The deltoid ligament, often termed the medial ankle ligament, is the primary ligament providing stability to the medial (inside) of the ankle. Inside ankle pain refers to a throbbing pain on the medial side of the ankle joint. The pain occurs when the strong deltoid ligament is stretched too far due to excessive dorsiflexion and eversion .
The posterior tibial tendon is a very critical tendon in your leg. It attaches your calf muscle and inserts into your foot bones, on the back of the shin bone. It passes along the back of your leg, not far from the Achilles tendon. The tendon is responsible for holding up the arch of the foot and offering support while walking.
Inside ankle pain ranges from mild (sprain) to moderate (a partial tear) to severe (a complete tear), depending on the injury sustained by the medial deltoid ligament. These types of pain are far less common than lateral ankle pain because of the strong deltoid ligament. However, this extremely uncommon pain takes longer to heal. Inside ankle pain is most commonly sustained by trail runners, basketball players, and water skiers.
How Is Inside Ankle Pain Graded?
Medial ankle pain is primarily felt inside the ankle (the deltoid ligament) is classified into grades based on the severity of the injury:
- Grade I:
Pain occurs due to the microscopic disruption and stretching of the deltoid ligament. The medial stability of the ankle is compromised due to pain.
Partial tearing and stretching of the medial deltoid joint are seen on MRI. Pain compromises the stability of the medial ankle.
- Grade III:
The medial deltoid ligament is completely torn and ruptured, resulting in inside ankle pain-causing instability of the medial ankle.
What Are The Common Causes Of Inside Ankle Pain?
An individual is most likely to experience foot pain when they step awkwardly or fall on an unequal surface. Wear and tear of the deltoid ligament also cause pain in the medial side of the ankle. The following are some causes of inside ankle pain:
1. Medial Malleolar Stress Fractures:
Stress fractures to the medial malleolus can cause pain in the medial side of the ankle. The medial malleolus is a bony knob located inside (medial) the ankle. The pain is often exacerbated during jumping and running activities and subsides when you’re resting .
2. Inside Ankle Sprain:
Sometimes, a sprain can also cause injury to the inside (medial) of the ankle, resulting in ankle pain. The type of sprain affecting the inside of the ankle is referred to as an eversion sprain. The sprain occurs due to upward rolling of the outside edge of the foot, tearing the deltoid ligament. The pain due to an eversion sprain is also accompanied by instability and swelling .
3. Posterior Tibial Tendonitis:
The inflammation occurs due to a sudden trauma or overuse of the posterior tibial tendon. This condition causes inside ankle pain originating from behind the medial malleolus. Tibialis posterior tendon tendinopathy causes pain on the inside of the ankle. Sometimes, pain also runs under the sole of the foot. If this condition is left unattended, posterior tibial tendonitis will eventually manifest as another problem called adult-acquired flatfoot deformity (AAFD).
4. Ankle Arthritis:
Inside ankle pain can also be caused due to osteoarthritis and rheumatoid arthritis. Another cause of pain on the inside of the ankle is post-traumatic arthritis, which occurs as a result of ankle-related injury .
5. Tarsal Tunnel Syndrome:
It is caused due to pressure exerted on the tibial nerve within the tarsal tunnel of the ankle. The tarsal tunnel is a very significant part as it contains the flexor digitorum longus tendon, posterior tibial tendon, and the posterior tibial artery and veins. Repetitive stress on the tarsal tunnel causes the pinching and constriction of the tibial nerve, resulting in excruciating pain in the medial ankle. The Tarsal Tunnel Syndrome pain can often be misdiagnosed as plantar fasciitis due to very close symptoms.
What Are The Symptoms Associated With Inside Ankle Pain?
The severity of inside ankle pain depends on how damaged the medial deltoid ligament is. The following symptoms indicate inside ankle pain:
- Pain felt in the medial portion of the ankle with movement.
- Stiffness and swelling of the ankle joint.
- Crepitus or clicking sounds while moving.
- Tenderness and bruising on the inside of the ankle.
- Instability of the foot while walking or moving .
How Is Inside Ankle Pain Diagnosed?
Typically you will undergo a physical examination by the doctor to get a clear idea of your condition. Inside ankle pain can be diagnosed by:
1. The Eversion Stress Test:
This test is used to determine how unstable the medial ankle is after injury to the deltoid ligament. This test also evaluates the integrity of the deltoid ligament. The test involves stabilizing the tibia with one hand while abducting and everting the heel with the other. Pain and laxity indicate that the test is positive .
Specific imaging tests, including X-ray and MRI scans, can help access the inside ankle pain. An X-ray is mainly used to diagnose signs of a fracture or ankle sprain and detect the detachment of the deltoid ligament from the ankle bones.
Treatment Options For Inside Ankle Pain:
The treatment of inside ankle pain depends on the cause of pain. The first step to alleviate the medial ankle pain is the RICE protocol if it is in it’s acute stages. If is is chronic then Prolozone Therapy may be able to help:
Ankle ligaments have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that helps to heal these structures.
Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.
As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.
The RICE treatment subsides the inflammation of the ankle joint, restores stability, and alleviates severe pain.
2. Physical Therapy:
Physical therapy involves rehab exercises to retrain the medial deltoid ligament. Your physiotherapist may recommend therapeutic exercises to stabilize the ankle joint and increase strength, range of motion, and function of the ankle. Retraining proprioception and balance are also included in rehab exercises .
Anti-inflammatory medications (NSAIDs) are prescribed if the inside ankle pain is caused by ankle arthritis, posterior tibial tendonitis, or sprains. This helps reduce the inflammatory response and ease the pain. The use of topical anti-inflammatories is another option to provide instant relief from the pain. If the pain is due to a severe fracture, stronger medications, like opioids, are prescribed.
Some of the non-invasive management of inside ankle pain include braces, custom orthotics, steroid injections, and splints.
If ankle pain is due to multiple ankle sprains and results in extreme ankle joint instability, surgery may be required. An orthopaedic surgeon will fix and reconstruct the ankle bones and ligaments to achieve the stability of the medial ankle.
How Can Inside Ankle Pain Be Prevented?
The key to preventing ankle pain is maintaining flexibility and good muscle strength. Below are some preventive tips:
- Maintaining a healthy weight.
- Stopping or slowing down physical activity if you experience pain.
- Wearing supportive footwear and walking boots while playing or running. Supportive insoles or orthotics can also be very effective in helping minimize over-pronation. Using ankle braces is also a good alternative.
- Warming up before doing any physical activity.
- Avoid resisted inversion of the foot.
The Bottom Line:
Pain on the inside of your ankle pain is a dull, throbbing pain accompanied by discomfort of the medial ankle. Wear and tear of the medial deltoid ligament or falling on an uneven surface can result in inside (medial) ankle pain. There are numerous approaches to deal with the issue such as medication, physical therapy, and biomechanical correction can alleviate pain associated with the inside of the ankle. The most important thing when suffering from medial ankle pain is the immobilization of the ankle and abstaining from any weight-bearing activity since this can aggravate the issue.
Frequently Asked Questions
Why is my ankle hurting on the inside?
Your ankle may hurt due to arthritis, injury, and normal wear and tear. The patient may feel stiffness, swelling, or pain around the ankle, depending on the cause. It is necessary to avoid putting weight on the ankle if you are observing any above indications. It gets normal with ice packs, rest, and over-the-counter medications.
What can cause inside ankle pain without injury?
The leading causes of ankle pain without injury are:
- Flat feet
- Reactive arthritis
- Rheumatoid arthritis
What exercise is good for ankle pain?
Elevating your foot 20 inches off the floor is good exercise for ankle pain. Then with toe mounting, twirl the foot to the left and back to the right. Maintain for 10 to 12 seconds, then return to the initial position. For each leg, repeat 20 times; you might feel better.
What are the signs of gout in the ankle?
Signs of gout in the ankle include:
- Limited range of movements
- Warmth to the touch
Is it ok to walk with posterior tibial tendonitis?
The starting treatment of posterior tibial tendonitis is complete rest so that the tendon can recover. After the 3 months of posterior tibial tendonitis, many people start walking normally. Low-impact activities can be continued after 6 months. However, returning to all the normal daily activities may take almost a year.
Which is the fastest way to heal posterior tibial tendonitis?
For 20 minutes, keep cold packs on the painful area of posterior tibial tendonitis. Repeat it 3 to 4 times per day to reduce the swelling. Moreover, do not apply ice to the skin directly. Applying the ice over the tendon right after the exercise assists in lessening the redness or inflammation around the tendons.
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