Ongoing Ankle Pain Unexplained

needhelpplz wrote:

I have been having ankle pain on the top of both my feet, sometimes one more predominantly the other accompanying a bunch of stuff like ITBS and sciatic stuff but starting to get better, but my ankles still hurt, mainly after runs and in the morning. If I dorsiflex the ankle it hurst.

This has been going for at least 3 months now. What am I looking at? Poroneal Tendonitis? Some type of arthritis?

Really annoying. ITBS getting a lot better through stengthening but still there if I push it too hard.

I am not so concerned about the intermittent "pain" in the top of your foot/ankle as I am the fact you mentioned ITBand Syndrome AND Sciatica, esp. the sciatica. Your "pain" may not even be tendon or muscle related, but nerve related. Do you have ANY other type of discomfort above your TFL area? Do you have pain in your glutes/groin/lowerback at ALL? And by pain I mean any spectrum of discomfort (i.e. tightness, stiffness, aches, throbbing, stabbing, burning, tingling, or even weakness). Often, even if you happen to have a minor lowerbody problem the real monster lies somewhat above that. You cannot ever truly be 100% healthy if you have sciatica. I don't mean that you cannot run, and possibly run fast, but it will catch up with you and get worse if you don't get to the bottom of what is affecting the nerve. My guess is your problem lies in one of two areas: your lower spine or hips. Because you mention your IT-band as a chronic issue, I am going to guess hips.

I need more info to help you narrow this down though. I could be wrong...

When else and where do you have pain?

Does it hurt to sit for long periods of time?

What about standing? walking? driving? laying down? Do you have specific discomfort at night or in the morning when you first get up? If so, describle exactly what is uncomfortable or painful, or even just doesn't feel healthy or normal in general. Details are key.

Thanks for the reply, actually I really never had sciatia, just mainly ITBand. Like my leg never gave out or anything, I think I had SI joint issues, maybe I still do, but now I can do 6-8mile runs at least. I think the sciatic thing was mainly in my head and if anything maybe a LITTLE bit just from a very spasm'd piriformis area at one point near the beginning. It's slowlyyyyyyyy gotten better. It has been about 3-4 months since the initial injury.

I first started with some ankle pain but ran through it, had some ITB pain with very tight quad, and then all my butt muscles went into spasm in the next couple days without me running, leading me to believe it was a SI joint problem. I also developed very bad lower back pain on that side but haven't felt any since about 1month from the initial injury. I have since done lots of glute strengthening exercises which I think have probably helped, but now my ankle is still hurting which I thought would have gone away by now. Some mornings I wake up and its quite noticeable. It goes away mainly during the runs.

The main problem has been when I start running again my hip/glutes/itband get tight REALLY fast and then bad things start happening. But I've been able to work up to a bit further runs by now. I've had sometimes really bad pain on my right ankle where it is noticeable in the form on my runs and then the next month it's my left ankle that really hurts. Right now it is mainly my left on the top outside of the foot kind of, but if I dorsi flex my right foot I can somewhat feel it hurting in the spot denoted by all the images I search and find from peroneal tendonitis.

It used to hurt if I sat down for long periods of time like long study sessions and plane rides, the tailbone would kind of be sore. I tried a Sacro Wedgy but that didn't really help. When I first get up just ankle soreness mainly. It could be a cooinsidence but when I first got the ankle soreness/injury I had just switched to a neutral minimlist shoe and obviously I have not gone back to that and went back to my normal shoe.

Thanks for taking the time to read, anything would be very helpful at this point. Thanks!

Hmm....

THREE of your statements stick out like red flags to me:

1. actually I really never had sciatia, just mainly ITBand. Like my leg never gave out or anything, I think I had SI joint issues, maybe I still do, but now I can do 6-8mile runs at least. I think the sciatic thing was mainly in my head and if anything maybe a LITTLE bit just from a very spasm'd piriformis

2. had some ITB pain with very tight quad, and then all my butt muscles went into spasm in the next couple days without me running, leading me to believe it was a SI joint problem. I also developed very bad lower back pain on that side

3. The main problem has been when I start running again my hip/glutes/itband get tight REALLY fast and then bad things start happening.

I find the 3rd statement to be the most concerning. I am not doubting the pain in your ankle. It may or may not be peroneal tendonitis. But I will tell you flat out right now, it is not what you should be concerned about, at least not in my opinion. I am basing my advice off a lot of research, personal experience, and experience with other serious runners and people who compete in sports with a lot of running involved. Something else is wrong and it has to do with your muscles tightness and dysfunction between your lower back and glutes.

Your hips and glutes and it-band should NOT be getting tighter as you run unless something is WRONG and they are trying to protect you from further damage. It doesn't have to hurt to be serious. I really STRONGLY recommend you go and see an orthopedic, but make sure you research them before you go to see them. You want to make sure they are knowledgeable with lowerback and hips - ESPECIALLY hips. I think you are putting unknown force on your lower joints (i.e. your ankle) because your stride is not natural and healthy do to chronic tightness and muscle dysfunction above.

Now, here is the part where you are going to want to naturally argue a bit (and I don't blame you, becuase you want to run). "I have been doing 'x,y,and z' for therapy and strength and my symptoms are getting better and now I can "run" for 6-8 miles.

Let me ask you the following:

How does this "running" compare to before the injury?

If you try to run at a faster pace does it bring on your symptoms? Is it really FUNCTIONAL running or are you constantly having to pay careful attention to your stride and mechanics and pain and symptoms? Do you feel discomfort during and especially AFTER you run more often than not??

I think you know what the answer to these questions should be if you are truly getting better.

I also think something is wrong besides your ankle because this has been going on for months. It's chronic. If it was just your ankle I don't think this would be the case.

Can I ask you a few more questions?

Besides pain in your itial tuberosity (sit bone), do you have any discomfort in EITHER of your hips or your glute or lower back when you are sitting for long periods of time?

Do either of your hips ever make a popping or clicking/catching noise, EVER? It might only be once a day, or a few times a week.

If you can answere these questions for me I can help narrow down what type of doctor you should look for and specifically what type of injury you may want to suggest they test you for. I already have one in mind but I want to make sure before I jump to conclusions.

I forgot to reinforce the fact that what you are describing (the ankle pain) CAN be a form of sciatica. Sciatica is not an "injury." It's a PATHWAY of pain and discomfort. It doesn't have to be complete and it's RARELY presented the same from person to person. It completely depends upon where the nerve is being irritated and to what degree.

You can have sciatica and it may not even HURT. I had sciatica for about 7 months straight and it was misdiagnosed because to me, it wasn't pain. It was a feeling of weakness and awkwardness that ran down the back of my leg and wrapped around the side (by my IT-band). It would then kinda disappear and skip my calf, but then I would get radiating sharp pain/burning in my ankle and on the top of my foot. It didn't feel like "nerve pain" to me.

I really appreciate you taking the time to type out that response, I'll try to be as detailed as possible.

I actually talked to a physio today who thought it was probably a stress reaction. It hurts on the top of my foot if I lean onto that foot and put a lot of pressure on it. Maybe I have had a stress reaction this whole time? He also said my peroneal tendon is a bit tight on the other side. I am going to go see a doctor soon for possible xrays.

I don't get the lower back pain anymore and my hips don't crack at all that I am aware of. The lower back pain was initially very sharp pain when I leaned to the right.

Also the ITBS that I have when it gets bad is right outside the knee pain and when I roll the IT Band at that point it has a lot of scar tissue and is really tight and takes a while to get it go back down.

I forgot to mention this but before the physio said that my hip was anteiorly tilted forward, could this be the cause of everything possibly?

I know about what you're dealing with. You can alleviate a LOT of issues with this simple exercise for your hips. Slouch down on a couch/chair and do reps of holding your hips in the air while squeezing your glutes hard, like 10 times for 10 seconds each, 3 sets or so.

Also, when in bed lie prone and while holding your legs slightly apart but straight at the knees, splay your feet out and hold it 10 seconds etc. feeling the tension in your hips. Then hold them IN for 10 seconds...come up with your own reps that you feel is effective.

These will strengthen your hip flexors and therefore hold your bones in the right place, freeing up your nerves from impingement leading to NO PAIN.

I've dealt with chiropractors for decades and nothing helped more than those two simple exercises to correct everything. This will strengthen those little muscles that keep the sacrum and ilium in their right position. It doesn't take much misalignment at all for them to cause trouble.

And of course to prevent or treat your ITBS, do your stretches such as hold your knee across your chest (i lay down to do it) but you probably already know that.

As for your PT; it might help to get some myofascial release massage on your entire lower body. Only well-trained MT's know how to do this right. Ask for it by name and if they give you a confused puppy look, look for another one. Tell them about your PT and they can focus on that area too.