Ankle pain

April, 2020 Lower limb pain (thigh, knee, foot)

The ankle is made up of three joints that move up and down and on both sides. The synovial joints are cartilaginous at the end and move in the synovial fluid environment. The ligaments are tight bands that connect the bones to each other. The muscles and tendons also help the joints and provide enough force to move them.

The most common causes of chronic ankle pain include :

Osteoarthritis

Ankle arthritis is usually in middle age and causes erosion of articular cartilage that causes pain and movement restriction. One of the most common cases is arthritis after trauma to the ankle.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic disease that can affect multiple joints throughout the body and is common in the feet and ankles. This condition is symmetrical, which means that the symmetrical joints degeneration usually develops on both sides of the body.

Symptoms :

Symptoms of akle sprain :

In ankle sprain due to tissue damage, the walls of the veins become permeable, and serum fluid and blood cells penetrate into the extravascular environment and surrounding tissues. Torsion symptoms due to the inflammatory process include: swelling, pain, movement restriction and vacancy.

Osteoarthritis Symptoms :

  • Tenderness
  • Increased pain and swelling in the morning
  • Difficult to walk
  • Pain during movement and activity

Diagnosis of ankle pain

The general health status, medical history and symptoms are reviewed, and the foot and ankle are examined to control tenderness and swelling. Walking, pain and stiffness are studied. This study evaluates how the bones in the foot and ankle move when walking.

Imaging : Imaging tests provide physicians with complete information on the diagnosis of anatomical problems and …. including:

Radiography x-ray : To check for arthritis, infection or bone mass, etc.

Computed tomography : If the above problems are present in simple graphs, CT scans can be used for more information. 

MRI : Used to examine soft tissues, including ligaments, tendons, and so on.

Treatment of ankle pain

Medication : Medications are used to relieve symptoms in the acute phase, including anti inflammatory painkillers and chondrogenic compounds.

Non-invasive treatments:

Physiotherapy : In physiotherapy, a combination of passive techniques and exercises is used to strengthen muscular structure and corrective movements. Passive therapeutic modalities such as ice / heat, ultrasound, and electrical stimulation reduce muscle soreness and spasms.

The patient with the help of specific exercises incorporates increased range of motion and increases the strength of the supporting muscles. Patients do not have to worry about switching to this treatment, even patients with pain and movement problems benefit from exercise.

Brace : Using a brace can help to improve movement. In addition, orthosis  can help relieve pressure and reduce pain.

Insole and medical shoes : If there is a deformity, the shoe insoles can return the ankle to its original shape, resulting in less pain in the joint.

Manual Massage and Manipulation Therapy : The basis of these techniques performed by hand also strengthens the muscular structure of the tissues around the ankle.

High Power Laser :

The use of high-power pulse lasers increases cellular energy and healing of damaged tissues and partially inhibits pathological progression.

Interventional treatments :

Interventional procedures are performed by a pain specialist under the guidance of X-ray (fluoroscopy) or ultrasound in the operating room, including:

Ozone Injection

Arthritis pain treatment using ozone injections is useful and effective. In the case of injuries, this treatment improves blood flow to the damaged tissue and thus accelerates healing by providing nutrients to the tissue. In this way, ozone is injected with 20 micrograms of damaged tissue, eliminating pain and swelling and causing cells to heal damaged tissue. Ozone injections should be repeated every 2 to 3 weeks, with patients receiving one to two treatment sessions to achieve desired outcomes (relief of pain and swelling).

PRP injection :

Injection of PRP or platelet-rich plasma is one of the effective treatments. In this method, concentrated platelets are produced that contain cell growth factors and are injected into the environment to prevent tissue damage and repair. This procedure has no side effects as platelet-rich plasma is taken from the patient’s own blood.

Orthokin injection :

In the orthokin injection method, the patient’s own blood is taken and its serum is refined, which contains the interleukin-1 antagonist, which reduces pain and inflammation of the damaged tissue and its repair.

Prolotherapy :

The combination of hypertonic glucose with concentrations of 12.5 and above is used to repair damaged tissue with repeated injections.

Radiofrequency :

Pulse-based radiofrequency is used to repair intra-articular problems as well as to modulate the neuronal message of pain (neuromodulation) and so on.

Thanks for reading the article on ankle pain to the end.

 Dr. Kazemi, Pain Fellowship

 

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