What is the cause of the pain in the bent ankle

The foot is a very important part of our body. We rely on our feet to walk every day, but sometimes we can clearly feel the pain in the bent ankle tendons. Generally, this is caused by accidentally spraining the ankle while walking or doing something else. In addition to this situation, lumbar protrusion, heredity or injury may also lead to this cause. The following is an analysis of the causes of bent ankle tendon pain, I hope it can help you find the right remedy for your condition.

Lumbar disc herniation is one of the more common diseases. It is mainly caused by different degrees of degenerative changes in the various parts of the lumbar disc (nucleus pulposus, annulus fibrosus and cartilage plate), especially the nucleus pulposus. Under the influence of external factors, the annulus fibrosus of the intervertebral disc ruptures, and the nucleus pulposus tissue protrudes (or falls out) from the ruptured part to the back or inside the spinal canal, causing stimulation or compression of the adjacent spinal nerve roots, resulting in a series of clinical symptoms such as low back pain, numbness and pain in one or both lower limbs. The highest incidence of lumbar disc herniation is at L4-5 and L5-S1, accounting for about 95%.

Causes

1. Degenerative changes of the lumbar intervertebral disc are the basic factors

The degeneration of the nucleus pulposus is mainly manifested by a decrease in water content, and may cause small-scale pathological changes such as vertebral instability and loosening due to water loss; the degeneration of the annulus fibrosus is mainly manifested by a decrease in toughness.

2. Injury

Long-term and repeated external forces cause minor damage and aggravate the degree of degeneration.

3. Weakness of the intervertebral disc’s own anatomical factors

After adulthood, the intervertebral discs gradually lack blood circulation and have poor repair ability. On the basis of the above factors, some inducing factors that may cause a sudden increase in the pressure on the intervertebral disc may cause the less elastic nucleus pulposus to pass through the annulus fibrosus that has become less tough, causing nucleus pulposus herniation.

4. Genetic factors

There are reports of familial incidence of lumbar disc herniation.

5. Congenital abnormalities of lumbar sacrum

Including lumbar sacralization, sacral lumbarization, hemivertebra deformity, facet joint deformity and articular process asymmetry. The above factors can change the stress on the lower lumbar spine, resulting in increased intra-disc pressure and susceptibility to degeneration and injury.

6. Predisposing factors

On the basis of intervertebral disc degeneration, certain factors that can induce a sudden increase in intervertebral space pressure can cause nucleus pulposus herniation. Common inducing factors include increased abdominal pressure, incorrect waist posture, sudden weight bearing, pregnancy, cold and moisture.

Clinical classification and pathology

The following classifications can be made based on pathological changes and CT and MRI manifestations combined with treatment methods.

1. Bulging type

The annulus fibrosus is partially ruptured, but the surface layer is still intact. At this time, the nucleus pulposus bulges locally into the spinal canal due to pressure, but the surface is smooth. This type of disease can usually be relieved or cured through conservative treatment.

2. Prominent

The annulus fibrosus is completely ruptured, the nucleus pulposus protrudes into the spinal canal, and is covered only by the posterior longitudinal ligament or a layer of fibrous membrane. The surface is uneven or cauliflower-shaped, and surgical treatment is often required.

3. Prolapse free type

The ruptured and protruding intervertebral disc tissue or fragments may protrude into the spinal canal or become completely free. This type not only causes nerve root symptoms, but also easily leads to cauda equina symptoms, and non-surgical treatment is often ineffective.

4. Schmorl's nodes

The nucleus pulposus enters the cancellous bone of the vertebral body through the cracks in the upper and lower end plate cartilages. Generally, there is only low back pain, no nerve root symptoms, and surgical treatment is usually not required.

treat

1. Non-surgical treatment

Most patients with lumbar disc herniation can be relieved or cured through non-surgical treatment. The treatment principle is not to restore the degenerated and protruding intervertebral disc tissue to its original position, but to change the relative position of the intervertebral disc tissue and the compressed nerve root or partially retract it, thereby reducing the pressure on the nerve root, loosening the adhesion of the nerve root, eliminating the inflammation of the nerve root, and thus alleviating the symptoms. Non-surgical treatment is mainly suitable for: 1. young patients, first-time patients or patients with a short course of illness; 2. patients with mild symptoms that can be relieved by themselves after rest; 3. patients with no obvious spinal stenosis on imaging examination.

(1) Absolute bed rest: When the disease first occurs, you should strictly rest in bed, and emphasize that you should not get out of bed or sit up to urinate or defecate. This will achieve better results. After 3 weeks of bed rest, you can get up and move around while wearing a waist belt for protection, and do not bend over or hold objects for 3 months. This method is simple and effective, but difficult to stick to. After remission, you should strengthen your back muscle exercises to reduce the chance of recurrence.

(2) Traction therapy uses pelvic traction to increase the width of the intervertebral space, reduce the intradiscal pressure, retract the protruding disc, and reduce stimulation and compression on the nerve roots. It needs to be performed under the guidance of a professional doctor.

(3) Physical therapy and massage can relieve muscle spasms and reduce pressure in the intervertebral disc, but be aware that violent massage can aggravate the condition and should be used with caution.

(4) Supportive treatment: Glucosamine sulfate and chondroitin sulfate can be tried for supportive treatment. Glucosamine sulfate and chondroitin sulfate are clinically used to treat osteoarthritis in various parts of the body. These chondroprotective agents have a certain degree of anti-inflammatory and anti-cartilage decomposition effects. Basic research shows that glucosamine can inhibit the production of inflammatory factors by spinal nucleus pulposus cells and promote the synthesis of glycosaminoglycans, a component of the intervertebral disc cartilage matrix. Clinical studies have found that injecting glucosamine into the intervertebral disc can significantly reduce lower back pain caused by degenerative disc disease and improve spinal function. Case reports suggest that oral glucosamine sulfate and chondroitin sulfate can reverse disc degeneration to some extent.

(5) Corticosteroids Epidural injection of corticosteroids is a long-acting anti-inflammatory agent that can reduce inflammation and adhesions around nerve roots. Generally, long-acting corticosteroid preparations + 2% lidocaine are used for epidural injection once a week, 3 times as a course of treatment, and another course of treatment can be used after 2 to 4 weeks.

(6) Chemical nucleus pulposus dissolution uses collagenase or papain, which is injected into the intervertebral disc or between the dura mater and the protruding nucleus pulposus to selectively dissolve the nucleus pulposus and annulus fibrosus without damaging the nerve roots, thereby reducing the pressure in the intervertebral disc or reducing the size of the protruding nucleus pulposus, thereby alleviating symptoms. However, this method carries the risk of allergic reactions.

2. Percutaneous nucleotomy/laser vaporization of the nucleus pulposus

Through the use of special instruments, the intervertebral space is entered under X-ray monitoring, and part of the nucleus pulposus is crushed, sucked out or vaporized by laser, thereby reducing the pressure within the intervertebral disc and relieving symptoms. It is suitable for patients with bulging or mild herniation, but not suitable for patients with lateral recess stenosis or obvious herniation, or those whose nucleus pulposus has prolapsed into the spinal canal.

3. Surgery

(1) Indications for surgery: ① Patients with a history of more than three months and ineffective conservative treatment or those with effective conservative treatment but frequent relapses and severe pain; ② Patients with first attack but severe pain, especially with obvious symptoms in the lower limbs, who have difficulty moving and sleeping and are in a forced posture; ③ Patients with combined compression of the cauda equina; ④ Patients with single nerve root paralysis, accompanied by muscle atrophy and decreased muscle strength; ⑤ Patients with combined spinal stenosis.

(2) Surgical method: Through a posterior lumbar incision, partial resection of the lamina and articular processes, or intervertebral disc resection through the interlaminar space. For central disc herniation, laminectomy is performed followed by epidural or intradural discectomy. Patients with lumbar instability and lumbar spinal stenosis require spinal fusion surgery at the same time.

In recent years, minimally invasive surgical techniques such as microdiscectomy, microendoscopic discectomy, and percutaneous transforaminal endoscopic discectomy have reduced surgical damage and achieved good results.