bone near the navicular bone and
tibialis posterior tendon. Pain is usually gradual in the
inner foot and ankle.
9. Anterior tibialis tendonitis:
Inflammation of the tendon near the front and inner
ankle particularly when turning your ankle up off the
10. Navicular Stress Fracture:
A bone that makes up your mid foot that is at risk
particularly in sports that require repetitive stress
such as running. Pain is usually diffuse but mostly
in the midfoot. This bone is at risk of arthritis if not
caught because of it’s limited blood supply.
11. Achilles tendonitis:
Irritation of the tendon that makes up the back of
your heal. Achilles tendonitis can be caused by tight
hamstrings, tight Achilles tendons, and other
inflammatory diseases such as rheumatoid arthritis,
spondyloarthropathy and gout. Symptoms include
morning stiffness, heel pain, pain at the start of
exercise, and resolution of pain with rest.
12. Achilles tendon rupture:
Patients can hear a loud popping sound at the time of
the rupture with onset severe pain in the back of the
heel. The ankle may feel unstable and the patient is
usually unable to raise the heel of the affected foot.
13. Os trigonum:
A region of persistant immature bone behind the talus
bone. A fracture can also result in this area that can
fail to reunite. The pain is usually in the back of the
outer ankle and can be aggravated by walking
downhill and squatting.
How can you characterize ankle injuries?
The injuries can be relatively new (also known as acute)
or the problems may have been present for a while and
have gradually progressed (also known as a chronic
ankle problem).
What are some important factors to consider when
assessing acute (new) injuries?
1. What was the mechanism of the injury?
The doctor will want some specific details regarding
your accident.
2. Was there noise such as a popping or cracking
at the time of the injury?
This may indicate ligament injury, tendon rupture, or
3. Does the ankle feel unstable since the injury
Does it feel like your ankle wants to give out on you.
4. What type of activity led to the injury?
Were you playing sports, working, or going on your
daily walk? The position that your ankle and foot was in
can also give your doctor clues to what type of injury
5. What is the location, radiation, intensity, and
duration of pain?
Is it on the inside or the outside of your foot? Does the
pain come and go or is it always there? Are you able to
stand and bear weight on it?
6. What aggravates the pain and what makes the
pain better?
7. Do you have numbness or tingling in the foot or
If so, you may be an irritated nerve.
8. Do you have weakness in your leg, ankle, or
9. Are you able to stand and walk using the painful
foot or ankle?
If not, you may have a fracture.
For chronic ankle pain (present for a long time),
your doctor would like to know:
1. What activity seems to make the problem
2. How often and for how long do you perform the
3. Has there been a recent increase in the amount
or duration of the activity?
Did track or soccer season just start?
4. Is pain present during or after activity, or both?
5. Is pain there when you take your first steps in
the morning?
Some forms of arthritis can have symptoms of morning
stiffness and pain.
6. Do you have problems doing activities
throughout the day such as climbing or
descending stairs?
7. Are you active in sports?
Is the problem only worsened with the sport? What
kind of training activities are you involved in to prepare
for the sport?
8. What treatment options have you already tried?
1. Medications
2. Physical therapy
3. Home rehabilitation
4. Shoe or activity modifications
9. Do you have pain and stiffness in other parts
of your body, skin rashes, or family history of
These signs and symptoms can be associated with
inflammatory and rheumatologic conditions.
What imaging studies are sometimes used to
evaluate ankle pain?
The type of x-ray needed will depend on the location of
the pain and what conditions are being considered by
your doctor.
1. Plain X-rays of the ankle:
(anteroposterior, lateral and mortise views of the
ankle) To look for fractures of the lower fibula and
2. Plain X-rays of the feet:
(anteroposterior, lateral and oblique views of the foot)
To look for arthritis, fractures and tendon injuries.
3. Computed tomography (CT):
Can be helpful to clarify the anatomy of the bone lesion.
4. MRI:
To look for inflammation caused by stress fractures,
tendon injuries (i.e. peroneal tendon), infection, etc.
5. Bone scan:
If pain persists and other imaging studies are negative.
The study shows areas of increased metabolic activity
where the body is trying to heal.
6. Ultrasound:
To check the integrity of the tendon. Particularly if your
doctor suspects Achilles tendon rupture.
7. Arthrography:
A local anesthetic is injected followed by an injection
of water-soluble contrast dye into the joint. The total
amount of fluid for this test is less than 10 ml. This
test is used to check the integrity of the joint capsule
and too see if the dye leaked out into other areas of
the ankle. If the joint capsule has been ruptured, the
joint usually accepts more than 10 ml and the dye
leaks out into other areas.
What other studies can be used to evaluate ankle
A local anesthetic usually 1% lidocaine is injected into
the painful site. Subsequent pain relieve can help to
identify the source of the problem.
What are some treatment options for ankle pain?
Treatment will depend on the diagnosis and severity.
1. Relative Rest:
Which is avoiding activities that cause pain.
2. Cold Packs:
For recent injuries to minimize pain and swelling. Cold
packs should be applied for 20 minutes three to four
times per day for ideal results. You should avoid
placing the ice packs directly on the skin and should
not use the ice packs during sleep.
3. Non-steroidal Anti-inflammatory Medications
Such as ibuprofen or naprosyn.
4. Immobilization with a cast:
Particularly important for stress fractures and cartilage
5. Corticosteroid Injection:
Usually 20 mg of Kenalog with 2 ml of lidocaine is used
to limit inflammation. Steroid injections are not good
for tendon injuries because they can increase the risk
of tendon rupture.
6. Ankle Bracing:
To improve ankle support and balance.
7. Physical Therapy:
Consisting of range-of-motion and stretching of the
Achilles tendon, hamstrings, and calf muscles that
support the ankle and foot followed by strengthening
then progressing to balance training and sports specific
exercises to minimize the likelihood of reinjury.
8. Iontophoresis:
The use of electrical current to drive medications
through the skin to the irritated areas. This procedure
is usually performed by a physical therapist.
9. Foot Orthotics:
Such as medial arch supports to treat flat feet.
A 3/8-inch heel lift can help treat Achilles tendonitis by
preventing the tendon from stretching during the acute
inflammatory phase.
10. Surgery:
Seeing an orthopedic doctor may be needed for
unstable fractures, tendon reattachment, etc.
"Nothing contained on this website should be interpreted to be medical advice. This website is for general information only.
Please consult a physician for medical advice regarding any medical condition."
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