Ankle pain....what to do.

[Barefoot Cassie]

I had a pretty crappy run yesterday. I was only able to go 1.5 miles. I have a pretty bad bruise on the bottom of my toe where I had that imbedded rock. It is okay to walk on and I gave it an entire week of rest so I thought I would go out on a run yesterday. Well it still hurts to run...not bad but enough that it messed with my stride.

Since my stride was off my ankle started hurting (on the other foot). I ended up stopping the run and walking home because of the ankle not the bruise.

The part that hurts is on the outside going around and up behind that bony area. The pain goes up a few inches onto the side of my leg as well. I also had some pretty wicked calf cramps on that leg as well.

I have been able to massage out the calf cramps but the ankle is still tight. No where near as bad as while I was running but it is still noticable.

What is going on here and what do I need to do about it?

 

[Barefoot TJ]

I don't know what is going

I don't know what is going on, but I do know that you need to take several days off from running until both those areas are without pain.

If you were feeling pain from the toe bruise, then it is possible that may have led to your ankle pain, since you altered your gait to compensate for that area.

Get better soon, Cassie!

 

[Barefoot Cassie]

Thanks TJ....I have been

Thanks TJ....

I have been doing some research on it and from everything I can find my pain seems like peroneal tendon issues. So not cool.

 

[twinkletoes]

Oh Cassie, This does sound

Oh Cassie,

This does sound exactly like peroneal tendonitis and I would be very careful about running on it. I just had ultrasound on my right ankle because my 3.6 and 4.6 mile runs last week had it swelled up like an orange still on Saturday.

I ran through the left PT but looking back on it, that was really dumb. It's making me crazy not to run every other day but the risk of a tear keeps me respecting the pain. Walking doesn't bother so much.

Ice, trigger point massage (I have a small smooth rock to dig in with-it's pretty grim pain), tiger balm, rest, ultrasound if you can find it, KT Tape. The worst? Time.

 

[ajb422]

 I had a problem with the

I had a problem with the inside of my ankle that I'm still dealing with alittle bit. I found wrapping it relatively tightly with an ace bandage to give it some compression throughout the day helped alot.

 

[Barefoot Cassie]

So, what kind of time off am

So, what kind of time off am I looking at here? I don't have any swelling at all just the pain.



I found a bunch of stretches online and have been doing those. They seem to help out a bit.

 

[twinkletoes]

Calf raises seem to help me

Calf raises seem to help me too when I remember them.

I don't know about the time off thing because I suck at it- I ran on it when it was still just "achy"- and then, bam! I couldn't bear weight on itl for a week and it was swollen for days. I took off nearly 2 weeks total, then ran and walked about 20 miles in 10 days when it flared up again and now I've been off 4 days. Might try a very short test run tomorrow before the big temperature drop on Wednesday...it's hard to know how much better it's getting with the rest until I run on it- but then I tend to always run too far I think.

 

[C. Beth Run.]

I'd suggest rolling out that

I'd suggest rolling out that soleus (lower calf) to get rid of those tight trigger points. When my ankles get sore I think it's often due to soleus tightness.

Here's what they're teaching me to roll the soleus (& the rest of the calf) in PT:

*Sit on floor. Put ankle up on a foam block or thick book.

*Get a ball (I use a Trigger Point Massage Ball but you can use a tennis ball) and put it under the soleus (lower calf.) Start 4 finger widths above the ankle bone to avoid rolling on sensitive areas that could hurt you more. You may need to hold the ball in place so it doesn't shoot out to the side!

*Find a tender spot (right on the bottom of your soleus, or on the sides--wherever it hurts.) Keep the ball on that spot and turn your ankle clockwise 3X and counterclockwise 3X then "slap" your foot 6 times (quickly pointing toes down and letting foot spring back up.)

*Move onto another tender spot. You can go all the way up the calf, but don't go directly behind the knee (again, sensitive area, can be easy to mess things up in there.)

The thing is, you don't want to stay too long on one spot or you can injure it more. Just do the circles & the slaps, and move on--you'll only be on that tight spot for maybe 10-15 seconds! Do it at least 2x a day, more if you want. Each session should be fast, maybe a minute or two on each leg.

We mid- & forefoot strikers often have very tight calves!! I don't know for sure if this will help your ankle but I'd say it's sure worth a shot. Since you're not working directly on that tendon (tendons can't be "rolled," only muscles can!), I don't think it's going to hurt!

I've been having to wear minimalist shoes for most of the last 4 weeks because I got a sore spot on my foot. The PT said it's probably a bone bruise from stepping on a rock or something. Bone bruises, he told me, take about 6 weeks to heal. Mine's feeling mostly better but I made the mistake of running on it soon after I got it, and it made it worse. For me, I'd prefer to be 100% in shoes (Vibrams these days) and still be running instead of waiting for a silly bone bruise that doesn't hurt as long as I have shoes on it. But that's just me!

 

[C. Beth Run.]

Oh, AND I'll add...if it

Oh, AND I'll add...if it doesn't get fixed soon, go to a good PT place. I love the place I'm going to for my IT band stuff. They're not only working on it in-office, but also giving me plenty of exercises to do at home including the trigger point therapy stuff that I'm so into. It's not cheap, but I wish I'd gone earlier instead of letting this be an issue that recurred over and over for 9 months.

 

[Barefoot Cassie]

Wow Beth, thanks for all the

Wow Beth, thanks for all the awesome info. I will have to wait for my oldest to get up from his nap to try this. He steals my tennis ball that I use to massage with and hides it in his room.

As of right now I don't have anything to wear to "pad" my bruised toe. I did get an e-mail today that my run amocs are shipping today...so the next few days I should have something. I will spend those days getting my ankle/calf feeling better so when the shoes come I can test them out.

I would take a picture of my bruise but it is like a tiny black pin prick. Almost my entire toe hurts and all I have is the tiny spot to show for it.

 

[Barefoot Cassie]

Oh, and a dumb question about

Oh, and a dumb question about the PT. Do I have to see a doc first to go or can I just go? Not sure how that works.

 

[C. Beth Run.]

Glad the info was helpful!As

Glad the info was helpful!

As for whether you need a referral to the PT--it depends on your health plan. If you're on a PPO you can probably just go; if you're on an HMO you probably need a referral from your primary care physician. (Not sure if you could get the referral by phone or if you'd have to actually go in.) If you call the # on your insurance card they should be able to tell you.

 

[twinkletoes]

C Beth- I've been able to

C Beth- I've been able to roll/massage the trigger points on the back of my heel/ankle and they're some serious zingers! My PT friend helped me find those. Thanks for the reminder about the calves- that worked on my left ankle PT.

 

[Barefoot Cassie]

O.M.G. Thanks sooo much for

O.M.G. Thanks sooo much for that Beth! There is a huge difference in how my ankle feels. My calf is still a bit angry and tight but I didn't want to push it. I will do this along with my calf raises and stretches for a while and see where I am. If it all kind of lingers I will look more into physical therapy. I have a PPO so I may just be able to go.

 

[jschwab]

I have a couple of things to

I have a couple of things to say about PT. This is often called the "Uggs" injury or flip flop injury because it is caused by wearing shoes where you have to "grip down" to keep them on your feet. I have had PT so bad I could hardly walk at all, gone out to just go through the motions wearing running shoes, gotten to where I start my runs feeling better and run 10 miles with no pain and had the pain not come back for 4 months. For me, running was therapeutic. I also have had no problems running barefoot. Look at your shoes that you where when you are not running and look at the shoes you where when you run, if any. A PT will give you all kinds of special exercises, but if it's just because you like your flip flops or to wear heels on Saturday night, none of that will help. Personally, I am not big on PT for anything like this, because you will just be trying to isolate the problem, you won't be fixing the underlying stress, whether it be shoes or gait or whatever. I would also completely halt calf raises - you are just adding stress.

 

[C. Beth Run.]

Cassie--I'm so glad it

Cassie--I'm so glad it helped!! Hooray. Glad you didn't push it. It'll stay sore for awhile and more work on it can make it worse instead of better. I was rolling for WAY too long and my physical therapist told me it should be FAST but I can do it as many times a day as I want...just need rest in between so the blood is flowing freely through the area.

twinkle--I am guessing the PT place is more conservative about where to roll because it can be hard to correctly isolate those trigger points that are near bones, ligaments, etc. The trigger point book I have does allow for finding trigger points in those areas though. I think if you are going to work those areas it's good to get professional help on finding the right spot (like your friend or my book!)

jschwab--Yeah, if you don't isolate the underlying cause it'll keep coming back! I'm using what I'm learning at PT (which includes strength training because my weak glutes/hips are part of what has caused my issues) but also really focusing on form. I think in my case having bad form (hips swaying back and forth, toes pointed out) is part of what caused my problem.

 

[twinkletoes]

I also just found a knot

I also just found a knot higher up on the tendon, more on the outside of my calf- so I will work that when I can at home tonight. Good stuff CBeth.

 

[C. Beth Run.]

twinkletoes--yeah! Glad

twinkletoes--yeah! Glad you're finding areas to work on.

By the way, I have a great one for shins too if anyone needs it. I don't think shin splints are common among BFRunners but I've been having some weird knee pain caused by shin tightness and the shin trigger point stuff worked on it really quickly.

 

[peacekaren]

Sounds a lot like PT to me. 

Sounds a lot like PT to me. It took me nearly 2 months to heal from a bad case of it in the summer of 2009. Don’t ignore the symptoms and don’t run on it until the discomfort goes away.

I did not do a good job of resting the ankle after the injury. I also donated blood at the Red Cross a couple of days after the injury presented. I didn’t think anything of it at the time, but in retrospect, I think it was a contributing factor to the length of my recovery. Hopefully, your recovery will be much quicker.



Here are my suggestions.

Rest and ice until the discomfort goes away.

When you can bear weight comfortably on it, follow this rehab exercise routine.

Get a foam roller and use it regularly on the calf muscles and the peroneal muscles.

Find a good sports massage therapist and visit as often as your budget will allow.

I also found soaking my ankle in a hot tub to be very helpful.

When you’re ready to get back to running, ramp back up slowly. Maybe do a longer walking warm-up before each run. Consider taking 2 days off between runs.



Hope that helps.



-------

In my case, I have new theory about the root cause of my PT and my subsequent TOFP tendonitis. I think they're both related to an anterior hip tilt (due to my tight hip flexors) affecting the angle that my foot lands when I run. I took one of the exercises BF Ken Bob suggests for TOFP and modified it and I'm finding it both helpful and instructive. Give it a try and see how it feels. I'm curious to learn if you experience anything similar to what I've found.

Ken Bob's suggestion for TOFP: Let your feet dangle off the end of the bed while lying face down with the top of your foot against the mattress. Pull your foot into the mattress and hold. This stretches the calf muscle and strengthens the shins.

My modification: First do a few reps of that exercise and notice how it feels. Then repeat again, only this time pulling using the outside edge of your foot near your pinky toe. Notice if it feels harder or unbalanced. Repeat again using only the inside edge of your foot near the big toe. Again, notice how you feel.

In my case, I had been doing the Ken Bob version for several days before I became aware of the problem with my running form (landing with my foot at an angle). The first time I tried the exercise pulling with the outer edge of my foot, wow, what a difference! It was only then that I realized that previously the inner edge of my foot by the big toe had been doing all the work. In fact, I thought all along that I had been keeping my feet flat against the mattress and had been pulling evenly, but once I paid attention I realized that my little toes had barely been making contact with the mattress at all!

If you find you have a similar experience, try one more thing. Push the top of your thighs firmly into the mattress and repeat the entire sequence. Pushing down through the thighs will force your hips to rotate under you which will change the alignment at the hip joint. If you notice this makes it easier to pull evenly across both edges of the foot, you may be dealing with a hip tilt.



Peace,

Karen

 

[C. Beth Run.]

Hey, Cassie, how's that ankle

Hey, Cassie, how's that ankle doing?