Inner ankle pain

Introduction

Under the name of pain in the inner ankle (malleolus medialis), various options must be considered, depending on which structures are affected in this area. Mostly it affects the bones, tendons, ligaments or even muscles, but vascular diseases or systemic clinical pictures such as rheumatism can also cause pain in the inner ankle. It is also important to differentiate whether the pain has been present for a long time (chronic) or acutely (e.g. after sport) and what accompanying symptoms such as redness and swelling are present.

Causes

Pain in the inner ankle can have many different causes. Roughly speaking, they can be divided into traumatic and non-traumatic causes. The latter can be caused by an underlying disease such as rheumatism or gout.

But also chronic incorrect strain, e.g. due to incorrect footwear or sporting overloading, can be the reason for pain in the inner ankle. It is also possible that these strains can have traumatic consequences due to the inflammation that develops in the area. This includes, for example, the classic ankle twisting.

The most common reasons for pain in the inner ankle are caused by the surrounding muscles, tendons and ligaments. In most cases, the focus is on incorrect strain due to unsuitable footwear (e.g. bottle running shoes when jogging, but also high heels in everyday life), chronic overstrain (long jogging) or overweight. The posterior tibialis muscle is part of the calf muscles and is involved in foot extension (plantar flexion) and stabilization of the transverse arch of the foot.

The tendon runs along the back and inside of the calf and then pulls behind the inner ankle to the underside of the foot, where it branches out. Pain in the muscle or in the area where the tendon runs is often the first sign of tendovaginitis. This is an inflammatory change in the tendon sheath, usually due to over- or under-exertion.

Affected are mainly middle-aged women, runners (unsuitable footwear and overloading), but overweight and lack of exercise can also play a role. During the clarification it is likewise important to exclude a fundamental illness such as rheumatism or gout as a cause. If the symptoms are ignored and no measures are taken to remedy the causes, the result is a flattened flat foot (flattening of the transverse arch) and in the worst case even a torn tendon.

Therapeutically, anti-inflammatory drugs (so-called NSAIDs) and immobilization are most often considered in the acute phase. In the long term, however, the causes (e.g. incorrect footwear or overweight) should be treated. The deltoid ligament (Lig.

deltoideum) consists of four parts and serves to stabilize the ankle joint. The tendons of the posterior tibial muscle (M. tibialis posterior) and the long toe flexor (M. flexor digitorum longus) cross the ligament. Injuries to the ligament structures at the ankle are usually caused by a twisting of the foot, whereby the outer ligaments are affected with almost 95%. Only seldom is there an inward buckling and thus damage to the deltoid ligament. However, if the deltoid ligament tears due to an exaggerated inward twisting (pronation movement), it usually has to be sutured during an operation.