Therapy
Depending on the cause of the pain in the ankle joint, the therapy options range from pain relief to immobilization to surgical treatment. 1) Ligament stretching: In the case of ligament stretching, taking light painkillers, cooling the joint and immobilization with an elastic support bandage is completely sufficient for a few days. 2) Torn ligaments: If the ligaments of the ankle joint are torn, instability determines the further procedure.
The routine procedure is to wear a special walking splint (orthosis) for about 3 weeks, which is supplemented by a 4-week support bandage. Subsequent physiotherapy can prevent a renewed torn ligament. A torn ligament is only operated on if it leads to severe instability in the ankle joint.
3) Torn ligament: If a ligament has been torn out of the bone (e.g. by bending), the ankle joint must be operated: The torn off piece of bone is placed back in place together with the torn off ligament.4) Chronic instability: Pain caused by chronic instability in the ankle can be relieved by surgery in which the unstable ligaments are reconstructed. 5) Weber fractures: The uncomplicated Weber A fracture is treated with a lower leg cast for 6 weeks. If the fractured bone fragment has shifted, however, surgery must be performed in the same way as for Weber B and C fracture.
Weber B and C fractures must be immobilized 6 weeks postoperatively, after which the load can be slowly increased again. Information about the therapy can be found in the article Exercises Ankle Fracture. 6) Achilles tendon rupture: The foot is plastered for 1 week in pointed foot position to bring the ends of the torn tendon closer together.
If this is not possible, surgery is required. 7) Tendon sheath inflammation: In most cases it is sufficient to take painkillers and to spare the affected foot. If an intensive non-operative therapy cannot improve the tendon sheath inflammation, the inflamed tissue must be surgically removed.
Information on this topic can be found in the article Tendinitis. The diagnosis of ankle pain is based on a thorough anamnesis, in which, for example, the cause of the accident or the exact quality and origin of the pain in the ankle joint is investigated. The ankle joint is then examined by comparing the sides.
In addition to swelling and redness, the physician pays attention to the blood circulation, sensitivity and general mobility of the foot and ankle joint. Depending on the suspected cause of the pain in the ankle joint, there are various test methods to confirm or reject the suspicion. Typical tests are the drawer test or the test of lateral opening in case of suspected rupture of the outer ligament.
An X-ray of the ankle joint in two planes can reveal bony injuries. Sometimes so-called “held images” are taken, in which the foot is passively brought into a certain position. The resulting distance between the individual bones is then assessed and provides clues for or against a ligament injury.
The ultrasound examination is another method: Here, ligament injuries can be detected indirectly by imaging bruising or a changed ligament structure. If the clinical examination, X-ray and ultrasound do not provide a clear result, CT and MRI are of course also available.
