Dear Dr Nina: Is it too late to rehabilitate my ankle?
Q I sprained my ankle a couple of years ago and it has been giving me a lot of trouble since. I am in my mid-40s and took a turn going down a step resulting in a lot of pain and swelling. The GP sent me to a pyhsio hut I never did the exercises. I feel a lot of pain every now and then and am afraid to run or play sports. Have I left it too late to fix?
Answer: Joint pain is most commonly due to a lifetime of wear and tear, injury or failure to care for our skeleton properly. If you injured a joint previously and it didn't heal as well as it should it can put you at risk of pain or problems in that area in the years to come. Obesity, poor posture or balance can alter the body's centre of gravity leading to pressure through the ankles and feet. High intensity exercise that involves jumping or running also puts a strain on the structures of the ankle. Pain across the ankle may be due to some arthritis or inflammation here.
A sprain occurs when the ligaments supporting the ankle are wrenched and stretched, usually as a result of injury.
Once a sprain has occurred it is important that the ligaments heal well and the ankle remains supported. If a significant injury is missed or proper rehabilitation doesn't occur you may end up prone to further strains or having an unstable ankle joint.
If your ankle has been problematic since the last injury and you have increasing pain now, then physiotherapy is a good place to start. A registered physiotherapist will formally assess your ankle and the supporting structures.
I do always stress that when a physio advises exercise it is similar to a doctor prescribing medicine. Completing the course is usually essential to full recovery. If pain is ongoing despite physiotherapy, I would advise seeing your doctor. X-rays are not necessary for a simple sprain but an MRI may be needed to define a more serious ligament injury.
Chronic inflammation and an old injury in the ankle do increase the chance of developing osteoarthritis. This develops when cartilage (a tissue that covers the ends of bone in a joint) becomes worn down. Cartilage normally protects the bones and helps absorb pressure and movement in the joint. When this becomes thinner the bony surfaces become exposed, rubbing off each other and this leads to pain and inflammation.
Over time the joint then becomes worn down. Serious joint damage can occur. Those affected commonly complain of pain and stiffness that gets worse with exercise or use of the joint and there is often a sense of clicking or grinding.
Movement can become quite limited. The symptoms are often worst when starting to move after a prolonged rest or sleep.
When ankle pain occurs, simple measures like applying ice, raising the foot and taking over-the-counter painkillers may help. Wearing good supportive shoes is essential. Finally ensure you have adequate dairy and Vitamin D to support good bone health, avoid smoking and maintain a healthy weight. This will all improve your skeletal health. Exercise and simple painkillers are usually effective. But in rare cases ankle surgery may be required.
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