Talocrural synovitis is an inflammatory reaction affecting the sensitive lining of the ankle joint capsule (known as the synovium). The reaction affects the inner part of the joint capsule and can produce fluid inside the joint.
CAUSES OF INJURY
This reaction can be caused by a number of mechanisms. Here are the three most common causes:
- An ankle sprain can generate a rapid stretch on the joint capsule and start an inflammatory response.
- Excessive swelling inside the joint, occurring with cartilage damage or bone bruising, causes a prolonged stretch on the synovium and will cause an inflammatory reaction.
- You can also cause synovitis by compressing the joint capsule and synovium, such as with an ankle impingement.
The reaction, once started, is slow to resolve and prone to flare ups. It can be aggravated by stretching or compressing the area.
SYMPTOMS OF ANKLE SYNOVITIS
The symptoms caused by ankle joint synovitis are a mix of sharp pain and a dull residual ache. The movements that can cause symptoms depend on the location on the inflammatory reaction.
For a reaction at the front of the joint, pain will occur on overstretch of the inflamed synovium, such as forcefully pointing your toe. You will also experience a sharp pain with compression of the synovitis, as can occur when you lunge forward with your knee moving over your toes.
For a reaction at the back of the joint, the movement has the opposite effect but still generates similar pain. You’ll experience pain on pointing your toe due to compression on the back of the synovium. In forward lunges, or any calf stretch position, you experience a dull pain due to overstretch.
The dull residual ache is due to the inflammatory response and is usually becomes a stronger pain as the condition worsens. This ache will typically occur after increased loading and can persist despite taking your weight off the foot.
TIPS FOR FIXING TALOCRURAL SYNOVITIS
The most effective fixes for talocrural synovitis combine an anti-inflammatory approach along with movement restriction and, if required, activity modifications.
- The severity of the reaction can be monitored by how much of the joint capsule is affected. You can test this by pressing on it directly – it runs across the front, sides and back of the ankle at the level of the tip of the bones on either side of the ankle (these bones are often called ankle bones but their anatomical names are medial malleolus and lateral malleolus)
- Your best approach, for the fastest resolution of talocrural synovitis, is a mix of anti-inflammatory medication and/or ice along with taping or bracing to restrict movement. You may also need to modify some activities, such as avoiding hills and top pace with running
- If the reaction is primarily affecting the front of the joint, wearing moderately high heels (up to ~3″ or 8cm) will actually help by avoiding joint capsule compression
WATCH OUT FOR THESE DECOYS!
- Stretching – DON’T DO IT!
- The joint may feel tight but stretching makes the reaction worse and delays recovery
- Avoid intermittent use of meds
- We all like to avoid medication wherever possible but ceasing the anti-inflammatories prematurely can allow the reaction to gain momentum again and lead to several recurrences
- The best approach is to take a set amount of meds for a short period, around 4-5 days. Then pause the meds and see if they’re still warranted. If:
- The symptoms begin to return, use another course of meds
- Nothing happens and the symptoms don’t return….win!
- Pain comes back as soon as you stop, seek further medical advice as it’s unlikely another course of meds will have an impact
- And as always, seek advice from a pharmacist or doctor if you’re uncertain of what to take or if it’ll react with you or other meds
- Be patient
- A premature return to full loading, or a frustrated training session where you push it ahead of schedule, is bad news
- It risks restarting the reaction and setting you back weeks or more
- Just increase your training gradually – don’t push it to see if pain starts. By the time you feel the pain, you’ve already started to poke the bear!
WHAT ELSE COULD IT BE?
- An ankle impingement has elements of synovitis as the pain-causing pathology, so you may have both as part of the one injury
- Talar dome lesion – it also causes aching, doesn’t like movement and generates
- Calcaneal bone stress injuries can cause similar symptoms with weight bearing, although it’s less symptomatic with non-weight bearing movement
- If the symptoms are only at the back of the ankle, consider an Achilles injury or bursitis