CRPS affecting the ankle, case analysis and treatment options

As we all know, Complex Regional Pain Syndrome is an extremely painful and potentially debilitating disease. There are no diagnostic tests available for this condition and the only possible way to obtain a diagnosis is through a clinical test. CRPS mainly affects the upper limbs (about 60% of cases) but it can also hit the lower limbs (40% of cases). More specifically, in this small article, we will talk about what concerns Complex Regional Pain Syndrome on the ankle. When it concerns the lower limb, this condition is more likely known to affect the ankle and foot area, rather than other parts like, for example, the knee.

This is also due to the symptoms: in the foot area this condition shows unequivocally while, in the knee area, many symptoms are not present, therefore it takes much longer to diagnose it. CRPS on the ankle, differently from when it affects the wrist or the upper limbs, tends to be more debilitating because, of course, a patient can’t walk on the affected foot. It is also the type of CRPS most likely to come because of a medical mistake: surgery is the second leading cause, only second to fractures or distortions.

Not only, if we consider that fractures and distortions may often not be the actual cause of CRPS, but a poorly positioned cast, a medical mistake could easily be considered the main cause of CRPS affecting the ankle. It has also been noticed that, when CRPS affects the lower ankle, patients have usually undergone multiple surgeries in the area. This is to the point that a study conducted in 2016 suggested to add “Complex Regional Pain Syndrome” as a possible post-surgical risk, to inform the patient.

As it happens for any other type of CRPS, women are more likely to be affected by this condition and, of all, 47,06% of the patients have a medical history of anxiety or depression. With attention to Complex Regional Pain Syndrome affecting the ankle, 17,65% of the affected patients had symptoms immediately after a surgery in that area.

With CRPS in the ankle it is vital to start a multidisciplinary approach because, as we have seen, it involves the whole wellbeing of the patient. It is important to immediately start a rehabilitative program to learn how to cope with pain. The acute phase usually lasts about 3 months but, nevertheless, it is the most important moment to work on it. When affecting the ankle, CRPS is more likely to worsen because of a consequent poor posture that will not allow a complete recovery of the area and, this, can cause the sensation of “spreading”. The spreading in this case is most likely to be a complication related to poor mobility and pain management treatments, rather than the condition itself: not being able to maintain a correct posture and mobility on the long term, will eventually cause pain and discomfort on the other ankle or the spine. In this picture, a healthy lifestyle can be very useful to treat, if not prevent, CRPS. This is important to keep in mind because, for example, overweight patients are more at risk. Not only, when affecting a lower limb, patients who were in excellent shape before, could easily gain weight because of the condition, worsening the entire situation.

Neridronate infusions have proven to be extremely useful for patients suffering from CRPS on the ankle, this is also due to the fact that, as we have seen before, this condition on that area is diagnosed more quickly. An immediate therapy will certainly help the whole situation and can lead to a full remission from all the symptoms. Minor pain management drugs might be required until the correct therapy kicks in at full effect but, usually, with the help of rehabilitation and a prompt therapy, a patient can hope for the best outcome.