I am a 38 year old, 5km runner with a stubborn ankle injury. I have seen two physiotherapists but still struggle with the same symptoms and really need to get a handle on my situation before I decide on my next move. I would really appreciate if you could spare a minute and offer your gut instinct and whether you would be confident sorting me out?

My history:
Back in 2004 I developed pain on inside of ankle during a run. Wikipedia reference-linkMRI scan showed nothing abnormal. Had ankle arthroscopy involving minor release of posterior tibial tendon to relieve symptons and a clean. Doctors said nothing wrong and minimal invasive work. Ankle fine when running for 6 years, except for odd twinge.

In January 2010, ankle pain returned suddenly during run. Sharp, shooting pain - unable to put much weight on left leg - as before. Pain also seemed to move around ankle and sometimes felt a pinching sensation on the inside and towards the back of the ankle. Also experienced twinges of ITBS. I initially saw a sports physio who prescribed numerous exercises, mainly to sort out weakness on left side of body. But he did very little hands on treatment. I still got ankle problem despite 2 months of sessions and daily exercises. Pain seemed to be worse after I have performed aggressive lower calf stretches (as prescribed by physio) - my left leg does not dorsiflex anywhere as near as far as my right. Physio concluded that there could be an issue with alignment of the ankle joint. Ankle worse when wearing high profile shoes or trainers, especially walking boots.
Anyway in June 2010 I got a 2nd opinion and new physio sorted me out instantly. This was their treatment:
‘mobilisatrion to the subtalar joint which was very stiff.
Mobilisation to the joints of the left medial longitudinal arch including the talo/ navicular joint, the naviculo /med cuniform joint. this lead to neutral orientation of the hind foot in plantar flexion and full and neutral hind and mid foot dorsiflexion. Also stiffness in metatarsal area’

The treatment works and I can run for 1/2 months before I suffer from tightness in the ankle again rendering me unable to run at all. I get a localised pain usually on the inside of the ankle. The pain returns very slowly over a few days, usually feeling the odd twinge, before the ankle stiffens and cannot run at all. Physio is not very forthcoming with exercises or stretches although I have sourced a few exercises myself but not sure if they are of any benefit. When pain returns, feels worse when I walk downstairs. Even after treatment, still poor ankle dorsiflexion compared with right ankle as noticed when I perform calf stretches

Right now I can run but ankle very niggly for first few minutes. Also struggle to land on my forefoot at first until ankle has warmed up. Then it’s fine and I can run up to 5km with no problem or perform a load of 200 metre reps. Although I did some intervals last night and this morning ankle feels like its impinging and still niggly as a walk around. I have seen current physio too many times recently for my liking and becoming very disillusioned that treatment is not having long lasting effect.

Other info:
90% of my training is done barefooted on grass and have done for many years – I only wear lightweight running shoes when I race or when I train on roads. But also am very sensible with my training and only do quality sessions concentrating on speed and resistance rather than mileage. I have been doing running barefoot for years, because it feels good and better for me considering my less than perfect biomechanics) and will not consider orthotics (have previously tried using them to no success).

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