Ankle and foot pain
A significant proportion of ankle pain is post-traumatic, usually following a direct blow or a sprain. Although ankle sprains are often dismissed because they are so common, they involve a wide range of possible associated injuries, some of which carry a worse prognosis.
In some cases, pain persists after the initial injury and can come from several structures, namely ligaments (most often the anterior talofibular ligament) or joints (most often the ankle joint itself, the distal tibiofibular, subtalar or talonavicular joints).
Ultrasound-guided anaesthetic injections play an important diagnostic role, pointing us to the exact source of pain. For joint pain, image-guided injections of hyaluronic acid (viscosupplementation) or platelet-rich plasma (growth factors) are usually effective in controlling inflammation. For ligament pain, anti-inflammatory or hyaluronic acid injections help control these areas.
Among non-traumatic causes, pain on the inside of the foot is common, resulting from inflammation of the medial band of the plantar fascia, the abductor hallucis muscle or the calcaneal branches of the tibial nerve, due to ankle pronation (the ankle rolling inwards), which is extremely common in the general population. Image-guided procedures (anti-inflammatory injections, platelet-rich plasma or peripheral nerve blocks) are usually effective in controlling pain, allowing biomechanical correction work to be done pain-free.
Achilles tendinopathy/tendinitis is a common cause of pain in athletes. Depending on the part of the tendon affected, image-guided hydrodissection or platelet-rich plasma injections, together with biomechanical correction of coronal-plane deviations, are key to successful treatment.
Finally, Morton's neuroma is inflammation of one of the nerves in the foot, causing radiating pain, usually between the third and fourth toes. Anti-inflammatory injections, radiofrequency or cryoablation are useful tools for pain control.
Dr. Miguel Reis e Silva
Doctor at Sport Lisboa e Benfica
Medical Director and Founder of Clínica Myalgia
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