Interestingly, there is not that much pain associated with ankle problems. They usually present with aching and swelling at night, then stiffness in the morning that requires time to ‘warm up’. Unfortunately, there is usually a problem before these symptoms intensify and testing (x-ray and/or MRI) should be performed to rule out or in more severe problems.
In short, pain and/or stiffness in the morning are more connected to injury, old or new. Chronic swelling and aching at night is more connected “overuse syndrome”, arthritis, and/or other associated medical conditions.
If I had to say what the percentage of ankle patients who come in with these general complaints, it would be 80 to 90%. Ankle’s that ‘give out’ are also in this category, but the swelling, aching and stiffness symptoms top the charts.
The problem with these tolerable symptoms, is that even with mild pain or swelling, there could be more extensive damage inside of the joint. These patient histories range from major trauma like car accidents, ankle sprains and ankle fractures to harsh worksite environments. And their timelines can span from weeks, to several months to decades.
So why are we able to get by with ibuprofen from time to time and get through our day?
We are designed to cover up pain with direct pressure or repetitive stimulus (walking and standing) all day. But all my ankle problem patients will tell you, they ache at night and “I feel like a 90 year old, hobbling to the bathroom in the morning… before it warms up a bit”.
The good news is that major surgery like Ankle Replacements or Ankle Fusions are no longer first in line. Proper testing (Radiograph, MRI, CT, Bone Scan) is imperative, but even a small cortisone injection can help patients with pain while ruling in or ruling out certain ‘internal’ ankle diagnoses. Custom orthotics are another conservative option for those who have foot and ankle alignment issues or foot pronation that cause or add to their ankle problem.
The Ankle Arthroscopic procedures are the absolute best first line of minimally invasive surgical treatment if conservative treatment fails. Studies show simply cleaning out debris or trimming partially detached cartilage will give patients pain relief, more ankle movement and better stability.
Warning: Minimally invasive procedure in the operating room setting
Another common problem encountered during these procedures is Subchondral Fracturing – a crushing or collapse of the bone just underneath the cartilage. This is vital to repair since this bone is what feeds the cartilage and keeps it alive.
Below is a short demonstration in the operating room showing the technique and application of this Calcium Phosphate product inside of the ankle joint.
And in addition to the bone repair are the next generation of biologics from Amniotic tissue (https://mimedx.com/amniofix/). This matrix works well mixed with saline, but better when mixed with PRP or bone marrow aspirate. Below is the an application for both enhancing ligament repairs and cartilage repair after an ankle arthroscope.
For more information or to find out more about your ankle problem, please feel free to log on to our website http://mfaspecialists.com/ or call 281-444-6800.
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