Joint Pain Of the Ankle and The Foot A sprained ankle is a very widespread injury.  A sprained ankle more often occurs when a person lands from jumping or running on to a rough surface. Around 25,000 people experience it every day.  It’s happen during athletic events or during everyday activities. Orthopedic doctors see patients for ankle sprains very often, and its most common foot and ankle injury.

 History

 Common complaints are pain, swelling and deformity.

Pain: Ankle pain on prolonged scanning or walking may be due to degenerative arthritis due to previous trauma. Rest pain or night pains in ankle joint may be due to tuberculosis arthritis. Pain in the heel which is more marked after a period of inactivity is typically seen in plantar fasciitis. Pain in the forefoot may be due to stress fractures, Morton’s metatarsalgia or callosities or corns.

 Examination

Inspection

 Swelling: Swelling of the ankle joint may be seen in synovitis or arthritis due to any cause. Synovial swellings may be seen all around the ankle joint. Swelling in the forefoot in the region of lInd metatarsal may be due to callus from a stress fracture of lInd metatarsal.

Deformity: The deformity may be seen from birth itself or it may be acquired. Congenital deformities are talipes equinovarus, calcaneovalgus, flat foot, cavus foot, and anomalies of limb formation. In ankle arthritis, the joint will be in plantar flexion. In congenital talipes equinovarus (CTEV), a small foot with hypoplastic heel and varus deformity at subtalar joint, equinus at ankle joint and cavus deformity in foot may be seen. In hallux valgus, there will be outward deviation of great toe with secondary cocking up on lInd toe. The prominent medial aspect of base of Ist toe and head of Ist metatarsal in hallux valgus is called bunion. If it is inflamed, it will be painful. Any scars, sinuses should be looked for.

 Palpation

Soft tissue palpation around the ankle joint includes palpation of tendons and synovium of the ankle joint. They should be palpated for any thickening, tenderness or nodular irregularities. The prominent bony points are the medial and lateral malleoli. Normally, the lateral malleolus lies lower down and behind the medial malleolus. A torsional deformity will disturb this relationship.

Movements

 At ankle joint: To test dorsiflexion and plantar flexion, hold the lower leg with one hand and hold the foot at the level of the head of talus with other hand and check the movements. This method prevents movement occurring at forefoot joints. The range of dorsiflexion is 0-25 degree and range of plantar flexion is 0-35 degree.

At subtalar joint: The movements are inversion and eversion.

To test these, the ankle is dorsiflexed to the maximum to lock the widest portion of the talus in the ankle mortisethereby, preventing any movement at the ankle joint. Then the heel is grasped and moved sideways on either side to test for inversion and eversion. The normal range of inversion is 20 degree and eversion is 0-10 degree.

 Midtarsal joints: The movements occurring are adduction and abduction. The movements are checked by holding the calcaneum with one hand and holding the forefoot with the other hand.

Measurements

Longitudinal measurements: The distance from the tip of medial malleolus to the floor in a standing position gives the height of the talus, calcaneum and heel pad thickness. Any reduction in the distance should be looked for in cases of, fracture talus, calcaneum and ankle arthritis. The length of the foot should be measured from the heel tip to tip of great toe, and another measurement should be taken from the heel tip to tip of little toe.

 Circumferential measurements: Calf should be measured for wasting of muscles. It should be measured at the level of maximum muscle bulk Oblique circumferential measurement at the level of ankle joint, arch of foot and at the level of metatarsal heads are also to be taken.

Lymph nodes: Popliteal and inguinal group of lymph nodes should be examined for enlargement and tenderness.

 Clinical Features

The patient typically presents with a twisting injury to the foot following which they complain of inability to bear weight, plain around the ankle and very often swelling around the ankle. Clinically the stability of ankle joint must be tested by valgus and varus stress under anaesthesia. Associated injury to the tendons and the neurovascular bundles, which run in close vicinity to the joint, has to be ruled out. The state of the skin must be checked. The skin over the deformed ankle may get unduly stretched, resulting into necrosis, if not reduced immediately.

 Physical Therapy modalities (such as ultrasound) and manual therapy modalities (such as friction massage) are often used when the acute phase is over. Physical Therapists a specialist trained to work with you to restore your activity, strength and motion following an injury or surgery. Physical therapists can teach specific exercises, stretches and techniques and use specialized equipment to address problems that cannot be managed without this specialized physical therapy training.