Have you been having sharp pain in your ankle,with no clue why? No history of trauma; not particularly active or athletic, but seem to have ankle pain, mainly on the inside, or outside of the ankle? You may or may not be overweight. You have been to the doctor, perhaps had x-rays, various types of treatment, but still have pain?

This discussion deals with one aspect of a painful ankle, that most non-footspecialists would fail to recognise. It deals with pain that is the result of nothing more than abnormal biomechanics of the foot. Biomechanics is defined as “the study of the mechanics of a living body, especially of the forces exerted by muscles and gravity on the skeletal structure”. More simply stated, it’s the way the body functions regarding the musculoskeletal system.

Unfortunately, most of us do not function the way the anatomy books suggest. There are many variations on the way the skeletal system is ‘supposed’ to function. Most of these would be considered normal,because a large percentage of the populationexhibits them. A simple example would be a limb length discrepancy, where one limb is slightly shorter than the other. It’s abnormal, compared to an anatomy text book, but normal in that many people exhibit that trait.

Regarding the ankle joint, it’s considered a hinge joint;the type that allows the foot to move up and down.

Pronation and Ankle Pain

One of the biomechanical faults that many exhibit, is over-pronation. I identify over-pronation,since most people pronate to some degree. The problem with over-pronation, is that the excessive pronation, forces the talus bone to abnormally sit in the joint space. Over time, this will cause a premature erosion of the joint, similar to how unbalanced tyres can prematurely erode the tyres’ tread.

Symptoms of Ankle Pain Secondary to Excessive Pronation

Lateral – On the outside of the ankle

• In its mildest form, it will cause arthritic changes within the ankle joint, eventually leading to pain, but not the type under discussion. However, due to the abnormal alignment of the talus bone in the joint, the outside of the talus bone will impinge or press into the end of the fibula bone. The result… a constant jamming and irritation on the soft tissue in that area; primarily, the lateral ankle ligaments that attach the two bones.
• The peroneal tendons are two tendons that come down the outside of the lower leg, and travel under the lateral malleolus (the outside ankle bone). Because of the over pronation and jamming effect, these tendons can become impinged. Usually, the outside of the ankle will swelltoo. Damage to the tendons can be as simple as an irritation, all the way to a partial tendon tear. This degree of damage will in many cases respond to conservative care, but sometimes the tear may require surgical repair.
• In some cases,a patient may not present with the usual issues;but instead, witha sharp burning pain on the outside of the ankle. This speaks to possible impingement of the sural nerve, which passes just below the outside part of the ankle, and may be ‘pinched’.

As well, a doctor was visited, who prescribed anti-inflammatory medication; possibly gave a cortisone injection; may have even tried physical therapy; or immobilised the ankle, all in a bid to reduce the pain. Generally,there may have been some relief, but once the treatment ended, the pain returned.

Medial -On the inside of the ankle

• If you are over-pronating, and jamming the bones on the outside of the ankle, what do you think is happening on the inside? The exact opposite; you are stretching the soft tissue structures between the talus and the tibia. There are two major problems that can occur on the inside of the ankle. The first is a tarsal tunnel.
• The second major problem is what is known as PTTD,posterior tibial tendon dysfunction. The posterior tibial muscles originate in the back of the leg.The tendon then passes below the inside bone of the ankle, the medial malleolus, and attaches into the navicular bone, which is a bone on the inside of the foot. The purpose of this muscle is to support the arch of the foot. In situations where there is too much pronation, the tendon gets stretched out, becomes inflamed, and loses its ability to support the arch.

Treatment for Ankle Pain from Pronation

Treatment is practical; reduce, or eliminate the excessive pronation. A medial heel wedge, generic or custom orthotics may be required, dependent on the degree of the problem/ pain. Within a few days, improvement will be noticed, and over a couple of weeks, the pain will dramatically diminish.

Initially, the custom orthotics must be used continuously. Some people will

wear them during the day, kick off their shoes upon arriving home, and then wonder why their ankle still hurts. Walking barefoot worsens this problem; the orthotics must be worn upon awaking, to bedtime, until the pain is gone.

 Supination

It’s the opposite of pronation.So, one might think that in excessive supination, the opposite ankle symptoms would occur. In theory yes, in practice, rarely. It is hardly seen in the general public, but much more prevalent in people with neurological disease. Since these personsare prone to having an abnormal gait, it is unusualfor themto come in with just ankle pain.People with very high arches, cavus type foot, also tend to supinate more, but they too aren’t representative of the kind of ankle pain under discussion.

Your feet mirror your general health . . . cherish them!