ankle pain

[j]

Okay so first I complained about the pins & needles feeling and your first suggestion was right on the mark. Hello, I tied my sneakers too tight. Seems like a no-brainer but apparently I"m clueless. So, pins and needles is no longer an issue.

Not sure though if I did damage that first pins/needles run though because ever since then my ankles are killing me. It seems around the ankle bone if I could possibly pinpoint the spot. I can't really get a good stride going anymore - more like a pathetic shuffle because landing seems to hurt like hell.

Where do I go from here? I"m still doing the structured training but not very well and distance is definitely minimal.

thanks for the help,
j

[Eugene Zeitler DC MS ART]

Jeanne, I’m glad to hear that your pins and needles have resolved. When running feet tend to swell and increase in size causing shoes to get tighter, decreasing circulation. This can cause the numbness and tingling, but should not cause the ankle pain.

The compressive load being absorbed by your foot and lower leg as your foot contacts the ground during running is probably causing your ankle pain. During running the lower extremity can absorb anywhere from 3 to 22 times your bodyweight with each foot contact. It the muscles, ligaments and joints are not use to this amount of stress they can become irritated, inflamed and cause generalized ankle pain. The longer your stride the greater the compressive load in your foot and leg and, therefore, the greater the pain.

I would suggest that you decrease your running over the next week and either try to walk and or increase your non-weight bearing cardiovascular exercises. You can do things such as biking, elliptical machine, stair master, or do aqua jogging if you have access to a pool. After exercising, ice both of your ankles for at least 20 minutes two to three times to decrease potential swelling.

Footwear is incredibly important in preventing lower extremity injuries. I tell any patient whom I see to get their footwear from a reputable store with knowledgeable staff. The couple of extra dollar you may pay for the running shoe is well worth it. Running shoes are probably the cheapest and most important of sporting supplies. I tell my patients that the extra money they pay for a good shoe and quality fit would be more then reimbursed because they wouldn’t have to pay me copays to rehabilitate them. It would also save them a great deal of frustration by preventing the injury from occurring in the first place.

Putting an insert into your shoe can decrease the compressive load on the ankle. A supinated (high arch) foot does not aborb compressive loads well, therefore, an insert or orthotic can be beneficial. A pronated (flat) foot causes excess twisting motion in the ankle irritating the joint, putting additional stress on the ligaments and muscles. Again an insert or custom orthotic can be very beneficial.

Increasing the strength and proprioception of the ankle muscles, ligaments, tendons and joints are extremely important. The muscles, ligaments, tendons, and joints contain little receptors broadly classified as proprioceptors. These receptors give feedback to the brain to let the brain know what is going on in different areas of the body. For example, close your eyes and touch your finger to your nose. How does your finger know where your nose is? The receptors in your arm, hand and fingers give your brain feedback and provide information letting the brain know where your upper extremity is relative to the rest of your body. This allows you to touch your finger to your nose without looking at your finger. How does this relate to your ankles? Well, each time your foot contacts the ground your brain gets proprioceptive feedback from your lower extremity to let the brain know what is going on. If you have slow or inaccurate proprioceptive feedback then each time your foot hits the ground you will get excess motion in your ankle, knee, hip etc…this causes additional wear and tear on the joints and causes the muscles to prematurely fatigue. A very easy exercise to improve proprioception is to stand on one leg for 30 seconds multiple times per day, preferably barefoot. Make sure your hips are level, that you legs don’t touch and that the knee of your down leg is slightly bent. This should get easier fairly quickly and you will notice that you sway significantly less over time.

I received the following six strength exercises from Russ Ebetts, Chiropractor for USA Track and Field a couple of years ago. Perform each exercise 3 times per day, ten steps for each foot per exercise.

1. Walk on your toes
2. Walk on your heals (this exercise must be performed with shoes on)
3. Walk with your toes pointed in
4. Walk with your toes pointed out
5. Walk with your foot inverted (rolled in)
6. Walk with your foot everted (rolled out)

These six exercises strengthen all of the muscles from the knee down to the foot. As always, if any of these exercises cause pain discontinue it.

Less likely causes of your ankle pain include:
· Stress fracture
· Ankle sprain
· Tendonitis
· Nerve entrapment

If your symptoms don’t resolve you should be evaluated by a sports medicine specialist.

I hope this helps!

Eugene Zeitler, DC, MS, ART