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Suggest Treatment For Ankle Pain

Posted on Wed, 6 Jan 2016

Question: Hi,
I know someone (female) who suddenly experienced pain in the ankle area while standing a few months ago. Then, the area around the ankle swelled significantly and needed ice to bring down. I understand that this happens each day. In the morning after sleeping and lying flat, the area around the ankle returns to normal but by nighttime it has swollen again.

What could cause such an issue, could it be related to the veins instead of the bones. The x-ray has shown two spurs at the bottom of the foot and the physiotherapist has said it could be arthritis.

Thankyou.
Regards.

Answered by Dr. Naval Mendiratta (1 hour later)

Brief Answer:
Venous insufficiency

Detailed Answer:
Good evening

Thank you for writing on health care magic

I have gone through your history.

It looks more like related to veins than the bones. When the veins are not working properly( venous insufficiency), they are not able to drain the fluid from the legs. So whenever we stand for too long or work around or walk, it gets accumulated in the ankles as it is unable to function against gravity. On lying down, the gravity is removed and so all the fluid gets drained in the night.

If it was due to bones, it wouldn't go off. Calcaneal spurs are a common finding after the age of 50 but they normally cause swelling above the heel area and it will hurt more on keeping the foot down. It wont cause swelling in the ankles as such. They can cause pain on keeping the foot down in the morning, but doesn't seem like the cause for her ankle swelling

I would suggest get a Venous Doppler done for the lower limbs. It would give us the exact diagnosis

Hope the information was useful. Do let me know for more queries. Would be happy to help out

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (24 hours later)

Thanks Dr. Naval,

I understand your explanation that the veins could be the likely cause. I'd like to ask what would be happening in the veins to cause the sudden sharp pain in the ankle followed by swelling. A cold pack was put on after the swelling but the pain and swelling continued. I have also found out that the x-ray revealed degeneration as well as spurs and wonder if the degeneration could possibly cause the pain/swelling.

I will pass on the suggestion for a venous doppler.

Thankyou,
Regards.

Answered by Dr. Naval Mendiratta (5 hours later)

Brief Answer:
Degenerative disease

Detailed Answer:
Good evening

Well, I would like to know where the degeneration is located exactly. If it is in the ankle, there is a chance of crystal arthritis( Pseudo Gout) happening in the degenerative joints which can cause acute arthritis attacks and subsides over the days. The CPPD crystals are normally present in the degenerative joints and get released spontaneously to trigger one of the worst attacks . Calcaneal spurs we normally dont expect to cause such pain and swelling in the ankles. It is localized only to the heel area.

If the swelling and pain is persisting, we need to investigate further either with an Ultrasound or MRI. Till then you can continue with Anti inflammatory medications.

If you could attach the X ray it would be helpful

Hope the information was useful

Do let me know for more queries

REgards
Dr Naval

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Naval Mendiratta (42 hours later)

Thanks Dr Naval,

I have the following x-ray report:

Findings

There is a bony plantar calcaneal spur. There is loss of the plantar arch. There is XXXXXXX beaking. There is mid foot arthropathy. There is an os trigonum.

The features are of established arthropathy of the left ankle.

Could these findings explain the symptoms because it seems strange why it would be a sudden onset of pain. Also for the degeneration as you mentioned it would not explain the subsiding of the swelling during the night.

Thankyou,
Regards.

Answered by Dr. Naval Mendiratta (13 hours later)

Brief Answer:
Degenerative arthritis

Detailed Answer:
Good evening

Sorry for the delayed reply. Had long duty yesterday

Well, yeah these features are more in favor of degenerative arthritis. The swelling on prolonged standing could be due to both the reasons. As it happens in osteoarthritis of the knees as well, when the knees get painful and swollen on prolonged standing, it can happen the same with ankle.

But till we dont do a venous doppler, we wont know if it is due to the venous leakage. That is a treatable cause which we can reverse. But if it is due to degenerative arthitis, it is something which doesnt go off and the management will be different.

Both will respond on rest and the swelling disappears.

so I would suggest just a venous doppler will suffice.

Do let me know the report once you get it done.

Regards
Dr Naval

Above answer was peer-reviewed by : Dr. Prasad