FAQ Category: Ankle

You may be describing a situation called subsidence. The implant can actually sink down into the bone. This can cause the symptoms you are having. You may also feel like
the leg on that side is shorter. Your pant legs may seem uneven or your waist may look lower on one side compared to the other.

Call your surgeon and report these problems. Early attention can make the difference between implant revision and removal.

Arthrodesis is the fusion of a joint. Bone graft is used most often around the joint to hold it together and keep it from moving. As the bone fills in around the bone chips used in the graft, a fusion occurs.

A takedown is used to convert a fused joint into a moveable joint again. A special joint implant is used to restore ankle motion. The most successful of these devices is the Agility total ankle made in the United States.

A takedown operation is fairly new in the United States. There are problems with arthrodesis or takedown. Doctors are working to find ways to improve both operations as they each have their place for different patients.

This may be a little like comparing apples to oranges. Both are round. Both are fruit. Beyond that the similarities end. Ankle fusion puts your ankle in one position and keeps it there. Joint motion is very limited. An ankle replacement allows continued joint
motion.

Sometimes the fusion fails and the ankle forms a “false” joint. The result is ankle motion where no motion is wanted. Walking and going up and down stairs is not normal or smooth with an ankle fusion. The loss of motion and the stability provided reduce or get
rid of pain.

Studies show total ankle replacement (TAR) reduces painful symptoms but doesn’t always increase motion. The patient with limited motion before the TAR will likely have reduced
motion after the ankle is replaced. Most patients report improved function anyway.

With less pain after TAR, even a small increase in motion makes it possible to manage walking, stairs, and most daily activities.

The term pilon is also known as a hammer fracture occurs when one bone is driven into another bone with force. The bone may be broken into more than one piece. This is a comminuted pilon fracture. It often requires one or more operations to
repair the damage. In 10 percent of cases, fusion of the joint is needed.

Pilon fractures can affect the spine and either bone in the lower leg (tibia or fibula). The most common pilon fracture affects the lower end of the tibia. The break occurs across the entire bone and into the ankle joint. It results from a high-energy, loading injury from the foot up into the bone. Car accidents, skiing injuries, and falls during horseback riding are the most commonly reported cause of pilon fracture.

There are several treatment options depending on the condition of the ankle joint and soft tissues around the joint. First a program of specific ankle exercises may help. The goal is to increase joint stability through increased muscle strength.

Second a treatment called prolotherapy may work for you. Sometimes this is called
sclerotherapy or reconstructive therapy. A doctor with special training injects an agent into the ankle. Scar tissue forms around the soft tissues to help form
stronger bonds where the torn ligaments normally hold the ankle stable.

Finally if these methods fail, surgery may be needed. In the past, ankle fusion was the only operation possible. Now the joint can actually be replaced. Total ankle replacement (TAR) can be used in the case of ankle instability. A severe ankle sprain or repeated injury such as you described can cause such problems. Ask your doctor which treatment would be best for you.

Sometimes the position of the foot and ankle has a direct connection to what’s going on in the knee. If the hindfoot is tilted inward or the forefoot is pronated or dropped flat, a chain of events can result in knee pain. The lower leg bone (tibia) rotates in, the kneecap gets pushed off center, and then the kneecap tracks up and down over the joint in the wrong place.

All these things can add up to knee pain called patellofemoral pain. In a recent study at the University of North Carolina, 16 nonathletes were studied. All had patellofemoral pain with forefoot pronation. A custom-made shoe insert (orthotic) was made for each one. All had relief from pain and stiffness. Everyone reported improved function, too.

It’s worth a try. You should be able to tell if it’s working within the first few weeks. In the study mentioned, subjects reported improvement within two weeks. The good results were still present three months later.

Running and jumping can lead to the formation of small spikes of bone near the ankle joint. These bone spurs form in the capsule of the joint. They can cause a lot of pain. Any damage from a previous ankle injury can also show up in new ways. For example repeated motions during practice can cause some soft tissues to get pinched if ankle
ligaments were torn in the past.

There are many other possible causes of symptoms in the ankle. Talk to the coach and see what he or she thinks. Perhaps a change in the training schedule is all that’s needed. If the symptoms persist, a visit with an orthopedic doctor may be helpful.

It may depend on the type of extra bone growth you have and how long they’ve been in your ankle. Bone spurs or a ridge of bone across the front has a good outcome. The chances of
a good result are even better if the conditions has been present for less than two years.

Results may vary if you’ve sprained that ankle before. This is especially true if you’ve sprained it more than once. Damage to other areas of the joint or the presence of scar tissue can lead to chronic recurrent ankle sprains or overuse syndromes.

Most often the doctor can repair damage to any of these structures with good results. You may have to back off training at first, but you should be able to resume running and even
running marathons.

Some people do seem more likely to get injured than others. This could be related to an overactive nervous system, lax ligaments, or poor joint position sense. There may not be an easily identifiable link, or there may be more than one factor involved.

In your case, it may be that training for the ankles worked well. You didn’t injure your ankles and they were able to with withstand outside forces. It’s possible the knee joint was stressed instead. When the ankles are strong, forces from the ground up through the
foot and ankle are transferred to the knee instead. Injury can occur here if this is the weakest link.

It may be best to keep training for improved ankle strength and improving the joint’s sense of position (called proprioception). An overall program to include ankle, knee, and hip may be best for you. If you need help, seek out the assistance of a physical therapist or athletic trainer.

Bracing and taping are two popular ways to prevent ankle sprains. Research shows both are equally effective. Some people get skin irritation easily with either of these choices. If they aren’t applied correctly, further injury can occur.

For athletes, an improperly fitted brace can reduce playing performance. Tape can both irritate the skin and come loose during activity. Research shows training with a balance board works just as well without any side effects.

A special proprioceptive balance board is used by physical therapists to train and rehab athletes. Proprioception, the sense of joint position, is often damaged with ankle injury. Restoring strength and proprioception can help prevent further strains and sprains. This may be a good option for your daughter. It can be done at home in five minutes each day.

The first step may be to conduct a little study. When a player is injured, have him or her fill out a form with some specific information. Find out which ankle was hurt and the exact location of the injury.

Find out what caused the injury. Ask the players to explain this in their own words. Ask them to describe the physical symptoms and any treatment given. By doing this, you may find a common link among the players to the injuries.

Studies show ankle injuries can be prevented in athletes using taping methods or bracing. This may work well for some players. Sometimes skin irritation occurs. Tape can come loose during play and reduce playing performance.

Another option is special foot and ankle balance training. This program can be done in five minutes each day using simple equipment like a rocker board and ball. A physical therapist or sports trainer can help you set this up. Keep records before, during, and after to see if what you are doing is making a difference.

This is a rare fracture of the ankle that is on the rise due to snowboarding. The snowboarder lands on the foot with the foot turned in and toes pulled up toward the face. The force of the impact is enough to break off the lateral process of the talus. This is called a Snowboarder’s fracture.

The talus is the ankle bone between the heel and the lower leg bone (tibia). The lateral process is a small bump on the back of the talus. Sometimes the fragment of bone is pulled away from the talus. In severe injuries, the bone may be broken into several pieces and the nearby ligaments are also torn.

Ankle injuries are on the rise with snowboarders. Sometimes the injury isn’t seen on X-rays and some other type of imaging is needed. MRIs will show unusual fractures but may not show the extent of the damange. In those cases, CT scans are better.

It may be best to see an orthopedic surgeon. The doctor will be able to assess the injury and advise you on the next step. Chronic pain of this type can be caused by a fracture that never healed. Loss of blood supply can lead to bone necrosis (death). It’s best to have the injury re-checked at this time.

X-rays are only two-dimensional pictures of bones. They can’t always “see” everything that’s going on in the ankle joint. The talus is a bone sandwiched in between two other bones (the heel and the tibia forming the lower leg bone).

The talus has two bumps on the back of the bone. These are the medial and lateral processes. X-rays only show four out of 10 cases (40 percent) where the lateral process of the talus is broken off.

When this fracture goes unnoticed, patients may be treated for an ankle sprain. They don’t get better and end up back in the doctor’s office with chronic pain and swelling. Further imaging is needed to get to the bottom of the problem.

Sometimes arthritis gets so bad the joint has to be fused so it doesn’t move any more. The surgeon takes bone chips from a donor bank or from the patient’s own pelvic bone and inserts them in and around the joint. New bone cells fill in forming a solid fusion.

Amputation after fusion occurs in up to 15 percent of all cases of ankle fusion. The reasons for this vary from patient to patient. Sometimes the bone doesn’t “take” and the joint doesn’t fuse. This is called a nonunion. In other cases bone infection eats away at enough bone that there’s a danger of gangrene. Amputation may be the only option to save the leg.

Believe it or not, many patients prefer amputation to the intense pain and suffering they’ve had with the arthritis. With a prosthetic device, they can walk again pain free. They report their improved quality of life was worth the loss of a foot.

There may be a chance for revision of the implant. The doctor may be able to just remove and replace the damaged implant. Bone grafting may be required to replace bone lost to infection.

Imaging studies will be done to see how much damage there is and what kind of condition the rest of the bone is in. Another option is ankle fusion. Bone chips harvested from your pelvis are placed around the joint. Bone will grow in and around the fresh bone. You’ll lose motion in the joint but gain stability.

As fast as the technology is changing, there may be more options a few years down the road. The doctor will advise you in which option today will preserve or salvage the joint and possibly allow you to take advantage of future developments.

Some patients may think so if the movement given by the implant improves their quality of life enough. But a study from the University of California at Los Angeles advises caution. Researchers collected data from two groups: patients having an ankle fusion and patients getting an ankle joint implant.

They used a computer program to extend the data out by 25 years. The results showed the ankle replacement didn’t last more than seven to nine years. More surgery was needed–sometimes to fuse the joint after all.

If you have a joint replacement now, you’ll likely have better motion. You can also expect a higher level of function compared with a fusion. Some people are willing to take the chance that new implant designs and improved technology will open up new options in another 10 years.

Talk with the ballet instructor and point out what you are noticing. He or she may not be aware of your daughter’s symptoms. A medical evaluation may be needed to rule out a true, anatomical problem.

Dancers are at risk for all kinds of problems just based on the extreme motions the joint goes through. For example, a dancer with a high arch has the perfect looking ankle by dancing standards. But in this position, the bones are shifted putting stress on the joint and ligaments.

Cracking or popping sounds and ankle locking are a sure sign that a exam is in order. Pain that doesn’t go away with rest is also a red flag.

Posterior ankle pain with kicking is common with a condition called posterior ankle impingement syndrome (PAIS). This problem is also known as ankle block, nutcracker syndrome, or os trigonum syndrome.

Whether or not you wear shoes while kicking may not be as important as the kicking motion itself. PAIS occurs with forced ankle plantar flexion. This refers to a position with the toes pointed down with force or compression. Kicking a football certainly fits the description of the motion that can cause PAIS.

Before putting your shoes back on, you may want to get an X-ray or MRI. There may be a fracture, bone fragment, or soft tissue impingement to account for your symptoms. Once you know the true cause of your problem then you follow your doctor’s advice.

The os trigonum is an extra piece of bone at the back of the ankle.
When the foot is forming, a separate bone center forms on the back of the talus (bone in the ankle). This occurs in children between the ages of 8 and 13 years.

This ossification (bone forming) center usually fuses with the remainder of the talus within a year. However, an extra bone, the os trigonum, forms if this ossification center fails to fuse after skeletal maturation.

About eight percent of the population has this condition. It’s usually just on one side. Anyone with this condition may have pain in the back of the ankle that’s worse when forcing the ankle and foot down into plantar flexion (toes pointed).

Treatment is usually rest, ice, antiinflammatories, and physical therapy. Steroid injections may be used along with taping. Rarely, surgery is done to remove the bone.