Chronic Lateral Ankle Pain

What is chronic lateral ankle pain?

Recurring or chronic pain on the outer side of the ankle often develops
after an injury such as a sprained ankle. However, several other conditions
may also cause chronic ankle pain.

What are the symptoms of chronic lateral ankle pain?

Pain, usually on the outer side of the ankle, may be so intense that
you have difficulty walking or participating in sports. In some cases,
the pain is a constant, dull ache.

Difficulty walking on uneven ground or in high heels

A feeling of giving way (instability)

Swelling

Stiffness

Tenderness

Repeated ankle sprains

What causes chronic lateral ankle pain?

The most common cause for a persistently painful ankle is incomplete
healing after an ankle sprain. When you sprain your ankle, the connecting
tissue between the bones is stretched or torn. Without thorough and
complete rehabilitation, the ligament or surrounding muscles may remain
weak, resulting in recurrent instability. As a result, you may experience
additional ankle injuries. Other causes of chronic ankle pain include:

An injury to the nerves that pass through the ankle. The nerves may
be stretched, torn, injured by a direct blow or pinched under
pressure (entrapment).

A torn or inflamed tendon

Arthritis of the ankle joint

A fracture in one of the bones that make up the ankle joint

An inflammation of the joint lining (synovium)

The development of scar tissue in the ankle after a sprain. The scar
tissue takes up space in the joint, thus putting pressure on the
ligaments.

How is chronic lateral ankle pain diagnosed?

The first step in identifying the cause of chronic ankle pain is taking a
history of the condition. Your doctor may ask you several questions,
including:

Have you previously injured the ankle? If so, when?

What kind of treatment did you receive for the injury?

How long have you had the pain?

Are there times when the pain worsens or disappears?

Because there are so many potential causes for chronic ankle pain, your
doctor may do a number of tests to pinpoint the diagnosis, beginning with
a physical examination. Your doctor will feel for tender areas and look for
signs of swelling. He or she will have you move your foot and ankle to
assess range of motion and flexibility. Your doctor may also test the
sensation of the nerves and may administer a shot of local anesthetic to
help pinpoint the source of the symptoms.
Your doctor may order several X-ray views of your ankle joint. You may
also need to get X-rays of the other ankle so the doctor can compare the
injured and noninjured ankles. In some cases, additional tests such as a
bone scan, computed tomography (CT) scan or magnetic resonance image
(MRI) may be needed.

What are treatment options?

Treatment will depend on the final diagnosis and should be personalized to
your individual needs. Both nonoperative and surgical treatment methods
may be used. Conservative treatments include:

Anti-inflammatory medications such as aspirin or ibuprofen to

reduce swelling

Physical therapy, including tilt-board exercises, directed at

strengthening the muscles, restoring range of motion and increasing
your perception of joint position

An ankle brace or other support

An injection of a steroid medication

In the case of a fracture, immobilization to allow the bone to heal

If your condition requires it, or if conservative treatment doesn't bring

relief, your doctor may recommend surgery. Many surgical procedures can
be done on an outpatient basis. Some procedures use arthroscopic
techniques; other require open surgery. Rehabilitation may take six to 10
weeks to ensure proper healing.
Surgical treatment options include:

Removing (excising) loose fragments

Cleaning (debriding) the joint or joint surface

Repairing or reconstructing the ligaments or transferring tendons

Prevention

Almost half of all people who sprain their ankle once will experience
additional ankle sprains and chronic pain. You can help prevent chronic
pain from developing by following these simple steps:
1. Follow your doctor's instructions carefully and complete the
prescribed physical rehabilitation program.
2. Do not return to activity until cleared by your physician.
3. When you do return to sports, use an ankle brace rather than taping
the ankle. Bracing is more effective than taping in preventing ankle
sprains.
4. If you wear high-top shoes, be sure to lace them properly and
completely.

RICE Treatment
As soon as possible after an injury, such as a knee or ankle sprain, you can
relieve pain and swelling and promote healing and flexibility with RICE
Rest, Ice, Compression, and Elevation.

Rest. Rest and protect the injured or sore area. Stop, change, or take

a break from any activity that may be causing your pain or soreness.

Ice. Cold will reduce pain and swelling. Apply an ice or cold pack
right away to prevent or minimize swelling. Apply the ice or cold pack for 10
to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is
gone, apply heat to the area that hurts. Do not apply ice or heat directly to
the skin. Place a towel over the cold or heat pack before applying it to the
skin.

Compression. Compression, or wrapping the injured or sore area

with an elastic bandage (such as an Ace wrap), will help decrease swelling.
Don't wrap it too tightly, because this can cause more swelling below the
affected area. Loosen the bandage if it gets too tight. Signs that the
bandage is too tight include numbness, tingling, increased pain, coolness,
or swelling in the area below the bandage. Talk to your doctor if you think
you need to use a wrap for longer than 48 to 72 hours; a more serious
problem may be present.

Elevation. Elevate the injured or sore area on pillows while applying

ice and anytime you are sitting or lying down. Try to keep the area at or
above the level of your heart to help minimize swelling.

What is Bell's palsy?

Bell's palsy is a paralysis or weakness of the muscles on one side of your
face. Damage to the facial nerve that controls muscles on one side of the
face causes that side of your face to droop
. The nerve damage may
also affect your sense of taste and how you make tears and saliva. This
condition comes on suddenly, often overnight, and usually gets better on its
own within a few weeks.
Bell's palsy is not the result of a stroke or a transient ischemic attack (TIA).
While stroke and TIA can cause facial paralysis, there is no link between
Bell's palsy and either of these conditions. But sudden weakness that
occurs on one side of your face should be checked by a doctor right away
to rule out these more serious causes.

What causes Bell's palsy?

The cause of Bell's palsy is not clear. Most cases are thought to be caused
by the herpes virus that causes cold sores.
In most cases of Bell's palsy, the nerve that controls muscles on one side of
the face is damaged by inflammation.
Many health problems can cause weakness or paralysis of the face. If a
specific reason cannot be found for the weakness, the condition is called
Bell's palsy.

What are the symptoms?

Symptoms of Bell's palsy include:

Sudden weakness or paralysis on one side of your face that causes it

to droop. This is the main symptom. It may make it hard for you to close
your eye on that side of your face.
Drooling.
Eye problems, such as excessive tearing or a dry eye.
Loss of ability to taste.
Pain in or behind your ear.
Numbness in the affected side of your face.
Increased sensitivity to sound.

How is Bell's palsy diagnosed?

Your doctor may diagnose Bell's palsy by asking you questions, such as
about how your symptoms developed. He or she will also give you a
physical and neurological exam to check facial nerve function.
If the cause of your symptoms is not clear, you may need other tests, such
as blood tests, an MRI, or a CT scan.

How is it Treated?
Bell's palsy affects each individual differently. Some cases are mild and do
not require treatment as the symptoms usually subside on their own
within 2 weeks. For others, treatment may include medications and other

therapeutic options. If an obvious source is found to cause Bell's palsy

(e.g., infection), directed treatment can be beneficial.
Recent studies have shown that steroids such as the steroid prednisone
-- used to reduce inflammation and swelling --are effective in treating
Bell's palsy. Other drugs such as acyclovir -- used to fight viral herpes
infections -- may also have some benefit in shortening the course of the
disease. Analgesics such as aspirin, acetaminophen, or ibuprofen may
relieve pain. Because of possible drug interactions, individuals taking
prescription medicines should always talk to their doctors before taking
any over-the-counter drugs.
Another important factor in treatment is eye protection. Bell's palsy can
interrupt the eyelid's natural blinking ability, leaving the eye exposed to
irritation and drying. Therefore, keeping the eye moist and protecting the
eye from debris and injury, especially at night, is important. Lubricating
eye drops, such as artificial tears or eye ointments or gels, and eye
patches are also effective.
Other therapies such as physical therapy, facial massage or acupuncture
may provide a potential small improvement in facial nerve function and
pain.
In general, decompression surgery for Bell's palsy -- to relieve pressure on
the nerve -- is controversial and is seldom recommended. On rare
occasions, cosmetic or reconstructive surgery may be needed to reduce
deformities and correct some damage such as an eyelid that will not fully
close or a crooked smile.