Question:

I’m finally back running after a right mid tibia stress fracture last fall. I’ve gradually been able to run up to 9 miles a week and as many as 6 at once. For the last 2 weeks (following the gym closing and my having to run exclusively outdoors) I’ve noticed mild pain just under my medial malleolus of my left ankle and brushing under both medial malleoluses. There is no pain during running, only mild pain in the days following a run. I’m afraid of getting another injury and having to take another 10 weeks off. What do you think is going on?


Answer:

Thank you for the question. Without doing a full evaluation its hard to speak exactly to what is going on in the right ankle. Generally those kinds of symptoms can be as a result of excess stress on the tendons of the muscles of the foot and ankle. This increased stress can be due to the recent rapid increase in running volume or due to poor control of the muscles of the foot and ankle while running. Often after injuries and long periods of immobility we lose our sense of balance over that ankle and can load it improperly as we return to sports and running, or the muscles are just not conditioned to that much training. This ability to run appropriately and sense of balance can be regained through proper training. Although the tendons are the most likely involved tissue there are other tissues in that area that can cause this type of pain. These include the bones/joints themselves or the ligaments that support the foot and ankle. A physical therapist can perform a thorough assessment looking at walking/running form, strength and how it is affected the ankle/knee and hip, mobility of the lower leg and they can rule out any risk factors associated with more serious injury. This evaluation can help differentiate and tease out which of the above tissues is affected. If there is anything during that assessment that warrants further investigation by a medical doctor that PT can refer you the appropriate doctor to get any further assessment. If further assessment is not needed that PT can structure your treatment plan to include things like hands on work to improve muscle and joint mobility, self-mobilizations, exercises to strengthen the appropriate muscles and any suggested changes to the way we perform our daily movements to decrease the risk of aggravation in the meantime while things heal. In the meantime the best advice based on that information is to avoid the exacerbating positions as much as possible and to seek assistance from a physical therapist. To find an Orthopedic Clinical Specialist in your area you can visit the website for the American Physical Therapy Association (www.APTA.org).


**This reply is for informational purposes only. It’s not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, physical therapist, or other qualified health provider with a medical condition.