Don’t ignore that pain in your ankle

It could be ortho-arthritis or a torn ligament. A massage may not help either, finds Brian DeSouza

Jitesh Joshi, captain of Maharashtra’s kabaddi team which won the nationals last December, first felt the pain in his ankle a few years ago while jogging near his Dombivli home. But the 28-year-old didn’t think much of it, given the nature of his profession. He thought the pain would go away. But when it became unbearable six months later, he decided to approach a doctor.

Dr Vivek Shetty at the Hinduja Hospital conducted an MRI and came up with an unusual diagnosis: He discovered a growth of small bones or spurs in Joshi’s ankle.
“This was a case of early ortho-arthritis,” says Shetty. Brought on, ironically, by the fact that Joshi was a sportsperson. “Unless you have a family history or are an active sportsperson, most of us are not likely to suffer from a condition like Jitesh’s,” Shetty says. He operated on Jitesh to remove the bones. He advised Joshi rest. Just so that he could get back on the field for the nationals later this month.

This does not mean that the rest of us, whose ankles are unlikely to undergo the stress that Joshi’s does, can be smug. Normal activity, it has been proven — climbing stairs, jumping off a bus or simply walking on uneven pavements — puts us all at risk for ankle sprains. If you work out, or are training for the Mumbai Marathon, you are at risk too.
Ankle sprains account for an estimated 90 per cent of all ankle-related injuries. Dr HR Jhunjhunwala of the Bombay Hospital says he treats about 100 cases of ankle sprain in a year, where the lateral ligament — one of three ligaments that help manoeuvrability — has been affected.

A pain in the ankle, however minor, should be examined by an orthopaedic — quite apart from physical therapy and RICE (rest, ice, compression and elevation), which are also effective. But, as orthopaedic Santosh Shetty says, “People don’t take ankle pain seriously as there are no tell-tale signs. It’s a mistake to massage the ankle and believe things will get better.”

According to doctors, an ankle sprain can take up to three months to heal completely, depending on the severity of the injury. Though this doesn’t mean a patient has to keep his ankle immobile, people want to start moving right away, doctors say. “If you neglect an ankle pain in the initial stages, there is a chance that pain will return later,” says Dr Vivek Shetty. Doctors say that patients rarely take the recommended rest. “We are asked if there has been a fracture,” says one doctor, implying that only then is injury taken seriously.

Overweight people have a greater probability of twisting their ankle. Wearing flat shoes that have broad heels can help prevent ankle sprain. Using the right gear for sports or jogging is not enough to strengthen ankles. Both flat foot and high arches are potentially risky. A flat foot is “squishy”, causing muscles and tendons to stretch and weaken — a condition that can lead to tendonitis and arthritis. High arch is rigid and has little shock absorption, putting more pressure on the ball and heel of the foot, and on knees, hips and back.

Shoes or orthotics (equipment to stabilise and prop up injured joints) that support the arch and heel can also help flat feet. The doctor may suggest an anklet — a brace made of cloth — to stabilise the foot and prevent additional strain. There are also isometric exercises that help strengthen the muscles that support the foot. As a home remedy, it’s also useful to keep an elastic crepe bandage and ice compression box at hand, so that ankle pain can be alleviated before a doctor is consulted.  
d_brian@dnaindia.net