Painful Inner Ankle – Solutions for Traumatic Arthritis
DeLoor Podiatry has a number of patients with post-traumatic arthritis. It affects around 6 million people in the United States. One of the symptoms is a painful inner ankle, called the medial ankle. Hurting the medial ankle is rarer because we usually sprain the outer ankle. But for soccer players, basketball players, runners and dancers, it’s relatively more common.
The pain usually happens when you turn your foot inward, or flex it downward, pointing your toes down. Because this movement is part of walking, painful inner ankles are difficult to ignore.
In worse scenarios, mere standing is also painful, because the inner ankle supports the arch of your foot. When this support doesn’t work as it should, the simple action of standing becomes out of whack.
Always, always consult a podiatrist when you have injured your ankle. This is the only way you avoid repeat injuries, which lead to damage in the surrounding tissues in the joint, the ligaments, and in the cartilage and bones of the joint itself.
What the inner ankle does
Your outer ankle supports your weight. The inner ankle’s function is to keep your foot and leg working in alignment.
The medial ankle has the strongest group of ligaments, infrequently injured. On your foot, this set of fan-like ligaments connect your leg bones (the tibia) and foot bones (tarsals) and prevent valgus stress on your ankle. That is, it prevents your ankle from “turning outward” in that rare everted rear foot sprain.
The tibialis posterior muscle goes up from the back of your shin bone, and goes down the inside of the ankle as a tendon, and goes through the tarsal bones in the middle of the foot. Together with a couple of other tendons (Flexor Hallucis Longus and Flexor Digitorum Longus) the Tibialis Posterior lies behind the bony prominence (malleolus) on the inside of the ankle.
The Tibialis Posterior supports the calf muscles in pushing your foot down in the plantarflexion, the ‘toe off’ part of walking and running. The Tibialis Posterior tendon also plays an important role in supporting the arch on the inside of the foot.
If the arch of the foot loses its support due to inner ankle damage, your foot biomechanics would be completely off-center. This is called acquired flat foot. It causes severe foot and ankle pain.
Symptoms of inner ankle injury and traumatic arthritis
If you were an avid runner, an athlete, or simply had a bad turn in your ankle previously, you possibly have post-traumatic arthritis.
It can sneak up on you suddenly, even years after the injury.
- Pain on the inside of the ankle during when you flex your foot downward (plantarflexion)
- Pain when you move your ankle inward
- Pain when touching your foot on the spot where shoelaces are tied. This is where the tibialis posterior tendon attaches to your foot
- Pain behind the bony lump of your inner ankle, the medial malleolus.
- Swelling around the medial malleolus
- A creaking sound from the medial malleolus during movement
- Joint pain, swelling, fluid accumulation in the joint
- Pain when walking, using stairs, playing sports that stress the inner ankle
- Pain and difficulty making turns when walking: ankle instability
DeLoor Podiatry can expertly confirm the cause of your painful inner ankle, whether it’s traumatic arthritis or tibialis posterior syndrome, through MRI scans.
Dr. Jose Loor says, “We’ll also talk to you about your history, what injury happened, the times your ankle hurts you– is it painful in the morning, is it swelling at night? That sort of thing. What makes the pain worse and what makes it better? I’ll also have to poke at your ankle, of course. Sometimes, aside from the MRI, we might also look at blood tests. It gives us the whole picture.”
“Post-traumatic arthritis involves previous injury coming back to haunt the patient”
Understanding painful inner ankle and ankle arthritis
Runners and football players are prone to wearing down and injuring their medial ankle. Running in sharp turns strains the inner ankle, causing wear and tear, and one direct kick to your inner ankle is all it takes to trigger tibialis posterior syndrome.
At DeLoor Podiatry, we’ve had patients who thought the medial ankle itself–the cartilage or ligaments of the joint– is to blame, but it was the damaged tibialis posterior muscle and tendon, or post-traumatic arthritis.
Post-traumatic arthritis involves previous injury coming back to haunt the patient, which is also common among active runners and athletes who ignored inner ankle sprains or general discomfort in their ankles.
Osteoarthritis is common to everyone who ever used their joints. It’s wear and tear, a natural result of our bones and joints degenerating as we grow older. BUT bone and joint degeneration are also caused by injury improperly treated and rehabilitated.
Cartilage, the cushion in between joints, gets damaged, wears down, becomes frayed. Pieces break off, or the bone becomes roughened due to rubbing together. All this causes inflammation, pain and disability. You affected ankle has a much decreased tolerance for walking and bearing weight.
Post-traumatic arthritis is almost identical to osteoarthritis. It may take years to appear, but when it does, the most common is foot and ankle arthritis, post-trauma.
Here’s why you should immediately go to a podiatrist and never leave a painful inner ankle untreated:
- Fallen arches, called acquired flat foot: Causes serious foot pain and ankle pain.
- Acquired flat foot goes on to become a major cause of mobility problems when you’re older
Recovery from injury and treatment of arthritis is important in regaining your range of movement and preventing further degenerative damage in your foot.
Solutions for inner ankle pain
PRICE protocol (protection, rest, ice, compression, elevation), supportive shoes, orthotics, weight loss, low impact strengthening exercises, local anesthetics and corticosteroids, and anti- inflammatories all help in reducing pain and inflammation in traumatic arthritis.
As a preventive and supportive measure, running shoes should have shock absorbing insoles.
If you are an athlete, or a serious runner, you’ve probably already been fitted for shoes with superior arch support. This lessens the stress placed on your inner ankle. In the case of arthritis and tibialis posterior syndrome, this gives you a reduction in pain and discomfort.
Dr. Jose Loor says, “If you have flat feet or fallen arches, we would fit you with orthotics you can insert into your shoes to support the arch of your foot. This relieves the pressure on your tibialis posterior tendon.”
DeLoor Podiatry would also prescribe pain management and physiotherapy to make your ankle joint functional again.
But none of these solutions cure the arthritis. When these treatments stop working, it’s time to consider for foot and ankle surgery to restore and maintain ankle function and offer a much longer-lasting and effective pain-relief. DeLoor Podiatry has provided, and continues to provide, these procedures that help patients return to former activities.
Platelet-rich plasma and Bone Marrow Aspirate Concentrate: PRP Injection and BMAC/Stem Cell Injection in New York
Foot and ankle surgery for ankle arthritis includes debridement (cleaning out loose pieces and smoothing the bone/cartilage) and reconstructive surgery.
When it comes to foot and ankle surgery, platelet-rich plasma and stem cell injection has a higher success rate in restoring ankle function.
What are platelets? What is bone marrow aspirate concentrate?
Platelets are the important cells in your blood that clot to stop you from bleeding to death. Platelet-rich plasma (PRP) is simply your own blood with platelets in powerful, concentrated form, full of healing growth factors that stimulate healing.
Bone marrow aspirate concentrate (BMAC) is fluid taken from your bone marrow, containing stem cells. Stem cells are cells that haven’t formed yet. When placed beside other cells, stem cells imitate those cells. For example, when injected beside cartilage or ligament, stem cells become cartilage and ligament cells, thereby promoting healing in the bone and joint.
DeLoor Podiatry specialists obtain and inject both PRP and BMAC in non-invasive procedures.
You are a candidate for either PRP or BMAC injection therapy if you have arthritis, cartilage damage, tendon and ligament injuries such as plantar fasciitis, Achilles tendon and ankle ligament injuries.
Both injections are not possible for those with infections and cancer.
What happens when you have a PRP or BMAC injection
Platelet-rich plasma injection therapy:
Dr. Loor says, “We will take a small amount of your blood. We spin this at high speed to get the platelets at three to five times the concentration usually found in your blood. This means we also have three to five times the amount of growth factors. We inject this plasma concentrate in and around your ankle. It can take one injection, or several. It depends on the extent of the injury, and the response to the injection.”
DeLoor Podiatry specialists use ultrasound, arthroscopy, or X-ray to guide the placement of the injection. The whole injection procedure takes no more than an hour.
After the PRP injection:
“There will be mild pain in the area for a few days,“ says Dr. Jose Loor. “We’d fit you with a boot, a brace, or a cast. You should avoid moving the ankle and putting weight on the leg.”
About three days to a week after the injection, you can come back to DeLoor Podiatry for a follow-up check. You can return to putting weight on the ankle.
How long until you can resume full activity depends on your response to the injection and therapy.
Bone marrow aspirate concentrate injection:
“For bone marrow aspiration, you would be under a sedative, general anesthesia,” says Dr. Jose Loor. “We usually take bone marrow from your pelvis, although it can also be taken from other areas on the same side of your body as the foot or ankle that needs the injection. If it’s your left ankle, we’d take and use bone marrow from left hip.
“We insert a hollow needle into the bone, attach a syringe and withdraw enough bone marrow fluid for the procedure. We would dress the aspiration wound. You’d have pain here for several days, but it goes away. DeLoor Podiatry would prescribe pain medicine to take care of your pelvis and foot post-operative pain.
“The bone marrow fluid is spun in a centrifuge, like your blood to get a concentrate of platelets, only this time it’s for a concentrate of stem cells. We inject this liquid containing a high concentration of stem cells directly on your injured ankle.”
After the BMAC injection:
You’d have pain in your pelvis and the injection site for about a week. Pain medication helps a lot in both the pelvis and ankle.
How long does it take to recover after a PRP or BMAC injection?
Dr. Jose Loor says, “It really varies. One of our patients received two injections at two-month intervals. She regained full mobility two months after the final treatment. She couldn’t climb steeply without pain, but she could stand for long periods and could comfortably tackle walking on uneven ground!”