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Old 10-18-2007, 11:07 PM   #1
Timothy Holmes
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Inner ankle pain when running

During the 10k on Tuesday, the inside of my ankle started to hurt. It was just behind that bone that juts out. The pain is only when I take a step. I've never had any problems with my ankles but I've never run more than 5k before (well, for a very long time, at least).

What puzzles me is that I could stop running for 10 seconds or so, I can continue running for a bit before the pain returns. I'm thinking it is possibly related to a muscle that is getting tired prematurely

Any ideas on what this could be, or how to remedy it?
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Old 10-19-2007, 07:11 AM   #2
Sean Dunston
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Re: Inner ankle pain when running

This is a shot in the dark, but something similar happened to me when I was training for my first half marathon last year.
It hit me at around mile 7 of a 12 mile run. I had pain in one ankle each time I landed on that foot, but I decided to gut it out and that was a bad decision - due to the compensating injury I sustained in the other ankle which had me off my feet for over month after that - right up to race day.
Anyway - one of the major causes of my pain was over pronation.

If you plan to continue regularly running long distances (not sure if 10K qualifies as a long distance) you would be doing yourself a favor to see a podiatrist. I was fitted with custom orthotics that I use in my "work" shoes (except when they don't fit), and I ALWAYS wear them when I run.
Result: no more pain.


Best of luck!
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Old 10-19-2007, 07:12 PM   #3
Timothy Holmes
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Re: Inner ankle pain when running

One of the purposes of crossfit is being able to do whatever is thrown at you. I don't normally run anything over 5k, but if I need to I want to be able to do it.

I did the second 10k (39:50 PR, yay!) using running shoes, rather than my Dunlop Volley's (minimal 'tennis' shoes) which I wear everywhere except work. I didn't have any of the pain. This leads me to believe that it might be over/under pronation, as you say. Maybe I need more support?

In terms of orthotics, I'm a little cautious of wearing them. They seem like a crutch, like straps. Am I being silly, or is there an alternative?
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Old 10-21-2007, 02:08 AM   #4
Matthias Neumann
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Re: Inner ankle pain when running

Does it hurt when you flex and extend your toes? This might be tendonitis of the posterior tibial tendon (PTT) - for a picture of the PTT see: (work/family safe): http://www.aofas.org/Images/PTT.jpg

Apart from looking into orthotics, you might want to try an ankle bandage (not a bandage in fact, but an elasticized sock minus the toes) when walking longer distances or running. When I had this, it flared up again when I thought it had gone, so you might want to be careful.
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Old 10-21-2007, 08:17 AM   #5
Corey Duvall
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Re: Inner ankle pain when running

I also think this is a posterior tibial tendon injury caused by over-pronation. As we walk/jog/run/sprint our midfoot (arch) pronates and supinates. The arch basically rises and falls to help absorb shock, this is so we don't cause too much damage to the hip/knee/back cartilege. Over-pronation comes in three forms, it either happens too quickly (doesn't absorb the weight of the body, like jumping on cement vs. a trampoline) it happens too much (the arch drops too far), or it happens too long (never fully gains the arch back). Now in real life, there is often a combination of the three events in each person with hyper-pronation so I want you to understand it isn't just one or the other. Now, how to remedy these things within ourselves.

Our foot is supported by muscles of our lower leg (the tibialis anterior and posterior, and the fibularis longus, brevis and tertius), much like a marionette. These muscles come down and cause the foot to move as it should. These muscles support the arch and guide the direction of forces through the foot as we walk, run, sprint. If these muscles are weak, or tire easily, this will not allow them to do their job and the stress will be placed on the ligaments of the foot, often leading to plantar fasciaitis. To strengthen these muscles I do what are known as the foot drills as part of my warm-up each day. Knock on wood, I have been doing them over a year and have not gotten shin splints nor rolled an ankle (both of which I was prone to before). Here is a brief article on them and how to perform them. WFS: http://wellness.ndsu.nodak.edu/fitne...footDrills.pdf (The author of this is my professor... I try to give him credit whenever I can).

With each step, our midfoot pronates (arch drops) to absorb the shock of ground impact. Then as we stride forward to toe-off the midfoot supinates (arch rises) to lock the foot for toe-off. Tight calves (gastroc, soleus, or both) will not allow proper dorsiflexion of the foot (top of the foot upward) when we walk. Dorsiflexion should occur each time we toe-off; in order for us to bend the knee to swing the hip forward we have to have a proper angle of the foot. When the ankle (tight calves) does not allow this to happen, our body instead keeps our mid-foot pronated (arch dropped) to gain that range of motion. This causes abnormal stresses to go through the muscles trying to raise/hold our arch. This can cause a tendonitis, commonly of the posterior tibialis, which will often present as pain along the inside of the ankle with each step. Now, I am only a student but I have diagnosed and treated two different people with this condition, both with success. I'll suggest that you stretch your calves (both with knee straight and with knee bent) and do the foot drills daily. You should have results within a week, with full recovery within two. Good luck.
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Old 10-21-2007, 01:55 PM   #6
Steve York
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Re: Inner ankle pain when running

Posterior tibial tendon dysfunction (PTTD) is a possible diagnosis. However, to possibly confirm or to rule out any other pathologies, could you elaborate on your presenting symptoms?

Pain - stabbing, dull ache, sharp? Describe? Any numbness? Redness to area? Swelling?
Severity - pain scale out of 10. 10 being the worst.
Position - is pain isolated to one spot or does it radiate? Is it below the medial malleolus or towards achilles?
Provokes - you describe taking a step, is it when your heel strikes the ground, when your foot is flat on the ground or when your heel is off the ground and you begin to push off your big toe?
When pain presents - what distance did it present? Pain in morning now?
Running history - how often do you run? Distances?
Shoes - reputable brand of running shoes? Age of shoes? Tread wear (outside edge or inside edge or heel?)?

Age?
Medical history? Medication? Arthritis? Knee problems/pain? Back problems/pain?

Functional tests - One leg balance time? Elevating onto both sets of toes with minimal support? Elevating onto affected foot's toes with minimal support?

Just some information that I would elicit.
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Old 10-22-2007, 06:55 AM   #7
Timothy Holmes
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Re: Inner ankle pain when running

Thanks for the help everyone.

Since it occurred only after running 5 of the 10k, I don't think that would be enough to cause tendonitis.

Corey, I think you are on the money. I'll do the exercises and more calf stretching and let you know how it turns out.

As far extra information goes, well:
I'm 19. I run only to the gym (<1.5k) and when called for in the WOD. It was a sharp pain when I took a step while running, about when my toes and heel are both on the ground (forefoot-first running). It started in my right ankle (which would have considered stronger, but less flexible) and increased to both ankles.
My calves and hamstrings are tighter (also, bigger and stronger) on my right, and I'm trying to rectify that.
I wear exclusively Dunlop Volley's (bloody awesome shoes. wfs: http://en.wikipedia.org/wiki/Dunlop_Volley). I used my running shoes (Puma) for the second, pain free 10k. The Volley's have a fair bit of wear on the outside, forefoot.

Steve, when you say "elevating onto both sets of toes", you mean balls of the feet, right?
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Old 10-23-2007, 12:31 AM   #8
Steve York
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Re: Inner ankle pain when running

Tim, I think you addressed your problem when you changed into proper running shoes. My suggestion would be to continue to use the Pumas for running and the Volleys for lifting. Although, from what I've seen of the Volleys, they do not offer much support, but as a lifting shoe offer greater ground reaction response than the running shoes.

My next suggestion would be to focus on increasing ankle (calves), hip flexors and hamstrings ROM through stretching.

Elevating onto the forefoot is what I meant.
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Old 10-29-2007, 01:37 AM   #9
Matthias Neumann
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Re: Inner ankle pain when running

After I posted in this thread just a few days ago, my own ankle injury flared up again on Saturday after a short, slow, easy run (ca. 1 mile or 1.6 km) and some air squats. I have custom orthotics, one pair for street shoes, one pair for running shoes (I wore the latter), bought about a year ago; running shoes are also about a year old. My age is 43.

The pain was stabbing, sharp; no swelling or redness. Icing it the same night didn't help, the next day, almost every step hurt. In particular, flexing the toes and pushing off with the toes hurt. I started wearing my ankle support bandage again … the pain already started to subside … went for a walk (about one hour) … the pain is basically gone now. Huh?!

What can I do to keep this from coming back? When I had this injury the first time a few months back, the doc told me to quit running altogether, do no stretching whatsoever (I have a number of other sports injuries – hamstring strain left leg, plantar fasciitis left foot, tendency to Achilles tendonitis left, calf strain right leg, shoulder injury left shoulder) and stick to weight training with machines, if I want to exercise at all, i.e., no Crossfit. This surely can't be the last word??

Last edited by Matthias Neumann : 10-29-2007 at 01:43 AM. Reason: Forgot to mention one injury ;-)
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Old 10-29-2007, 01:50 AM   #10
Steve York
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Re: Inner ankle pain when running

Can you pinpoint the location of your discomfort?

Are your orthoses functional orthotics or prefab orthotics?
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