Do you have pain in your inner ankle? You’re not alone. Many people suffer from inner ankle pain, and it can be quite debilitating. In this blog post, we will discuss the causes of inner ankle pain, as well as some treatment options. We hope that this information will help you to find relief from your symptoms!
The source of inner or medial ankle pain can be caused by a wide variety of issues given the complexity of the joint itself. These are some of the explanations for inner ankle pain.
Stress fractures causing inner ankle pain
A stress fracture is an overuse injury whereby the bone eventual fails and fractures with time. This is not caused by an acute, obvious injury like with a classic ankle fracture, falling from a height or being involved in a motor vehicle accident. This can occur to the inner part of the tibia called the medial malleolus or slightly higher up in the shin bone. Treatment typically consists of rest, ice, immobilization and likely a period of casting/boot until the stress fracture heals.
Sprain leading to inner ankle pain
The inner part of the ankle contains the deltoid ligament. This is an expansive ligament that connects the lower tibia to the rest of the foot including the heel bone (calcaneus), talus and another bone called with navicular. Deltoid ligament sprains are much less common than the typical ankle sprain which causes injury to the outer/lateral ankle ligaments. The deltoid ligament consists of two basic components including the superficial (outer) and deep part. If the deep part of the ligament is injured it could like to instability of the ankle joint causing development of arthritis. Sprains are typically treated first with immobilization, ice, physical therapy but if the ankle is unstable then the ligament needs to be reconstructed with surgery.
Posterior tibial tendinitis
The posterior tibial tendon starts very deep in the back of the lower leg, turns into a tendon, wraps around the inner side of the ankle joint and eventually attaches in the foot to the navicular bone and other foot bones. This tendon is an important stabilizer of the arch and with walking and runner it prevents excessive pronation and can act as a shock absorber. Progressive tendinitis of the posterior tibial tendon can lead to partial and even complete rupture which can cause progressive flattening of the arch. Tendinitis is successfully treated with conservative means in most cases including activity modification/restriction, orthotics, physical therapy, bracing and possible some advanced options like shockwave therapy and platelet-rich plasma injections. In more advanced cases, like with a partial or complete rupture, surgical repair needs to be performed either in isolation or sometimes with a flatfoot deformity repair.
Damage to cartilage on the talus bone
This pathology has many names including an osteochondral lesion of the talus or osteochondritis dessicans. Pain can be isolated to one area or can be more widespread and difficult to pinpoint. Relevant imaging can include regular x-rays, MRI or a CT exam. Isolated lesions can be repaired through a variety of ways either through a minimally invasive approach called ankle joint arthroscopy or sometimes open with a larger incision. The simplest way to treat this issue is with a clean up of the joint and trying to stimulate some new cartilage cells to develop. More advanced techniques involve placing donated juvenile cartilage grafting at the site of the defect.
Tarsal tunnel syndrome
Similar to carpal tunnel syndrome in the wrist, tarsal tunnel syndrome is the squeezing or compression of the tibial nerve running from the inside of the ankle down into the foot. Usually the patient will have nerve-like sensations from the ankle into the foot. This issue can be treated conservatively and surgically. Conservative treatment options include injections, orthotics, medications, and physical therapy. If conservative measures fail, a surgical tarsal tunnel release can be performed which releases the nerve.
Os trigonum syndrome
The Os Trigonum is an accessory bone found in the back/inner part of the ankle and can cause issues mostly in patients that excessively plantarflex the ankle. A common activity that can cause os trigonum syndrome would be in ballet especially getting in the the en point position. Pain can usually be reproduced with upward and downward movement of the big toe because the flexor tendon that moves the big toe downward runs directly adjacent to the os trigonum in the back of the ankle. Treatment includes bracing, activity modification, physical therapy and if all else fails, one can consider surgical excision of the os trigonum.
Arthritis in the ankle
Osteoarthritis and rheumatoid arthritis can cause similar inner ankle pain.
If you have been suffering from inner ankle pain or weakness, the experienced doctors at District Foot and Ankle can evaluate and diagnose the problem and recommend the appropriate treatment and aftercare measures for your condition or injury. Contact us today to schedule an appointment