Anatomy
The joints of the foot include the large ankle joint (talocrural joint), the joint below the ankle joint (subtalar joint, talocalcaneal joint) between the heel bone (calcaneus), ankle roll bone (talus) and several of the tarsal bones (ossa tarsi) as well as many smaller joints between the tarsal bones, metatarsal bones (ossa metatarsi) and toe joints.
The foot from above:
A. Phalanx media
B. Tuberositas ossis metatarsalis V
C. Os cuboideum
D. Calcaneus
E. Talus
F. Os naviculare
G. Os cuneiforme laterale
H. Os cuneiforme intermedium
I. Os cuneiforme mediale
J. Os metatarsalei
K. Os sesamoideum
L. Phalanx proximalis
M. Phalanx distalis
Cause of the problem
When a joint is severely twisted, an ‘inflammation’ of the synovial membrane (synovialis) can occur, which thickens and produces more fluid, causing the joint to swell. Fluid accumulation in the joint (traumatic synovitis) is commonly seen as a result of ligament injuries around the ankle and can be caused by damage to the joint, such as cartilage damage.
Fluid accumulation can occur slowly after prolonged overload, for example due to changes in the joint (e.g. osteoarthritis). Increased fluid in a joint thus signals that there is an injury in the joint.
Joint swelling can also be part of a general arthritis condition.
Symptoms
Swelling of the joint. Pain when pressing on the joint lines and with passive and active movement of the joint.
Examination
Diagnosis can be difficult to make on clinical examination alone, and often X-ray, ultrasound or MRI scans are necessary (Arnold JB, et al. 2022). Diagnosis can be difficult to make on clinical examination alone, but often there is reduced mobility and pain on movement. However, it is often necessary to supplement with ultrasound scans, and possibly X-rays and MRI scans.
Ultrasound scans show even minor swelling in the joint and inflammation can also be seen in the joint. See ultrasound scan of ankle joint with increased synovial fluid.
Treatment
Treatment primarily involves relief from pain-inducing activity. Of course, if a triggering cause can be identified, it should be treated if possible. Joint mobility and muscle strength should be maintained without provoking the joint to cause further pain and swelling.
Conditioning can be done by cycling or swimming. If the joint swelling does not subside despite off-loading, medical treatment can be supplemented with anti-inflammatory drugs (NSAIDs) or drainage and ultrasound-guided injection of adrenal cortex hormone into the joint (Paterson KL, et al. 2019).
If there is persistent unexplained swelling or pain that does not subside despite relief and medical treatment, additional examinations may be indicated, including an arthroscopic examination (arthroscopy) and possibly surgery.
Complications
If the progress is not smooth, you should consider whether the diagnosis is correct or if there are complications:
In particular, the following should be considered:
