Where can I seek ankle pain treatment Singapore? Where can I find more information about ankle pain diagnosis and ankle pain singapore?

• The Orthopaedic & Pain Practice is here to address your musculoskeletal needs through personalised treatment plans and a multi-faceted approach to pain management. Reach out to us by contacting +65 9898 3595 for a consultation with an orthopaedic surgeon.

(image source: https://www.sportsinjuryclinic.net/sport-injuries/ankle-pain)

Introduction to Ankle Pain

The ankle is the joint where the lower leg bones and the foot bones meet. It is formed by the tibia (shin bone), fibula (calf bone), and talus (anklebone). Cartilage, ligaments, muscles, nerves, and blood vessels are all important parts of the ankle (Dwyer, 2009). The foot can turn inwards, outwards, and tilt to the side because of the flexibility provided by the ankle.

As we progress with our daily activities, there is a lot of pressure put on the ankle joint. Ankle pain is a common complaint in adult Singaporeans. Maintaining healthy ankles is crucial for several reasons, including injury prevention, improved mobility, posture alignment, and speedy recovery from injuries.

Causes of Ankle Pain

Our ankles support the weight of our entire body. Acute pain can usually be from injuries to the bone, joint, or tendons sustained during sports or activities. Chronic pain is usually atraumatic, and it may be a result of either ligament instability or tendon and joint issues with the ankle (Johns Hopkins Medicine, 2022). Ankle pain can be traced to 2 primary causes:

1. Traumatic ankle pain is usually linked to ankle fractures and ankle sprains. These can happen during strenuous activities, sports, exercises, and even sudden accidents or movements. Sprains occur when a ligament is overstretched or torn, while fractures occur when you break one or more bones. Ligament sprains involve the lateral ankle ligaments and syndesmotic ligaments.
2. Atraumatic ankle pain is mainly linked to tendinopathies of tendons around the ankle and cartilage issues including osteoarthritis. Tendinopathy arises when the tendon is repeatedly stressed, resulting in microscopic tears. Some other causes include ankle instability resulting in impingement, tendon degeneration, and damage and cartilage issues in the ankle.

Signs and Symptoms of Ankle Pain

The following symptoms are associated with ankle pain. You may experience one or more of these, depending on the severity and the source of pain (Mayo Clinic, 2023).

• Pain in the ankle area
• Redness or swelling
• Stiffness or bruising
• A loose or unstable feeling
• Difficulty walking or standing
• Inability to climb stairs or run
• Visible deformity (ankle at an odd angle)

(image source: https://www.cafootankle.com/blog/three-common-causes-of-heel-pain)

Risk Factors That Contribute to Ankle Pain

Some individuals have certain characteristics that increase the risk of developing ankle pain (Mayo Clinic, 2022). These risk factors include:

1. Age – As we become older, our joints lose some of their lubrication. The cartilage thins out, affecting joint mobility and overall flexibility.
2. History of ankle conditions – An individual with a history of ankle injuries is more likely to experience sprains, fractures, or ankle strain.
3. Physical condition – People with weak or stiff ankles are more likely to experience difficulties while playing sports, which may lead to injury.
4. Participation in sports and other activities – People who enjoy sports like basketball, tennis, football, soccer and running have a higher risk of developing ankle issues. 
5. Ill-fitting footwear – Ankles are more vulnerable to injury when people wear improper footwear that is too loose or too tight for the feet.

When to Seek Medical Help

According to Ottawa Ankle Rules, those who have trouble standing on one leg are more likely to have an ankle fracture. If you have difficulties supporting your own weight after the injury, you should consult an orthopaedic surgeon right away. Depending on the cause, ankle pain is typically treatable.

Methods to Diagnose Ankle Pain

Be sure to keep a record of your medical history. These can include allergies, previous surgeries, immunisations, and test results. This information will help your doctor gain insights into your current lifestyle and condition (OrthoInfo, 2020).

1. A medical interview will be conducted to identify your symptoms and functional needs. Your orthopaedic surgeon will assess your medical history and perform a focused examination.
2. The foot and lower limb alignment will be checked through a physical examination of the affected areas. Plain radiographs and MRI scans may also be deemed necessary based on the initial diagnosis. Recurrent sprains and injuries will likely need further work-up in the form of MRI scans.

Surgical and Non-Surgical Treatments for Ankle Pain

Ankle pain can be attributed to a wide range of causes. Your orthopaedic surgeon will provide a treatment plan that will be focused and targeted to the cause of pain (Cleveland Clinic, 2020).

1. A sudden injury to the lower leg or ankle joint region may necessitate pain medications such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and opioid medications to manage joint pain and inflammation.
2. Ankle fractures are typically managed with fracture surgery. If surgery is deemed unnecessary, they will be placed on ankle casts for up to 2 months. Immobilisation of the affected area allows the bones to heal.
3. Ankle sprain treatment will depend on severity and frequency. Up to one-third of patients with ankle sprains for the first time will develop chronic symptoms. Individuals may experience instability such as chronic pain with uneven ground/slopes and the ankle giving way during sports or walking.
4. If there is frequent recurrence or symptoms of instability, surgery may be necessary for ligament repair.
5. Ankle sprains can sometimes also involve the cartilage of the ankle joint. In these cases, cartilage injury to the joint necessitates surgery to potentially reduce the risk of osteoarthritis.
6. High ankle sprains (involving syndesmosis) will almost always need surgery.
7. Tendon injuries can be managed surgically or non-surgically depending on severity. Should the MRI reveal a tear, or if the patient’s symptoms are chronic and intractable, surgery may be necessary. Non-surgical treatments for minor injuries involve rest, physiotherapy, and medications.
8. Orthotics may sometimes be prescribed on a case-by-case basis. These are custom-made medical devices in the form of shoe inserts or braces to improve one’s function and mobility.
9. Injections with autologous solutions or steroid/local anaesthetic mixtures may be helpful for tendon recovery.
10. Tendon and ankle sprains can primarily be treated using physiotherapy to manage ankle pain. Physiotherapy is helpful in restoring mobility and function through a range of exercises, stretching, isometric strengthening, and other methods.
11. Cartilage injury treatment will depend on the severity of the condition. If there is moderate to severe cartilage loss, it may be linked to osteoarthritis of the ankle. Focal areas of cartilage injury can result in loose bodies in the ankle. Loose bodies are characterized as fragments of bone or cartilage.
12. Focal cartilage injuries in adults will usually necessitate surgery. Cartilage injuries can happen through injurious sources (sudden accidents) or non-injurious sources (sports and normal wear and tear)
13. Loose bodies and focal cartilage damage can predispose to osteoarthritis of the ankle.
14. For the management of osteoarthritis of the ankle, options include non-surgical options such as weight loss, medications, physiotherapy and injections, and surgical options such as total ankle arthroplasty and ankle fusion procedures.

(image source: https://www.footcarespecialists.com/blog/when-your-ankle-injury-may-require-surgery)

When Does Ankle Pain Require Surgery?

It all depends on the cause of ankle pain as detailed in the previous sections. Your orthopaedic surgeon will diagnose your condition and devise a treatment plan for your unique needs. There are various types of surgery that may be performed such as:

1. Fracture surgery around the ankle is usually conducted in an open fashion with skin incisions and metal implants placed to hold fractures in place until it heals.
2. Tendon surgery is usually conducted in an open fashion, where torn tendons are repaired and debrided. Debridement is the process of removing damaged or affected tissue.
3. Ligament and cartilage surgery is usually conducted in a minimally invasive fashion using ankle arthroscopy. An arthroscope is a device with a camera and light used to provide real-time images.

Rehabilitation Techniques and Expectations with Post-Injury Recovery

Your recovery and rehabilitation after surgery will depend on the specific procedure and nature of the surgery. In most patients undergoing ankle surgery, the estimated time to return to full activities is 2 to 3 months.

1. Fracture surgery may require a period of partial or non-weightbearing. This means that you will be advised to avoid bearing weight on the affected area. You may be required to use a crutch or wheelchair to move around.
2. Ligament repair surgery will usually require a period of orthotic wear and physiotherapy. Orthotics are custom shoe inserts or ankle braces that encourage joint alignment and support lower extremities.
3. Cartilage surgery will usually require orthotics and a period of protected or limited weightbearing. Orthotics help align the affected body parts, while limited weightbearing eliminates pressure and allows for proper recovery.

(image source: https://bmjtherapy.com/do-and-do-not-ankle-sprain/)

Lifestyle Changes to Manage Ankle Pain and Prevent Future Injuries After Treatment

Adjusting your lifestyle can help you manage ankle pain and discomfort. This would include maintaining a healthy weight and taking precautions during physical activity. While on the mend from an injured joint, it is important to protect the ankle from further injury (Cleveland Clinic, 2020). Depending on the instruction of your orthopaedic surgeon, you can follow these steps:

1. Practice good exercise habits such as exercise warmups and cooldowns.
2. Use supportive footwear and avoid loose shoes or flip-flops.
3. Use braces for injured joints to relieve pressure and allow for proper recovery.
4. Take physiotherapy sessions to promote mobility and pain management.
5. Follow your doctor’s instructions about protected weightbearing and the use of orthotics.

Strategies to Avoid Ankle Injuries

1. Catch and hold a 2 kg dumbbell in one hand and stand on one leg. Hold this position with your eyes open for 30 seconds. Repeat on the other side. From here, close your eyes and continue to hold the position for 60 more seconds.
2. Perform a drop jump off a 40 cm box. Focus on landing softly on the ground. Once you have mastered this, try landing on different surfaces and in different directions.
3. Perform the bottom half of a single-leg squat by lowering down to a chair without letting your injured leg touch the floor. From here, stand back up on the injured leg only.
4. Begin your exercise program with a thorough warm-up and finish with a cool-down. Gradually increase the intensity of your exercise.
5. 5. Select the correct footwear. Choose shoes that are appropriate for the activity you have chosen, fit your feet comfortably, have good cushioning, and offer good support for your feet and ankles. Avoid shoes that are worn out or old. 6. Consider environmental conditions. If the ground is too wet, muddy, or filled with debris, avoid the path and seek a safer area to exercise. Adapt your activity program to suit your individual risk factors; for example, no uphill running if you have been identified to be at higher risk of an ankle ligament sprain.

If sprained ankles are already a problem for you, or you have never done regular balance and ankle exercises, visit a physiotherapist or podiatrist to provide initial advice on how to ensure you are doing these exercises correctly. Many podiatrists and physiotherapists can also provide sporting advice on specific exercises for an individual’s sport or training requirements.

Final Words

The ankle joint bears weight, allows movement, and plays a significant role in our daily activities. Sprains, strains, osteoarthritis, and other medical conditions can contribute to ankle pain. There are instances that self-medication can lead to misdiagnosis which can exacerbate your condition. Since there is a multitude of factors to consider, it is best to seek medical advice from your orthopaedic surgeon. In Singapore, there are surgical and non-surgical methods to treat ankle pain. Your treatment plan may include orthotics, over-the-counter medicine, physiotherapy, minimally invasive techniques, or open surgery. Your orthopaedic surgeon will recommend the optimal solution for your unique needs.

Frequently Asked Questions

Dr Yong Ren profile

Dr Yong Ren graduated from the National University of Singapore’s Medical faculty and embarked on his orthopaedic career soon after. Upon completion of his training locally, he served briefly as an orthopaedic trauma surgeon in Khoo Teck Puat hospital before embarking on sub-specialty training in Switzerland at the famed Inselspital in Bern.

He underwent sub-specialty training in pelvic and spinal surgery, and upon his return to Singapore served as head of the orthopaedic trauma team till 2019. He continues to serve as Visiting Consultant to Khoo Teck Puat Hospital.

Well versed in a variety of orthopaedic surgeries, he also served as a member of the country council for the local branch of the Arbeitsgemeinschaft für Osteosynthesefragen (Trauma) in Singapore. He was also involved in the training of many of the young doctors in Singapore and was appointed as an Assistant Professor by the Yong Loo Lin School of Medicine. Prior to his entry into the private sector, he also served as core faculty for orthopaedic resident training by the National Healthcare Group.

Dr Yong Ren brings to the table his years of experience as a teacher and trainer in orthopaedic surgery. With his expertise in minimally invasive fracture surgery, pelvic reconstructive surgery, hip and knee surgery as well as spinal surgery, he is uniquely equipped with the tools and expertise necessary to help you on your road to recovery.

References

Cleveland Clinic. (2020). Ankle Pain. Retrieved from
https://my.clevelandclinic.org/health/symptoms/15295-ankle-pain

Dwyer, T. (2009). The Bone School. Retrieved from http://www.boneschool.com/

Johns Hopkins Medicine. (2022). Foot Pain and Problems. Retrieved from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/foot-pain-and-problems

Mayo Clinic. (2022) Sprained ankle. Retrieved from https://www.mayoclinic.org/diseases-conditions/sprained-ankle/symptoms-causes/syc-20353225

Mayo Clinic. (2023). When to see a doctor. Retrieved from
https://www.mayoclinic.org/symptoms/ankle-pain/basics/when-to-see-doctor/sym-20050796

OrthoInfo. (2020). Ankle Fractures (Broken Ankle). Retrieved
from https://www.orthoinfo.org/en/diseases–conditions/ankle-fractures-broken-ankle/