Ankle Injuries, Problems & Pain
Sports injuries, trauma, congenital issues…There are many potential causes of ankle pain. As with all lower extremity pains and strains it is important to figure out the root cause, and treat from there. We rely on the information patients provide us with, and a thorough physical exam to guide diagnosis. Weight bearing x-rays are also a very vital part of the process.
Doctor Adams is a Fellowship Trained Foot and Ankle Surgeon whom focused on adult and pediatric reconstructive surgery in his training. The ankle is one of the more complex joints in the human body due to the unique nature of the talus bone. Treating injuries and pain pertaining to the ankle is ideally managed by a specialist with Fellowship training.
If you have ankle pain, and have questions or concerns, please feel free to call Doctor Adams at (317) 477-6683 or schedule a consultation online.
Dr. Adams is a born and raised Hoosier. He attended Indiana University-Bloomington where he met his wife Allison. He got degrees in Nutrition Science, Biology and Chemistry. Dr. Adams then got his doctorate from Kent State College of Podiatric Medicine where he was a Dean’s List student. He then came back to Indianapolis to do his residency surgical training and was Chief resident. He stayed in Indianapolis and completed a specialty Fellowship focusing on Adult and Pediatric Reconstruction. During his Fellowship Dr. Adams helped launch the first foot and ankle dedicated surgical practice at Hancock Orthopedics, and has been employed there since.
Dr. Adams enjoys teaching as he helps educate and train the surgical residents at Community Health Network, and the Fellows at American Health Network. He actively participates in research and editing for national peer reviewed journals.
He is also a consultant for orthopedic device companies where he is afforded the opportunity to help train and design with other surgeons across the country.
Dr. Adams has special interests in the following areas:
Dr. Adams is a father of two and resides with his family in Fishers. He enjoys the short commute to Hancock Health in Greenfield.
Acute Ankle Sprain
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Avascular Necrosis of the Talus
A fairly uncommon condition that occurs when the Talus bone is severely injured and/or the vascularity to it is disrupted. The condition is often initiated by typically a high energy trauma such as a motor vehicle accident, or a fall from height. The Talus is a very hard bone, covered entirely by cartilage. It has no tendinous attachments making it a unique structure. When the blood supply to this bone is compromised it causes the bone to lose its shape and structure. This predisposes the ankle and subtalar joints to arthritis and chronic pain. There are both conservative and surgical treatment options for this condition. The options tend to be more complex than for other conditions. Patient age and expectations have a huge impact on options utilized.
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Chronic Ankle Instability
Chronic Ankle Instability or CAI, is a manifestation of repeat ankle sprains that typically were never treated aggressively, conservatively, at the original date of injury. When an individual suffers a bad sprain, and proper immobilization and recovery are not utilized this can damage both the lateral ankle ligaments, but also the proprioceptive nerve fibers that innervate the joint. When these nerve fibers are damaged in conjunction with the stretched out or attenuated ligaments, repeat cases eventually lead to insufficient or lax soft tissues that support the outside of the ankle. Once this complex becomes chronically damaged patients tend to suffer repeat sprains and pain. They will often complain of hesitancy and lack of confidence in their ankle. Patients will state that if they walk on gravel, or in a bumpy grass field they have pain and instability. They feel as if their ankle is going to “give out”. Patients may wear bracing to help control and prevent eventual arthritis but ultimately surgical repair of these ligaments is recommended.
Osteochondral Lesion of the Talus and Tibia
Osteochondral lesions (OLT’s) of the Talus and Tibia are not uncommon. The cartilage on the talus is damaged much more frequently than the tibia however. They most often occur with ankle sprains, but can occur during any traumatic injury that involves the ankle joint. An OLT is essentially a chip, or defect that occurs in the cartilage when an injury is sustained. All joints in the human body are susceptible to these. The ankle and knee joint are 2 of the most common joints that will be treated for symptomatic/painful OLT’s. There are a variety of ways to treat this issue; both conservatively and surgically.
Conservative options that may be recommended for symptomatic OLT’s are ankle braces, steroid injections, a period of immobilization in a walking boot, physical therapy, and oral anti-inflammatories.
Surgically, the first line of treatment for symptomatic OLT’s is arthroscopic care. A small scope/camera is inserted into the ankle joint through two tiny incisions. The defect in the cartilage is found, the defect is cleaned up (smoothed) with a shaving tool, and then the bone that underlies the cartilage is drilled. This is done in hopes of causing bleeding. The idea is that if good bony bleeding occurs the defect may fill in with an alternative to the native hyaline cartilage that should be present. This alternative is known as fibrocartilage. Varying rates of success have been published in orthopedic literature. Due to the fact this method has been performed for multiple decades it is most recommend by surgeons as the first line of treatment unless the defect is very large, >1.5cm.
When the defect is larger than 1.5cm, or the arthroscopic microfracture repair has failed, we often recommend cartilage restoration procedures. There are a variety of methods to do this. The three main methods for doing this are cadaveric graft, juvenile graft, and autograft. Each of these resurfacing methods has its pros and cons. Please use the Ask Dr. Adams feature if you want very specific information regarding which method we recommend for you.Request Ankle Problem Consultation
Peroneal Tendon Injury
The Peroneus Longus and Brevis are separate tendons that both act to evert the foot, or in lay terms, flatten the arch during gait. They are located on the outside (lateral) aspect of the ankle. They are injured most commonly during inversion ankle sprains when considering acute injuries. In the chronic setting they are injured often in people with very tall arches or Pes Cavus. (See Cavus foot deformities for more detail on this).
Tarsal Tunnel Syndrome
See Nerve Problem Section
Accessory Muscle Syndromes
The Peroneus Quartus is a true accessory muscle that occurs on the outside of the ankle adjacent to the Peroneal Longus and Brevis. Literature shows varying degrees of prevalence but most agree it is present in the population around 10-20% of the time. My personal experience has suggested 10% is more likely – this is an unscientific estimation. Regardless – the significance of this muscle is that it can cause a crowding effect within the Peroneal tunnel. It has been hypothesized that in scenarios where the Peroneal tendons are chronically inflamed, the Quartus may have been the inciting factor. We know chronic inflammation over time leads to degeneration of tissue, and potentially chronic tearing if not mitigated. In my opinion, when patient’s have instances where trauma is not a factor, I do think Peroneal tears could be attributed to an accessory Quartus or low-lying Peroneus Brevis muscle belly.
The Flexor Digitorum Accessorius Longus muscle is a lesser discussed anomalous muscle tendon that is found at the inside (medial) ankle. It is in the same anatomic location as the PT and Flexor tendons. It is not very prevalent in the population, and is therefore not often the driving force of a doctor’s office visit! It is however a potential factor with exercise induced compartment syndrome, or tarsal tunnel syndrome. In the same way the Peroneus Quartus muscle can cause a crowding effect – this anomalous muscle can cause the same issues over time. It has only been suggested to be present in less than 5% of the population depending on the source.