Mystery injury - really need to get back to running!

Sorry, doesn't sound too good. So the strengthening exercises didn't work? Hmm... I've had peroneal tendon issues but they really healed up more quickly (like a few months)... I'd give the orthotics another chance.

anterior ankle impingement

this just means you have a pain in the front of your foot caused by the two ankle bones, the tibia and the talus, moving against each other. it doesn't mean the physio has identified the cause of the pain, it just means he has a posh sciencey way of saying, "ankle pain," that makes him sound clever and justifies whatever you paid him.

what interests me is that after having this problem for two years, seeing numerous highly qualified medical professionals, having x-rays, doubtless an MRI scan and direct examination numerous times you think a bunch of anonymous strangers with no obvious qualifications might be able to help.

He made custom orthotics

there is very little scientific evidence that orthotics, custom or otherwise, can cure, obviate or correct problems caused by foot mediation (varying the alignment) during running. your foot is designed to pronate and no one can tell you what "over-pronation" is.

I am not a doctor or other suitably qualified medical professional, but my best, utterly uninformed guess based on nothing more substantive than a mere thirty years as an athletics coach, is that you either have, or had, a bone spur. which means either of these:

1) before you stepped on that treadmill, you had a small bone spur. running incorrectly and squeezing your foot to hold that poorly-laced shoe broke off the bone spur and it is now lodged in somewhere, slowly getting bigger and causing you grief.

2) before you stepped on that treadmill you had a very, very small bone spur. that day you aggravated it, tore a tendon or some such and subsequent calcification has caused the spur to get bigger.

assuming you have a spur, then no amount of exercises, patience, waiting, ice, orthotics, gels, creams, lotions, smoking, music or praying is going to do a thing. the only cure for painful bone spurs is surgery.

nothing would make me happier than to be wrong.

Cheers.

Do you kniw the prognosis of recovery from this sort of surgery? Would i likely be able to run after recovering? And, sorry for all of the questions, but what sort of imaging would detect this, given that past xrays havent detected anything? I do feel something more is going on, given that this pain is just so relentless no matter what i try...

Also, i was surprised by the diagnosis because my pain is primarily around my peroneal tendon, specifically below the fibula... i’ve rarely ever felt pain on top of ankle. I suppose a bone spur (or tendon tear) could be the culprit? I guess this means an ortho and more imaging... because the orthotics really aren’t doing much and I’m sick of this pain and not training. Thanks for the input, of course i don’t expect random strangers to know exactly whats going on, but its nice to get advice/input from fellow runners...

Do an MRI

like I said, I'm not a doctor. the internet is probably your best guide here, or ask your doctor. the posh sciencey name for a bone spur is osteophyte.

absolutely. I have previously coached a lady who had a bone spur on her heel that caused serious issues with her achilles tendon. she had this operated on. went to the clinic in the morning, operation just before lunch through a tiny slit in her heel, two stiches, bandage, went home at supper time. she was running (easy) in about ten days, hurdling inside a month and back in full training in eight weeks. I have no idea how typical that is and it is a different location in the foot to yours so it may not be a valid comparison.

definitely not my area of expertise, but it's bone so I would have thought it would show on an x-ray. whether the person looking at the x-ray saw it or not, or whether they even thought to look for bone spur or not are unknowns. it's also possible that the spur was obstructed (in the x-ray) by something else so it could not have been seen even if they were looking. speak to your doctor.

you obviously know that your feet are very complex structures, over a quarter of all the bones in the human body are found in the feet. the peroneal is two separate tendons, the peroneus longus and the peroneus brevis that lie on top of each other and attach to the outside of the foot. if a spur broke off it could be lying between the two tendons, irritating them and annoying the hell out of you.

there are also ligaments attaching the fibula to talus, fibula to calcaneus and talus to calcaneus. any of these could have been torn, stretched or otherwise damaged in the original injury. the injury itself will have healed a long time ago but the cartilage built up in repairing the damage can often form a lump similar to a scar that is not an actual bone spur but impedes the free movement of the joint. in areas where direct digital massage is possible, in the hips for example, this can often reduce the build up to assist with movement but in your foot this is not possible.

I can't emphasise enough that I am not a doctor, but these seem to me more likely scenarios than sudden-onset over-pronation that can be fixed by a simple orthotic. specialists tend to diagnose problems as fitting inside their own speciality.

I also think that you should consider continuing with some other form of exercise. I meant to put this in my first reply this morning but forgot. try something that doesn't require weight bearing on your foot, like swimming, for example. this is a very useful outlet for the frustration you must be feeling after so long without even a proper diagnosis.

Good luck.

Thank you so much for getting back to me. I’ve been biking, doing hot yoga, and strength training with weights, but the injury is even a dull discomfort with biking (or, honestly, even when i’m not exercising...). The “overpronation” diagnosis seemed questionable to me, because the persistent weakness and pain in the foot that definitely is worse with running but is always sort of there just seems like something more is going on. Overall, I think i’m due for recent imaging. I had all of these xrays quite some time ago, and i know that especially with a bone spur, scar tissue build up, and so forth, things can change. Again, I really appreciate you opening my eyes to the possibility that this could be something more than just a case of overpronation.

Also, i think i may do an MSK ultrasound first of the peroneals, if nothing is evident than I’ll go the MRI and/or xray route. I’m trying to avoid radiation when possible, ultrasound is a bit more financially feasible, and it seems that at times MRIs can lack detail when it comes to the peroneals... I’ll have to check w my dr though!

Did this ever resolve?