Back of Ankle Pain

[Stoplookinatme]

I’ve been running completely barefoot for a little more than 1 year. I just started getting back of ankle pain a few days ago that wraps around the back of my ankle like a horseshoe from below the ankle bone on the outside to below the ankle bone on the inside. My Achilles tendon does not hurt at all. After I run it hurts to walk, probably a 3 to a 4 on a scale from 1 to 10. It also only seems to hurt when I bear weight not from moving it unloaded.
The biggest question that I always have when I get pain that I can easily train through is, should I?
I am not completely sure if this is a running injury. I drive a standard with a clutch pedal that has some good resistance and needs to be pressed in very far. Last week there were three separate occasions where I was stuck in bumper to bumper traffic, moving 2 or 3 feet at a time, for more than 2 hours and it is my left ankle that hurts.
I could not find anything on the web on running sites that sounded similar.
Thanks,
Jim

 

[Stoplookinatme]

I wanted to give you a follow up. It was feeling ok yesterday, so I ran. About 2 miles in, I started to feel it just a little. After my 4 mile run it hurt worse than before. It is hard to locate the pain. It is very dull and it hurts most during my walking gate just as my heel starts to lift.
I appreciate your advice.
Jim

 

[Dr Emily Splichal]

Hi Jim -

Without examining you it is hard to accurately diagnosis what may causing you pain - however since you described the symptoms so well and the events leading up to the pain - it sounds like it may be a case of flexor hallucis longus tendonitis.

The FHL tendon runs from the bottom of your big toe, around the inside of your ankle and then behind the ankle. Pain is often felt on resisted plantar flexion of the great toe - and is typically felt behind the ankle.

The repetitive stop and go of a clutch in which you are primarily using the great toe to push the clutch would totally aggravate this area.

FHL tendonitis - like any tendonitis - requires control of the inflammation and reduction of activity. You can take OTC anti-inflammatories such as motrin, alleve (as long as you do not have a history of GI issues - and always take them with food!) - and I'd limit activity for a full week. Soft tissue typically responds well to your class RICE within 7 - 14 days.

I would see a Podiatrist as there is a small bone in the back of your ankle - that you just want to make sure isn't fractured. You can google Shepard's Fracture to learn more about it.

Good luck!

 

[Stoplookinatme]

Dr. Emily,
Thanks for the advice. I've been off of it since Tuesday and it felt pretty good on a 2 mile walk today. I also did a hop test earlier today, to try and rule out fractures.
If I start running on it again next week how quickly should I resume my normal miliage and are there exercies that I should be doing to make this less likely in the future?

Thanks again,
Jim

 

[Dr Emily Splichal]

Hi Jim -

Glad that you are feeling better!

I always recommend to my patients eccentric and intrinsic muscle exercises as the foundation to their recovery program - and for prevention of injuries! Even tho you run barefoot you still need to do some foot-specific exercises at least 1x a week.

Since the foot is the first contact point (actually only) when we run - it will dictate how the rest of your lower extremity (knee and hip) assist in absorbing shock.

Slowly increase your mileage as the threshold at which you can re-injury yourself is much lower right after an injury. Allow the both the tissue but also the neuromuscular system adapt to the gradual increase in mileage - and you should be set!

Good luck!!