Sore Ankle - Inflamed tendons?

[DanPatch]

Hi!

My right ankle has been giving me some trouble lately. First, a bit of history. I swim, usually 5 times per week (training for competition). I also injured my ankle (sprain) approximately 5 years ago. I was using flippers last night (a bit too large), and my arches began to cramp horribly. Then the back of my right ankle began to cramp as well, and spread up into my calf muscle.

Firstly, the back of my ankle (either side of the tendon, at the top of the heel structure, at a level slightly lower than the ankle bone) has been somewhat sore. This has been an ongoing issue - mostly noticeable when putting on shoes. I believe it is likely residual from the sprain a while ago.

Secondly, the front of my ankle (at the vertex of my foot and leg, either side of the tendon) is also sore. The pain is noticeable when I walk on it, and is quite localized. It is not on the 'surface' of the ankle (tendons I can feel). It feels more to be at the base of these tendons. I think perhaps this is a result of overstretching the foot with the flippers last night.

Any suggestions to strengthen/help repair this ankle are much appreciated!!

Thanks so much!

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[nmarman]

Wow - you sound like you have insertional Achilles tendinitis and Medial tibial stress syndrome. This is a big problem together as it means you have been pushing through the pain and injury to get two concomitant injuries.

What would you like to happen quick recovery least rest possible or or lots of rest and slow recovery?

Quicker option involves a more expensive treatment normally used for pro athletes.

[ATTIreland]

Hi Danpatch,

I would agree with nmarman that the the long term injury sounds like it is involving the distal (lower) Achilles tendon, be it an insertional tendinopathy, a lower mid-portion tendinopathy, a retro-calcaneal burstitis or a mixed picture of more than one entity.

Without examining the area in person it would be difficult to differentiate between the potential causes although the description of trouble with putting on shoes would suggest that the bursa could be involved. As the treatment for the different causes will vary your best bet is to go see a good sports physio or sports rehabilitator who will be able to pinpoint the problem and therefore focus any treatment and rehab needed.

As for the anterior (front) pain I would very much disagree with a diagnosis of medial tibial stress syndrome! The pain has only been one day in duration, from your description it is located over the anterior tibio-talar (ankle) joint and given the history of using the over-sized flippers it is most likely a straight forward strain of the anterior joint capsule/anterior tendons which will settle down with some icing and a few days of relative rest (ie avoid using flippers untill it has settled down).

Anyway its the achilles problem that needs more attention as if you have had it for 5 years it is unlikely to go to go away on its own. Bite the bullet and get in to see someone about it, they wont be able to fix it overnight but should be able to give you the exercises you need to manage it yourself and slowly get it under control.

Regards

[nmarman]

I can't disagree and I think the newer pain would be better diagnosised by what you mean by oversized. I understood it to mean your foot was to small. Not the flippers were long. To cause a tarlo tibial joint or even tarlo navicular joint strain in water might be a stretch (no pun) due to speed and drag issues. Ice and rest should defiantly be tried agreed.
My thought process was that the over size foot hold caused the flippers to via to one side causing and lateral torque for e to the tibialalis anterior tendon. This would fit in with the cramping sensation. Both would hurt when you walk and both would respond to ice and rest.
Ice rest for two weeks and review symptoms.
True diagnosis can only come from palpation and ortho tests.
Otherwise there is the London foot pain clinic which do shock wave therapy great for both conditions.
Happy Holidays

[finchr]

I think the Achilles tendinitis is the correct initial diagnosis. Anterior pain can be caused by overstretching of the tibialis anterior, decreased posterior motion of the talus, a tight inferior syndesmotic area caused by decreased dorsiflexion. The anterior pain should resolve rapidly as has already Been alluded to as it sounds acute, or recent in nature. Athletes love to overdo it, but we have to.
If it continues, have a therapist look at it.