Structure of the ankle joint

Ankle joint is a weight bearing joint for the body during walking. It is formed by the conjunction of three bones.  The end of the tibia (main long bone of the leg) and a thinner long bone fibula (stay on the outer side of the tibia) meet a large bone in the foot called talus to form the ankle. The protrusions of each side of the ankle called malleoli. These provide stability to the ankle joint making it as a hinged joint capable of moving in two directions, flexion and extension.

The ankle joint is enclosed by a fibrous joint capsule. Two ligaments are tightly strapping the outside of the ankle with the lateral malliolus (lateral colleteral ligament) and the inside of the ankle with the medial malliolus (medial colleteral ligament) to provide the stability of the joint. Several tendons attack the large muscles of the leg to the foot wrap around the ankle from the front and behind. There are large tendons in the back such as Achilles tendon of the calf muscle attaches to the heel, posterior tibial tendon passes behind the medial malleolus, and the peroneal tendon passes behind the lateral malleolus to attach into the foot.

     There are powerful muscles located in the front and back portion of the leg contact and relax during walking that move the ankle. Normally the ankle has the ability of approximately 20 degrees of dorsiflexation (toward to the body) and 45 degrees of plantar flexion (away from the body).

Causes of ankle pain

l        Sprains. Ankle sprains are one of the most common musculoskeletal injuries, and happen when there is a preexisting muscle weakness or previous injuries of the ankle joint.  The typical injury occurs when the ankle is twisted in a sport activity or by stepping off an uneven surface. Injury caused ligament to be tore partially or completely, either on one side of both sides of the ankle. Partial tears retain some ankle stability where as complete tears lose the normal joint function. Broken or chipping of bone might also accompanied. Severe pain with swelling over the injured area usually immediately occurred.

l        Tendinitis. Tendinitis of the ankle represents inflammation of the tendons which can be caused by trauma, infection, or inflammatory arthritis.

l        Tarsal tunnel syndrome. This is a result of nerve compression at the ankle as the nerve passes under the normal supportive band surrounding the ankle called the flexor retinaculum. This syndrome is similar to Carpal tunnel syndrome of the hand. It can be caused by injury, overuse or even varicose veins. Other pain, it is manifested by tingling or numbness at the inner heel arch or toes.

l        Plantar fasciitis. Plantar fasciitis most often seen in athletes, obsess people, and person whose daily life require a considerable amount of walking or standing. Plantar faciitis is one of the most common causes of heel pain results from inflammation of the plantar fascia. Plantar fascia is a broad, ligament-like structure that extends from the calcaneus (heel bone) to the base of the toes. Repetitive stress or excessive weight can cause small tears in the fascia, leading to various degrees of pain many times that can take a long time to resolve.

 

The role of acupuncture in the treatment of Ankle pain

 

Sprains.  The standard treatment of acute injury to the ankle is the same as those apply to the musculoskeletal trauma, that is RICE—raise, ice compression, compression and elevation. One thing has to make sure is there is no fracture of bones exited. Although many times a small chip of bone may not need any further added treatment.

Acupuncture in sprains can do at least three things. First of all, it increases the local (micro-) circulation which relieves the swelling that enhance the healing process and alleviate pain on the same time. Secondary, acupuncture decreases pain by increasing subject’s tolerance and stimulation of endophines. Thirdly, function can be improved by less local edematous and milder pain suffering.

 

Literature review

 

Perez-Millan R, Foster L.

Low-frequency electoacupuncture in the management of refractory plantar fasciitis: a case series.  Medical Acupuncture 2001;13(1):47-49

Walter Reed Army Medical Center, Washington, D.C.

 

OBJECTIVE: To examine the role of electroacupuncture in the management of Plantar Fasciitis.

PATIENTS: 11 patients (73% female, average age 40) all had been suffering from plantar fasciitis for a minimum of 2 months. These patient were referred for acupuncture after other conservative methods of treatment had failed.

INTERVENTION: Needling point selection consisted traditional acupuncture points K1, 3 and 6; UB60 and 67; GB44 and local trigger points on the affected side of foot. Electro-stimulator was connected between K1 to a local trigger point and to two other points in the medial arch area. Electro-stimulation was applied for 20-30 minutes. One treatment weekly for a maximum of six sessions or until a maximum favorable response was attained.

MEASUREMENT:  Using a 10-point visual analog scale (VAS) with 10 representing severe pain to evaluate the effect of treatment. 11-question foot function index questionnaire that addressed how the pain affected different functions and activities also used in this study.

RESULT: 10 of the total 11 patient (91%) in the study group reported an improvement in pain reduction of greater than 50% (complete resolution of symptom 18%; great improvement 18%; Much improvement 46%; moderated improvement 9%). Only one patient (9%) stated that the heel pain had been reduced by less than 25%. VAS pain scores fell an average of 46% per patient (from 5.7 at the beginning to 3.0 at the end of the study). Foot function scores improved an average of 3.5 points per category, with the greatest improvement seen in the areas of walking and greatest level of pain.

CONCLUSION: The combination of eletro-acupuncture and traditional acupuncture algorithms to the affected intrinsic foot musculature produced a marked reduction in pain and a concomitant improvement in function with a limit number of treatments.