Tag Archive for: ankle pain

Chronic Lateral Ankle Pain

Walking is something everyone takes for granted. However, pain on the outer side of the ankle, which can be chronic or ongoing ankle pain, can lead to instability, limitations, arthritis, and tendon problems. Chronic lateral ankle pain on the outside of the ankle may be so intense that not just walking but participating in sports becomes problematic. While chronic lateral ankle pain often develops after an injury, such as a sprained ankle, several other conditions may cause it. That’s why the place to start is at OCC – Colorado Center of Orthopedic Excellence in Colorado Springs, Colorado, where you’ll get the very best care possible.


Chronic lateral ankle pain is lasting pain on the outer side of the ankle that often develops after an injury, such as a sprain or fracture of the ankle where there is a failure of the ankle to heal properly. An ankle sprain refers to the tearing of the ligaments of the ankle. Ligaments are bands of tissue—like rubber bands—that connect one bone to another and bind the joints together. In the ankle joint, ligaments provide stability by limiting side-to-side movement. The most common ankle sprain occurs on the lateral (outside) part of the ankle. There’s a good chance one might have sprained the ankle at some point while playing sports or stepping on an uneven surface — some 25,000 people sprain their ankle every day. Almost half of all people who sprain their ankle once will experience additional ankle sprains and recurrent chronic lateral ankle pain. Ankle sprains that can lead to chronic lateral ankle pain occur among people of all ages and at all activity levels; in fact, they are the number one reason for missed participation in athletics. Up to 40% of ankle sprains go on to develop chronic lateral ankle pain.


The ankle is a complex mechanism. It is the joint that connects the foot to the lower leg. Healthcare providers sometimes refer to it as the tibiotalar joint or the talocrural joint. What is normally thought of as the ankle is actually made up of two joints: the subtalar joint and the true ankle joint. The true ankle joint is composed of three bones: the tibia, which forms the inside, or medial, portion of the ankle; the fibula, which forms the lateral or outside portion of the ankle; and the talus underneath. The true ankle joint is responsible for the up-and-down motion of the foot. Beneath the true ankle joint is the second part of the ankle, the subtalar joint, which consists of the talus on top and the calcaneus on the bottom. The subtalar joint allows side-to-side motion of the foot. These components of the ankle, along with the muscles and tendons of the lower leg, work together to handle the stress the ankle endures when walking, running, and jumping.


Chronic lateral ankle pain refers to persistent pain on the outer side (lateral) of the ankle that lasts for an extended period of time. The most common cause of chronic lateral ankle pain is incomplete healing after an ankle sprain. When the ankle is sprained, the connecting tissue between the bones is stretched or torn. Even with thorough and complete rehabilitation, the ligament or surrounding muscles may remain weak, resulting in recurrent instability. Poor strength or flexibility in the ankles may increase the risk of a sprain when participating in sports. Shoes that don’t fit properly or aren’t appropriate for an activity, as well as high-heeled shoes in general, make ankles more vulnerable to injury. As a result, one may experience additional ankle injuries.

Read more about Chronic Lateral Ankle Pain on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with an ankle specialist today.

Peroneal Tendon Injury

Your ankle relies on your peroneal tendons for stability so when they are somehow injured, it creates a perfect storm for an unstable joint. At times, an injured peroneal tendon can heal with conservative treatments. Still, if left untreated, complications can develop that can have a negative impact on your life and your ability to get around. Peroneal tendon injuries need to be high on the differential diagnosis list of patients who are seen with persistent pain after an ankle injury. There are treatments that can help, especially when you get that help from the foot and ankle specialists at the Colorado Center of Orthopedic Excellence in Colorado Springs, Colorado. You can trust their experts to give you the best of care.


Peroneal tendon injuries refer to injuries involving the peroneal muscles and/or the peroneal nerves which are located in the lower leg on the outside of the calf expanding to the foot. Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. Basic types of peroneal tendon injuries are tendonitis, tears and subluxation (one or both tendons have slipped out of their normal position. Peroneal tendon injuries may occur suddenly or develop over time.


To understand peroneal tendon injuries, it’s essential first to understand what the peroneal tendons do. A tendon is a cord of strong, flexible tissue, similar to a rope, often referred to as a “mechanical bridge” connecting muscles to bones. This allows the transmission of muscle strength to the bones and joints.

The peroneal tendons are two tendons that run side by side along the outside of the ankle behind the fibula bone. One attaches along the outermost part of the mid-foot. The other peroneal tendon travels under the foot and adheres to the arch. The purpose of tendons is to connect muscles to bones to allow for smooth movements. Together, they serve to move the foot inward and outward to help stabilize the ankle joint. Because the two peroneal tendons lie on top of each other, they create a lot of friction with movement, which often causes problems like tendonitis or tendon rupture.


Common peroneal injuries include:

  • Peroneal tendonitis: inflammation of the tendons and the protective sheath surrounding them
  • Tendinopathy: the presence of both a tendon tear and tendinitis
  • Peroneal tendinosis: degenerative tears which usually affect peroneal tendons slowly, over a period of years
  • Peroneal tendon tears: partial or complete tear of peroneal tendon
  • Peroneal tendon subluxation/dislocation: peroneal tendons slip out of normal position
  • Ankle sprains: the peroneal tendons can be injured, especially if the foot is forcefully turned inward

Read more about Peroneal Tendon Injury on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with a foot and ankle specialist today.

Ankle Fusion

Pain caused by ankle arthritis can become severe and unrelenting, greatly impacting one’s quality of life. An ankle fusion, also called ankle arthrodesis, aims to relieve the pain and maintain or improve function by fusing two or more bones in the ankle. The procedure can help treat a number of different underlying problems in the foot by limiting mobility in the joint. Whatever the cause, no one should have to suffer debilitating pain. The highly-skilled foot and ankle specialists at the Colorado Center of Orthopaedic Excellence in Colorado Springs, Colorado, have vast experience treating all ankle and foot conditions and can get you treatment to help you get back to life.


Ankle fusion is for people who want a permanent solution to their ankle pain so they don’t have to think about it again. It is also recommended to people for whom total ankle replacement is not an option. Ankle fusion has also become a more popular way to treat end-stage ankle arthritis in younger adults. It’s a way to save the ankle and preserve some function. Thus, the operation is also called a salvage procedure. By fusing the bones, an ankle fusion stops the ankle joint from moving at all. It takes a stiff, painful ankle and converts it to an unbending, relatively painless, or in some cases, totally pain-free ankle. An ankle fusion can often last a lifetime compared to a total ankle replacement.


The ankle joint is a complex mechanism. It is also called the tibiotalar joint, and although typically referred to as a single joint, it is actually two joints; the subtalar joint and the true ankle joint. The true ankle joint is composed of three bones: the lower end of the tibia (shinbone), the lower end of the fibula (the smaller bone of the lower leg), and the talus (the bone that fits into the socket formed by the tibia and fibula and rests on the heel bone). It is responsible for the up-and-down motion of the foot. Beneath the subtalar joint is the second part of the ankle, composed of two bones: the talus on top and the calcaneus on the bottom. The subtalar joint allows side-to-side motion of the foot. The ends of the bones are covered by articular cartilage. The space in the joint is lined with a thin membrane called the synovium, which cushions the joint and secretes a lubricating fluid called synovial fluid. These components of the ankle, along with the ligaments, muscles, and tendons of the lower leg, work together to handle the stress the ankle endures when walking, running, and jumping.


The ankle is the least likely area of the body to be affected by arthritis. Ankle arthritis happens when there is a breakdown of the cartilage that covers the ends of the bones that form the joint. Moving the arthritic ankle tends to make the pain worse. There are three main types of ankle arthritis:

  • Osteoarthritis, which develops from wear and tear on the joints over time
  • Post-traumatic arthritis occurs after a significant ankle injury, such as a fracture
  • Rheumatoid arthritis is an autoimmune disease that damages the joints.

Symptoms usually develop gradually and worsen with time and overuse. These include:

  • Pain with motion
  • Pain that flares up with vigorous activity
  • Tenderness when pressure is applied to the joint
  • Joint swelling, warmth, and redness
  • Increased pain and swelling in the morning or after sitting or resting
  • Difficulty in walking due to any of the above symptoms


Ankle fusion involves cleaning the worn-out ankle joint and fusing the tibia and talus bones together with screws, plates, and bone grafts. By doing so, the bones are stabilized and can no longer rub together, reducing pain. Fusion of the ankle does result in the loss of approximately 75% of ankle motion, but some motion is kept through the joints underneath the ankle and into the mid-foot. Limited mobility can change how you walk, and that can cause wear and tear and, ultimately, painful arthritis in other parts of your ankle, knee, and foot. Recovery is longer with ankle fusion than with ankle replacement.

Read more about ankle fusion on our new Colorado Springs Orthopedic News Site – Colorado Springs Orthopedic News. Schedule an appointment with an ankle specialist today.

When does chronic ankle pain require total ankle replacement?

When does chronic ankle pain require total ankle replacement? If you are experiencing ankle pain, inflammation and stiffness that impedes walking or living your desired active lifestyle, it’s time to evaluate your options. There are many causes of ankle pain, but some conditions produce joint damage severe enough to consider total ankle replacement, such as severe arthritis that was a result of a past joint injury, osteoarthritis in older adults that is the byproduct of wear and tear over time, or rheumatoid arthritis – an autoimmune disease that affects the body’s joints.

Total ankle replacement is not generally considered for cases of mild or moderate arthritis. At Colorado Center of Orthopaedic Excellence, our ankle specialists frequently recommend conservative treatments for these cases such as orthopedic shoe inserts, physical therapy regimens or pain management treatments that include oral pain medicines or corticosteroid injections.

When conservative treatments to not resolve the pain or support the needed activity level, other surgical procedures that include arthroscopic debridement or ankle fusion are considered. Individual conditions require individualized care and CCOE foot and ankle surgeons offer a wide range of solutions to meet each patient’s needs.

Total Ankle Replacement Surgery

Total ankle replacement surgery is the process of replacing a damaged ankle joint with an artificial implant. The tibiotalar joint within the ankle is where tibia comes to rest on the top of the talus. Arthritic conditions damage the body’s joints, including the tibiotalar joint. Arthritis causes the cartilage on the surface of the bone to wear away and lead to joint inflammation, which can, in turn lead to unbearable pain.  

In these situations, total ankle replacement surgery replaces the damaged joint to provide relief from the pain and swelling.

Typically, the procedure takes place under general anesthesia. Your surgeon will make an incision in your ankle to access the affected joint. Although individual cases vary, generally, total ankle replacement surgery includes making a cut in the front and sides of your ankle to remove damaged or worn cartilage and the affected portions of your tibia and talus bones before smoothing the remaining bone surfaces to receive artificial replacement parts.

The risks of the multi-hour surgery vary depending on the patient’s health and circumstances and CCOE surgeons thoroughly discuss each patient’s treatment plan prior to surgery. Imaging tests such as X-rays, CT scan, or MRIs provide essential visual tools to ensure the optimal treatment solution for each condition.

Total Ankle Replacement Surgery Recovery

Total ankle replacement surgery typically requires a multi-day hospital stay to ensure proper care of pain management, post-surgery healing monitoring and ample mobilization. Once the patient can tolerate activity, movement is an important part of recovery process. Splints and crutches are common recovery tools that ensure that your new ankle joint does not bear your full body weight for a few months. Your CCOE ankle expert will prescribe a full post-surgery rehab plan that guides your recovery. 

That plan includes pain management, gentle range of motion exercises, follow up appointments to remove stitches and imaging to assess progress milestones that enable approval for weight bearing action and your resumption of daily activities.

Each patient’s successful total ankle replacement story is unique and CCOE is here to help you write yours when your circumstances require a solution for your chronic ankle pain. Learn more or make an appointment with one of our foot and ankle specialists.

Dr. John Shank specializes in foot and ankle conditions and reconstructive procedures, arthroscopic and open fusion, ankle replacement, ankle arthroscopy, fracture care, ankle cartilage restoration procedures, bunion removal, and sports medicine.

Podiatrist vs. Orthopedist

When you have a problem with your foot or ankle that needs medical attention, where do you go – to a podiatrist or an orthopedic surgeon? And does it make a difference?

To answer those questions, let’s first look at what each of these specialists do.

A podiatrist is a doctor of podiatric medicine (DPM), specifically a specialist whose focus is strictly on foot and ankle care. That includes treatment of such conditions as:

·       Bunions

·       Toe and hindfoot fractures

·       Diabetic ulcers and wounds

·       Plantar fasciitis (inflammation of connective tissue on the bottom of the foot)

·       Hallux rigidus (stiff big toe)

·       Flat feet

·       Gout

·       Toenail disease

·       Heel spurs

·       Athlete’s foot

·       Corns

An orthopedic surgeon is a medical doctor (MD), specifically a specialist whose focus is on the care of bones, muscles, ligaments, tendons and nerves throughout the body – including in the foot and ankle. In regard to the latter, that includes treatment of such conditions as:

·       Achilles tendon tear and repair

·       Ankle replacement and cartilage restoration

·       Bunions

·       Flat feet

·       Plantar fasciitis

·       Heel spurs

·       Morton’s neuroma (nerve inflammation near the toes)

·       Hammer toe, mallet toe, and claw toe deformities

·       Stress fractures

·       Toe fractures

·       Hindfoot fractures

·       Metatarsal (forefoot fracture)

As you can see, both podiatrists and orthopedists perform many of the same foot and ankle procedures. Both are highly trained and qualified to treat foot and ankle conditions both surgically and non-surgically. The only discernible difference between them is that an orthopedist manages parts of the foot and ankle that pertain to the bones, soft tissues and joints, while a podiatrist manages the same areas, but also the biomechanics and dermatology of the foot and ankle. For instance, a podiatrist is often an integral care provider for people with diabetes who have serious concerns about foot health.

So, who do you choose for diagnosis and treatment of your foot or ankle problem?

It often depends on your particular foot or ankle problem – and how comfortable you are with one doctor over another. But it’s a dilemma you don’t have to face at Colorado Center for Orthopaedic Excellence in Colorado Springs. That’s because our practice specializes in both podiatry and foot and ankle orthopedics.

Our board-certified podiatric surgeon Dr. Frederick Hainge is highly skilled in diagnosing and treating structural and biomechanical issues, wounds, toe and foot deformities, nerve pain, and much more.

Meanwhile, fellowship-trained Dr. John Shank and our team of orthopedic physicians help patients manage their foot and ankle conditions through reconstructive procedures, arthroscopic and open fusion surgeries, physical therapy, and other procedures. And it’s all done under one roof.

The Colorado Center for Orthopaedic Excellence in Colorado Springs regularly treats injuries to bones and joints, providing the best of care. If a foot or ankle injury or pain is cause for concern, our board-certified orthopedic surgeons will quickly diagnose and treat the condition. Call us at (719) 623-1050 today for an appointment.