[20F] With chronic ankle pain and numbness

Patient Description

A 20-year-old female has been experiencing extreme ankle pain since the age of 6. The pain is described as throbbing and sometimes sharp, particularly exacerbated by activities such as horseback riding, which leads to burning, throbbing, numbness, and locking of the ankles. The patient reports that the pain occurs with ongoing pressure on the feet, such as during stretching or walking, and can become intense enough to cause difficulty walking and random ankle rolling or twisting. Despite undergoing x-rays and scans, no nerve, muscle, or bone damage was identified. The patient experiences numbness and tingling in the feet or toes during or after certain activities, and the ankles swell significantly. Relief is typically achieved by getting off the feet, although prolonged pain episodes offer no relief. The patient has not been diagnosed with any other medical issues in the past and has no family history of joint problems, arthritis, or neurological conditions. Currently, the patient is on Prozac, 60 ml daily, and reports no known drug allergies.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, there are a few potential explanations for your ongoing ankle pain and related issues:

  1. Chronic Ankle Instability: Given your history of ankle rolling or twisting, it's possible that you have chronic ankle instability. This condition can develop after repeated ankle sprains and may lead to persistent pain, swelling, and a feeling of instability.

  2. Tarsal Tunnel Syndrome: The numbness and tingling in your feet, especially during or after activities, could suggest tarsal tunnel syndrome. This condition occurs when the tibial nerve is compressed as it travels through the tarsal tunnel near the ankle.

  3. Tendinitis or Tendinopathy: The throbbing and sharp pain, especially with activity, might be related to tendinitis or tendinopathy, which is inflammation or degeneration of the tendons around the ankle.

  4. Flat Feet or Overpronation: If you have flat feet or overpronation, it can lead to ankle pain and instability, as well as contribute to back pain due to altered biomechanics.

Typical treatments for these conditions may include physical therapy, orthotic devices, bracing, or in some cases, surgical intervention. Diagnostic tests like MRI or nerve conduction studies might be recommended to further evaluate your condition.

What you can do

Ankle Pain and Instability:

  • Rest and Elevation: Try to rest your ankles and elevate them when possible to reduce swelling.
  • Ice Therapy: Apply ice packs to your ankles for 15-20 minutes several times a day to help with pain and swelling.
  • Compression: Consider using an ankle brace or compression wrap to provide support and reduce swelling.
  • Footwear: Wear supportive shoes with good arch support to help stabilize your ankles.
  • Physical Therapy: Engage in exercises to strengthen the muscles around your ankle and improve balance and stability. A physical therapist can guide you with specific exercises.

Numbness and Tingling:

  • Avoid Prolonged Pressure: Try to avoid activities that put prolonged pressure on your feet and ankles.
  • Stretching: Gentle stretching exercises for your feet and ankles may help alleviate symptoms.

Back Pain:

  • Posture and Ergonomics: Pay attention to your posture and use ergonomic supports if needed, especially during activities that trigger back pain.
  • Core Strengthening: Strengthening your core muscles can help support your back and reduce pain.

Consider using MDandMe to journal your symptoms, track your progress, and share your notes with your healthcare provider for a more comprehensive evaluation.

What you should look out for

While your symptoms are concerning, they do not appear to be immediately life-threatening. However, you should seek medical attention if you experience:

  • Sudden, severe pain or swelling in your ankles or feet
  • Inability to bear weight on your feet
  • Significant changes in sensation, such as increased numbness or tingling
  • Any new or worsening symptoms

It's important to consult with a healthcare professional for a formal diagnosis and personalized treatment plan. They can provide further insights and recommend appropriate interventions based on your specific condition.

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1 mo ago

People Also Ask

What is chronic ankle instability and how is it treated?

Chronic ankle instability is a condition characterized by a recurring giving way of the outer side of the ankle. It often develops after repeated ankle sprains. Treatment may include physical therapy to strengthen the ankle, bracing to provide support, and in some cases, surgery to repair damaged ligaments.

What are the symptoms and causes of tarsal tunnel syndrome?

Tarsal tunnel syndrome is caused by compression of the tibial nerve as it passes through the tarsal tunnel near the ankle. Symptoms include numbness, tingling, and pain in the foot. Causes can include injury, swelling, or anatomical abnormalities. Treatment may involve rest, anti-inflammatory medications, orthotics, or surgery.

How can tendinitis or tendinopathy in the ankle be managed?

Tendinitis or tendinopathy in the ankle involves inflammation or degeneration of the tendons. Management includes rest, ice, compression, elevation (RICE), physical therapy, and sometimes anti-inflammatory medications. Severe cases may require corticosteroid injections or surgery.

What impact do flat feet or overpronation have on ankle health?

Flat feet or overpronation can lead to ankle pain and instability due to altered biomechanics. This can also contribute to back pain. Management includes wearing supportive footwear, using orthotic inserts, and engaging in exercises to strengthen the foot and ankle muscles.

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