Ankle Pain is the most chronic degenerative arthritis and one of the most important problems in the lower limb that are caused by the following conditions of overweight, muscle wasting, tendon, and ligament injury ankle sprain, and post-traumatic problem. Ankle osteoarthritis is basically found the people who are older age, post manuposual women, athletes, football, hockey, and cricket playing players.
Causes of Ankle Pain
According to the American Academy of Orthopedic Surgeons (AAOS), three primary types of arthritis affect the human ankle joint that are osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.[rx]
Osteoarthritis (OA) – This is one of the most common causes of ankle pain in the elderly population, although it can affect any time off and age group population. Furthermore, aging, hereditary factors, high BMI, joint abnormal anatomical abnormalities, congenital problems are also involved and post-menopausal women are the high-risk factors that are linked to the development of ankle osteoarthritis.
Rheumatoid arthritis (RA) – It is one of the most dangerous causes of inflammatory arthritis condition that affects the peripheral ankle joints symmetrically or both legs. The exacted causes of osteoarthritis remain unknown, but it is thought to be a multifactorial problem that is working behind this condition of ankle arthritis.[rx][rx]
Post-traumatic arthritis – It is another cause of the development of osteoarthritis of the ankle because of traumatic reasons, walking uneven surface, quickly running, playing or time such as injuries to the ligaments, capsule, tendon, and may fracture of the ankle bones. Due to the loss of adequate proper treatment, the damaged bone and joints bones frequently increase the risks of developing arthritis over time and in near future[rx].
- Swelling – It is one of the most common causes of ankle rheumatoid arthritis, osteoarthritis, morning stiffness, tenderness. It basically occurs in patients with ankle osteoarthritis, rheumatoid arthritis.
- Blood deficiency – Blood deficiency, peripheral blood vessel problems may also increase the risk of ankle osteoarthritis. It is one of the major side effects of ankle osteoarthritis and rheumatoid arthritis. The patient total count of blood may increase that are leads to rheumatoid arthritis.
- Decrease the range of motion – The pain increases with the affected joint and the range of motion gradually decreases due to abnormal immunity systems, muscle, tendon, ligament injury.
- Change the joint normal structure – The normal structure of the joints due to osteoarthritis of the ankle become abnormal or pain are increases when bending on the different side. With this condition, synovial fluid is decreased in the affected joint that leads to permanent ankle osteoarthritis and rheumatoid and joints stiffness.
- Muscle wasting – The most important cause of ankle osteoarthritis with rheumatoid arthritis symmetrical affected joint muscle. It causes muscle wasting that form the abnormal nodule around the joint.
Other causes – may be defined as ankle arthritis, pain, swelling, tenderness, edema due to infection (septic arthritis), crystal-induced arthritis, reactive arthritis, and systemic symptoms of diseases like sarcoid arthropathy, myelodysplastic, and leukemic disorders bone tumor and bone necrosis disease, cancer, etc.
Symptoms of Ankle Pain
- Pain swelling, tenderness with redness in the asymmetrical joints
- Morning stiffness or pain increase in the morning
- Decrease the range of motion in the affected joint of the ankle
- Edema or abnormal nodule are found during joint that are feel when palpation
- Pain may be an increase during the time of rest
- Creations sound are may hear during hand bending or extending or rotating the ankle joint
- The deformity may occur in small fracture and the formation of osteoarthritis, ankle osteoarthritis are also seen weakness and instability for the ankle joints.
- Pain may be accompanied by fatigue, sleep disturbance, emotional liability, and symptoms of pain illness are also may be increased.
- Pain from arthritis is usually worse by activities and at the end of the day or during the rest hand.
- Ankle osteoarthritis, rheumatoid arthritis with inflammatory arthritis will also cause pain and stiffness in the morning and during rest that may initially improve with activity, but subsequently gets worse with prolonged use of ankle joint with others and day to day activity.
- Constitutional symptoms such as fevers, chills, fatigue, night sweats, and weight loss may be associate with wrist rheumatoid arthritis. The systemic cause may be a systemic rheumatological associate disease, malignancy, or infectious septic arthritis.
Diagnosis of Ankle Pain
Ankle osteoarthritis and rheumatoid arthritis test and diagnosis is following
- History – The most common symptoms of wrist arthritis are pain, swelling, a tenderness that is diffuse in the whole ankle joint. The character of pain may differ for men and women due to osteoarthritis and the joint swelling is worse with joints and is relieved by rest. Your doctor may feel pain and often associated with stiffness, tenderness, and worse in the morning, and gets better as the day goes on. Symmetric involvement or the same types of joints pain is also the most common in ankle rheumatoid arthritis. Other than pain, swelling is an important feature of hand arthritis. Swelling can be due to effusion or synovial hypertrophy may occur for women for a special reason that includes patient history.
- Redness and warmth – Most of the joints feel warm during tests or keep tenderness with swelling in a non-traumatic wrist joint also suggest inflammation or inflammatory arthritis and infectious septic arthritis. Patients may also complain of the presence of limitations in range of motion and can even feel weakness and worm, tenderness.
- Inspection – Swelling, edema, and deformities both are the two most important findings associated with arthritis pain ankle. Swelling and tenderness are important to identify between a joint effusion, swelling from tenosynovitis, or a localized abnormal mass formation may be found. Ankle osteoarthritis and rheumatoid arthritis usually produce diffuse circumferential swelling. Chronic inflammation in diseases like hand rheumatoid arthritis can cause the deformities such as volar subluxation of the carpus, carpal collapse, and radial deviation of the carpus.
- Palpation – Palpation is the manual test that helps in identifying the specific affected area by the underlying pathological condition. In hand rheumatoid, the wrist is best palpated in slight flexion and feeling the dorsal surface of the wrist with the support of thumb with wrist and fingers of both the hands. Dorsal instability is a common sign of joint swelling and effusion. The instability can be also tested by looking for transmission of pressure from one hand placed at one side of the joint to the second hand placed on the opposite side.
- Range of Motion – The doctor or clinicians must test the active range of motion first for hand rheumatoid arthritis. They should be seen if there is any limitation to look for any important improvement. The range of motion tested at the ankle is flexion, extension.
- Special tests – It is called the manual test that is in excluding causes of ankle rheumatoid arthritis and other than arthritis in a patient with wrist pain with the associate condition.
- Laboratory tests- Leukocytosis is one of the most important tests for ankle osteoarthritis and rheumatoid arthritis that supports the possibility of infection and bone-related disease. Blood cultures, urine examination, or other possible primary sites of bone infection that obligatory when a septic infectious joint is being considered for examination. The and elevated inflammatory condition markers like ESR or CRP include suggesting an infectious or inflammatory disease condition of the ankle joints.
- Rheumatoid factor and anti-CCP – cyclic citrullinated peptide antibodies test should be increased if there is clinical abnormality for ankle osteoarthritis and rheumatoid arthritis are found.
- A serum uric acid level – It is often considered by clinicians and doctors when gout, pseudogout is suspected, but it is not a reliable and dangerous condition as it may be spuriously elevated or high in acute inflammatory conditions or acutely during a true gout attack or not.
- Synovial fluid analysis – A joint arthrocentesis or the system of aspiration of synovial fluid with blood and synovial fluid analysis that are mandatory if an infection is suspected or dangerous. Such patients should also be started properly treatment by using empiric antibiotic therapy as soon as possible if the synovial fluid sample is obtained from the joint. The fluid analysis or any kinds of abnormalities is also helpful in diagnosing crystal formation with osteophyte and steroid-induced arthritis. The degree of the high elevation of synovial fluid are founded by WBC count can be useful in differentiating inflammatory abnormality or from non-inflammatory causes of hand and ankle osteoarthritis and rheumatoid arthritis.
- Radiographs of the joint – Conventional x-ray and radiography is the most widely used imaging modality and allows for the detection of bone fractures, osteoporosis, and abnormal pathologies condition like fracture, osteoporosis, erosions, osteonecrosis, osteoarthritis, or a juxta-articular bone tumor, neoplasm. Characteristic features of hand rheumatoid arthritis include marginal osteophytes formation, joint space gradually narrowing, subchondral sclerosis formation, and cysts.
- CT Scan – High contrast ct scan is more effective to diagnose hand rheumatoid arthritis. Abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid. It also helps to identify the bone tumor, necrosis, abnormal joint condition, etc.
- MRI – It is called magnetic radical imaging is also helpful to find the bone conditions, abnormal tendon, ligament, cartilage, muscle and osteophyte, synovial fluid. It also helps to identify the bone tumor, necrosis, abnormal joint condition, etc. It is the final stage test to confirm that all joint abnormality.
- Bone scintigraphy – It is the most important test to diagnose bone cancer, neoplasm, fractures, necrosis of bone, and joints. It also helps to identify the tendon, sprained ligament, cartilage, muscle spasm.
Treatment of Ankle Pain
Non-pharmacologic treatments of ankle osteoarthritis and rheumatoid arthritis
- PRICE – Meaning
- Protection – In ankle osteoarthritis or rheumatoid arthritis and acute or chronic injury with pain. Protection means the save the ankle joint from further injury and dislocation, sprain, strain. It can be done by the tapping process or adhesive bandage.
- Rest – After injury from osteoarthritis of ankle the lag are keep in rest for some time to day to preven injury and accelerate the healing. It is the excellent manual process to protect ankle joints.
- Ice – The application after acute injury is helpful for healing process of ankle joints,. It basically constricted the peripheral blood vessel that help to prevent edema, swelling or accumulated water. It can be use alternatively by ice and heat therapy at a same time.
- Compression – It is the most important manual techniquue to protect the swelling, effusion and keep the tendon, ligament, cartilage intake and regenerate the joint cartilage.
- Elevation – Elevation is the process to prevent swelling, edema and fluid accumulation in ankle joints.Your doctor may advice to elevated the legs at the same position of heart horigontally. The leg must be elevated just small high compairing to heart position in sleeping times.
- Physiotherapy – It is one of the most common and effective non-pharmacological treatments in the world. It has a variety of treatment module to erase acute and chronic pain. It is especially helpful in muscle spasticity, spasms related to hand and shoulder or backs pain. Inflammatory and noninflammatory pain is treated by ultrasound, MRI, Shortwave, microwave, wax therapy, IRR, laser therapy, interferential current therapy.
- Exercise – Different types of exercise may be done under the supervision of a physiotherapist or healthcare provider. It falls into the active range of motion, tapping, isometric movement, active range of movement, or passive range of motion.
- Stretching – It is one of the most helpful treatments to reduce muscle pain, spasm, spasticity that is gradually increasing due to old age and not perform daily workouts or activities.
- Bracing – It is one of the most important self-help devices that is used in hand rheumatoid arthritis, osteoarthritis and, maintaining proper joint position, reducing swelling, improve posture and maintain the range of motion exercise.
- Acupuncture – It is the China-oriented acute and chronic treatment system where are needle is used to stimulate the pain receptor to reduce pain. It is also helpful in some spasticity formation pain, stroke, hemiplegia and chronic rheumatoid arthritis pain in hand.
- Diet – Diet may be normal or according to the doctor mentions food you can take for you, such as papaya, banana, potato, nut cereal, seasonal fruits, and drink of water. In your daily routine meal must have the magnesium, calcium, iron, zinc, folate, vitamin B complex, Vitamin A, Vitamin C etc.
- NSAIDs – It is considered to be the fast-acting nonsteroidal anti-inflammatory drugs (NSAIDs) as including acetylsalicylate, naproxen, ibuprofen, indometacin, and etodolac, ketorolac in pain is acute. Aspirin is also an effective anti-inflammatory for ankle osteoarthritis rheumatoid arthritis when used at high doses, due to the decrease or inhibition of prostaglandin synthesis. It is also called one of the oldest NSAIDs used for multiple joint pain. NSAIDs work by inhibiting cyclo-oxygenase to prevent the synthesis of prostaglandins, prostacyclin, and thromboxanes. It has also some side effects of aspirin at high doses when used are including tinnitus, hearing loss, and gastric intolerance.
- Muscle relaxant – It is important for patients with chronic muscle spasms, wasting, and muscle cramping releasing drugs. The drugs are tolperisone HCL, eperisone, baclofen, dantrolene, etc. The drug increase the blood supply with oxygen and nutrition to the affected joint.
- Nerve relaxant – It is basically used to reduce neuropathic pain, inflammation, nerve root entraption, myalgia, neuralgia, and fibromyelgia. Your doctor may prescribe gabapentin, pregabalin, vitamin B1, B6, B12, etc. Major side effects are abdominal pain, nausea- vomiting.
- Calcium & vitamin D3 – to improve bone health and healing fractures and osteoporosis, osteonecrosis. Your doctor may prescribe to take calcium and vitamin D3 supplementation to prevent thinning of the bone and muscle pain. In scientific study show that a normal men and women needed calcium 1200miligram and vitamin D3 500 miligram.
- Glucosamine & Diacerein – It is one of the most important supplements that can help to tighten the loose tendon, cartilage, and regenerate cartilage or inhabit the further degeneration of cartilage. The dosage of glucosamine is 15oo mg per day in divided dosage and chondroitin sulfate approximately 500mg per day in different dosage may be taken.[rx]
- Vitamin B1, B6, and B12 – It is essential for neuropathic pain management, pernicious anemia, with vitamin b complex deficiency pain, paresthesia, numbness, itching with diabetic neuropathy pain, myalgia, etc. Side effect may be nausea- vomitting, abdominal pain, cramping
- Corticosteroid injections – Corticosteroids to healing the nerve inflammation and clotted blood in the joints that are accumulated in the joint. The injections may provide temporary pain relief anywhere from days to several months. With repeated injections, several times the patient may experience a more permanent improvement in their symptoms.[rx] The steroid injections are typically used in severe conditions when normal treatment can not respond.[rx] Common side effects muscle cramping, increase metabolism, dry mouth, vertigo, blurred vision.
- Dietary supplement – Especially seasonal fruit vitamin B complex, vitamin b12, omega-3 fatty acid, antioxident, spirulina, cord liver oil, avocado soybean unsaponifiables, fish oil etc to remove general weakness & improved health.
- Injections – For patients with severe pain, especially leg pain, steroid injections may be a reasonable treatment option reduce the chronic ankle pain. The injections are effective in helping to reduce pain and increase a patient’s functional mobility and increase the range of motion. If a steroid injection does work to relieve the patient’s pain, it can be done up to three times per year. Injections your doctor injects cortisone into the affected joint to give you temporary relief from the pain and inflammation.