Ankle Pain During Stretching - Member Case Study

author : AMSSM

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The only time it hurt is when I stretched my left calf. I guess, "flexing" the ankle the way you do when stretching your calf is what was hurting it. The place it hurt is just fore of the ankle bone.

Question from Steve:

I twisted my left ankle about 3 weeks before the 2004 Chicago Marathon, which was held on October 10, 2004. No swelling occurred and it didn't hurt when I ran on it (I'm a forefoot/ball of foot striker, not a heel striker). Low and behold 3 days later, twisted the darn thing again. But still no swelling the next few days. Really no swelling and again, it didn't hurt when I ran on it.

The only time it hurt is when I stretched my left calf. I guess, "flexing" the ankle the way you do when stretching your calf is what was hurting it. The place it hurt is just fore of the ankle bone (the bone that sticks out) but definitely a tendon ON the fore part of the ankle bone.

After the marathon run (no pain the entire run in the ankle) and again, I could only "cause" it to hurt a bit if I stretched my calf muscle and "flexed" my ankle. Then I could feel the tendon or ligament or whatever it is produce a slight pain...but it goes away when I stop "flexing" it in that position and didn't hurt even when I walk.

Ok, fast forward 5 months later to today. I have not put in any significant running since the marathon. I just really started back up running in January and have only been doing about 6-8 miles a week 25-35 minutes at a time. But my ankle still hurts the same as it did 5 months ago. Again, absolutely NO soreness or pain while running, only whenever I flex it into that calf stretch position and it hurts right on the ligament/tendon on top of the fore part of the ankle bone. It hurts the same (aka I can produce the pain the same) if I flex it before I run (when it's cold) or after I run (when it's warm)...no difference in pain in this flexed position.

So my questions are:

1. Why hasn't this pain gone away after so many months and particularly after so much time off my feet (I've really only been swimming regularly and bike once every other week).

2. What can I do to get rid of this pain...aka fix the strain and/or strengthen the ligament/tendon that hurts.

3. Why doesn't it hurt when I run?

Answer:

I think it’s possible that you may have impingement of the lining of the joint of your ankle. It sounds as if the pain is in the anterior joint line of your ankle, located in the front, or “fore” part of your ankle. If you are only experiencing pain in this region with extremes of dorsiflection, then the capsule around the joint may be chronically irritated because it is being pinched between the larger of the leg bones (tibia) and a large bone in the ankle called the talus. With chronic ankle pain and previous trauma to your ankle, you may also have developed a spur in this area, which may be enhancing the impingement.

Specifically, my recommendations on what you can do to get better would include a good rehab program that would include specifics on proper stretching techniques without pain. Strengthening exercises of the muscles around the joint as well as the intrinsic muscles of the foot would also be helpful. Balance and coordination techniques would also be important for minimizing your discomfort. I often tell patients to initiate “relative rest”. This strategy allows any activity that does not cause pain.

If these simple interventions are not helpful, and impairment generated by the pain in your ankle is intolerable, further evaluation and x-ray would be recommended. At times, a steroid injection might be helpful with continued rehab for a period of time. Depending on the problem and the degree of disability, surgical intervention might be considered once the above treatment plan has failed.


Tracy Ray, MD
Member AMSSM
www.amssm.org
 

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date: April 9, 2005