Tibial Stress Fracture - Medial Ankle Pain - Related?

[flips712]

In Dec 2008, an MRI confirmed I had a Medial Tibial Plateau Stress Fracture on my left leg due to recently starting a running program. I was told no running until March 2009, which I strictly followed. I began riding a bicycle instead.

After seeing the orthopedic surgeon for a follow up visit and he gave me the go ahead to begin running again on March 1st. I started off slow and worked my way up to running 1.5 miles. I began running in Nike Free's and Vibram Five Fingers to simulate barefoot running in hopes of preventing future running injuries.....wishful thinking!

My runs have been done on gravel and grass mostly with some occassional road running. My calf muscles were really sore initially because my new shoes forces me to run on my forefoot and midfoot. I noticed that my left ankle was very sore on the medial side and began to swell around the medial malleolus.

I sprained my left ankle about 5 years ago but the pain was on the lateral side of the ankle. I don't think this has any relation to my current ankle pain. My previous sprain was caused when I rolled my ankle, which immediately left my ankle unable to bear weight and unstable. I took off a year from running to let my ankle completely heal.

The medial ankle pain that I'm currently experiencing was NOT caused by a traumatic event like rolling my ankle, etc... I'm able to walk on it but running on it is very painful. The ankle seems stable and I'm not experiencing any laxity. It keeps swelling up upon running even though I've been taping it up when exercising. Any advice? Should I get a MRI?

Thank you!

[Heidi]

Hi
Following your previous ankle sprain, did you restore full flexibility to you calf muscles? This can contribute to ankle pain and is always the first thing I would suggest. Stretch the calf muscles, both gastroc and soleus on a daily basis (3-5 times a day) and see if this helps:

http://www.sportsinjuryclinic.net/cybertherapist/stretching/allstretches.php

I had never heard of the five finger things so have just googled them. Do you run in just them? They look like they have next to no support with the arch. Even people who do not overpronate need some arch support and definately cushioning. I am not even convinced by the Nike free's from what i have seen, they don't seem to be very supportive either.

Out of interest, have you ever had your feet assesed for overpronation or supination? If not this is well worth doing, as in the majority of runners this is the cause of most ankle, lower leg and knee pain.

[flips712]

I went to a podiatrist today. X-rays didn't show a fracture. He did a sonogram, which showed that I sprained my Achilles Tendon. He gave me a prescription for Celebrex to reduce inflammation and told me no running for 3 weeks. He didn't say I needed to tape or wrap the ankle but do you think it would help speed up the recovery time?

The Vibram Five Fingers are a minimalist shoe designed to simulate barefoot running. The shoe is like a lightweight slipper with a thin soled rubber bottom and individual toe slots. They force you to run on your forefoot and midfoot because the heel area has NO cushioning and NO ankle support. I know it may sound crazy running in a shoe like this but its been found that people who run barefoot tend to experience less running injuries than those who use traditional sneakers.

http://www.vibramfivefingers.com

http://www.runquick.com/corcorn/barefoot.html


Thanks,
flips712

[Heidi]

Ok, I'm still not sold on the barefoot running thing, but I'm old-fashioned at heart!

Its good you have seen someone and they are providing some treatment. I have to say its not a typical presentation of achilles injury, be it a tear or tendinopathy. Paina nd swelling on the inside of the ankle is the symptom that is thorwing me. But, nevertheless carry on with treatment for a few sessions and hopefully you will se an improvement.

http://www.sportsinjuryclinic.net/cybertherapist/back/achilles/tendinitis.htm

Good luck!

[flips712]

I was very surprised by the doctor's diagnosis of a sprained achilles tendon because the inside of my ankle is sore NOT the back of my ankle. I keep reading accounts of people who injured their achilles tendon and they said it felt like someone wacked the back of their leg with a bat.

I never experienced a sudden or sharp pain. I went running for a 1.5 miles and had very sore calf muscles for a day or two, which I attributed to running on the balls of my feet while wearing the Vibram Five Finger shoes. I also noticed my left inside ankle was sore and tender to the touch. The calf muscle soreness went away but the ankle soreness stayed. I went for a few runs afterwards and wrapped my ankle with tape before my run.

Should I be wearing a brace, cast, or taping my ankle to help facilitate healing if it is an achilles tendon sprain? I have a lace up ankle brace from when I sprained my ankle in 2004. The doctor I went to is a Podiatrist. Perhaps I should have gone to see an Orthopedic surgeon instead. What is weird is that after doing some research on achilles tendon injuries, it seems the standard test to be done is the Thompson test.....but the doctor never did it. That makes me question his diagnosis.....

[Heidi]

The thompson test is only really useful in cases of suspected ruptures so its not always done.

I don't think it is achilles, although I am surprised that the Dr was a podiatrist. They are obviously experts in feet/ankle!

have a look at this page:
http://www.sportsinjuryclinic.net/cybertherapist/front/ankle/tibialisposterior.htm
See if these symptoms are similar to yours.

[flips712]

Heidi,

I checked out the link you provided. My pain is definitely centered around my medial malleolous on the inside of ankle. The rest of my ankle feels fine. I can walk on it ok but get pain upon running.

The ultrasound that the podiatrist did yesterday is what he based his results on to diagnose my pain as achilles tendon sprain. What also concerned me was that I told him I had an MRI in Dec '08 and was diagnosed with a medial tibial plateau stress fracture on my left leg. While he was looking at the X-Rays he took of my ankle he said, "the stress fracture on your leg is healed."

To give him the benefit of the doubt maybe he misheard me when I said it was a MEDIAL TIBIAL PLATEAU stress fracture because it is located at the top end of the tibia near the knee NOT at the bottom of the tibia near the ankle. Shouldn't a podiatrist have common knowledge of this??

[Heidi]

Yes he should. However, as you said, benefit of the doubt, maybe he thought you said medial tibial malleolus (inner ankle bone).