Understanding Inner Ankle Pain: Causes and Diagnosis
Inner ankle pain, also known as medial ankle pain, is common among active individuals and athletes. The inner ankle is a complex region comprising bones, tendons, ligaments, and nerves, making it susceptible to various injuries and conditions. This article outlines the possible causes of inside ankle pain and how doctors can diagnose it quickly.
Common Causes of Inner Ankle Pain
Posterior Tibialis Tendonitis
The posterior tibial tendon plays a crucial role in supporting the foot arch. Degeneration and partial tear of this tendon from overuse can lead to posterior tibialis tendonitis, causing pain and swelling on the inner ankle. Often, symptoms occur with weight-bearing, including walking and running. Left untreated, it may result in flatfoot deformity.
Inner Ankle Sprain
While less common than lateral ankle sprains, medial ankle sprains occur when the deltoid ligament on the inner side of the ankle is overstretched or torn. A deltoid injury is often caused by eversion forces, such as rolling the ankle inward. Generally, people report pain and swelling inside the ankle after an ankle sprain.
Accessory Navicular Syndrome
An accessory navicular is an extra bone or cartilage on the foot’s inner side near the navicular bone. Sometimes, the junction of the accessory navicualr bone, also called the synchondrosis, can be disrupted by an ankle sprain. In accessory navicualr syndrome, Athletes report pain and swelling on a focal area close to the navicualr bone.
Ankle Joint Arthritis
Osteoarthritis or inflammatory arthritis affecting the ankle joint can lead to medial ankle pain. This condition is more common in older individuals or those with a history of ankle injuries.
Ankle Stress Fractures
Stress fractures of the medial malleolus or nearby bones, such as the navicular, talus, or calcaneus, can develop from repetitive impact activities like running. These injuries often cause localised pain that worsens with activity. As the stress fracture worsens, pain can also occur at rest and night.
Less Common causes of inner ankle pain
Tarsal Tunnel Syndrome
Tarsal tunnel syndrome occurs when the tibial nerve, which runs through the tarsal tunnel on the inner ankle, becomes compressed. Pressure on the nerve can be caused by various factors. Generally, symptoms include burning pain, tingling, or numbness along the inner ankle and foot.
Tarsal Coalition
Tarsal coalition is an abnormal connection between the bones of the ankle. This connection leads to abnormal ankle forces, which in turn causes pain and swelling in the ankle. Generally, inner ankle pain from the tarsal coalition is due to an abnormal connection between the talus and calcaneus called a talocalcaneal coalition.
Flexor Tendonitis
The flexor tendons, including the flexor hallucis longus and flexor digitorum longus, can become inflamed due to overuse or repetitive strain. This condition typically presents as pain during activities that involve toe flexion or pushing off.
Referred Pain from the Spine
Occasionally, nerve impingement at the lumbar spine can cause pain in the inner ankle. Although the pain is localised to the medial ankle, touching the ankle does not reproduce it. Sometimes, other nerve symptoms, such as numbness, pins and needles, or muscle weakness, are present.
How to Make a Diagnosis of Medial Ankle Pain
Generally, an accurate diagnosis of inner ankle pain involves a thorough clinical evaluation supported by imaging studies when necessary.
First, your doctor will take a detailed history of your pain’s onset, duration, and aggravating and relieving factors. Second, you will be asked about recent injuries or changes in activity. Finally, you should also tell your doctor about other symptoms, such as swelling, tingling, numbness, or lower back pain.
In addition, your doctor will perform a comprehensive examination of the ankle joint, looking for swelling, tenderness, and weakness of the inner ankle and foot. A neurological exam may also be necessary.
Usually, imaging studies are often needed to confirm the diagnosis and may include
- X-Ray: Useful for identifying fractures, bony abnormalities, or arthritis. However, X-rays may fail to detect stress fractures.
- Ultrasound: Helps visualise soft tissue structures like tendons and ligaments, detecting tears or inflammation.
- MRI: Provides detailed images of soft tissues and bones. It is the imaging choice for detecting stress fractures.
- CT Scan: Sometimes necessary for assessing bony structures in greater detail or when X-ray or MRI is inconclusive.
- Nerve Conduction Studies/ EMG test: Occasionally necessary to diagnose nerve-related pain.
Click on the Ankle Image to find out Possible Causes of Inside Ankle Pain
Big toe pain
Second toe pain
Mid-foot pain
- Mid-foot arthritis
- Lisfranc injury
- Navicular stress fracture
- Os naviculare
- Tibialis anterior tendonitis
- Knot of Henry pain
- Metatarsal stress fracture
- Kohler's disease
Heel pain
Front of ankle
Mid-foot pain
- Cuneiform stress fracture
- Base of second stress fracture
- Mid-foot arthritis
- Deep peroneal nerve entrapment
Final word from Sportdoctorlondon about Inside Ankle Pain
Inner ankle pain can arise from various causes, from tendon injuries to nerve entrapment. Early diagnosis and appropriate treatment are crucial to prevent complications and ensure a smooth recovery. If you experience persistent or worsening inner ankle pain, consult a sports medicine specialist for a tailored assessment. With timely care, most conditions can be effectively treated, allowing you to return to your active lifestyle.
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