I know plantar fasciitis and you, sir are no plantar fasciitis.
January 25, 2008 11:39 AM   Subscribe

The medial side of my ankle hurts during the first two minutes of walking around each morning. The pain quiets down after 2 minutes or so of moving around. I've had plantar fasciitis before; this feels different.

I am an active cyclist and I play a lot of basketball. I also climb about 24 flights of stairs/day. For the last 2 months, my left ankle hurts like hell when I get up. Its not swollen. I'm guessing something is inflamed or I have some sort of tendonitis. It usually quiets up after a few minutes of walking around. But those first few minutes are hell!

It doesn't bother me during basketball; then again I wear an ankle brace. Its not really an issue while I'm on my road bike.

I'm prescribing myself RICE for at least two weeks. No basketball, no stairs, no running, no cycling. I may still ride base if I can.

I know YANMD but has anyone been through this before? I've had PF before, I remember my heel and the bottom of my foot hurting; not necessarily my ankle.
posted by neilkod to Health & Fitness (17 answers total) 3 users marked this as a favorite
Response by poster: I should also add that I do not have pain in my legs or toes.
posted by neilkod at 11:41 AM on January 25, 2008

Does this happen every time you get up? Or only in the morning?

When I had knee surgery, for a while, every time I stood up, my knee would hurt like hell, then it would go away as I walked around. I always figured the blood was going places it shouldn't, then getting pumped away.

I'm not a doctor, etc.
posted by Comrade_robot at 11:52 AM on January 25, 2008


That is RICE
posted by Comrade_robot at 11:52 AM on January 25, 2008

neilkod, I have similar pain when I don't properly stretch my ITBs. (fwiw, I am a cycling coach and cyclist, and have some physiological knowhow, but ANAD).

Let me ask you this, have you broken / sprained that side and/or do you have a leg length discrepancy? My left leg is my 'long' leg, and I have similar ankle pain in it. Unlike you (I think) I broke that ankle several years ago in a MTB mishap. The resulting achiness has been diagnosed as a touch of osteo arthritis BUT (here's the tricky bit), it's more complex than that:

When I don't stretch the ITB (and subsequently the knee ligaments) often enough / properly, the whole leg tightens up, and my ankle aches. This is because the combo of the tightness and the osteo 'roughness' combine in the ankle joint to cause it to ache, especially on cold mornings. I have come to expect this, hell I'll be 40 this year.

Simple fact: all this stuff is interrelated, and amazingly enough, if I diligently stretch my ITBs and do some yoga / pilates type exercises 2-3 times a week, the achiness and low-grade grief magically goes away.

So my simple answer: You might get checked for a touch of osteoarthritis. Failing that, and/or in addition to that, try a few ITB stretches on a regular basis. As a cyclist, you need to be doing these anyway, as many cyclists are chronically tight in the hip flexors, low back and ITBs anyhow. You might also try some of the stuff I recommended for the guy in my answer to his posture issues.

JimN2TAW, RICE is an acronym. Stands for Rest, Ice, Compression, Elevation, a standard physical therapist's prescription for soft tissue pain.
posted by lonefrontranger at 12:00 PM on January 25, 2008

I'm a runner and I get pain there sometimes, but it does not go away after a couple of minutes in the morning and it is nowhere near "hell" -- more of a nuisance, really. If it were me, I would maybe add some foot/ankle stretches to the RICE.
posted by Airhen at 12:01 PM on January 25, 2008

If I can join in on the questioning...I do a lot of Spinning and I have pain there too....kinda like on the medial side of my foot, up my ankle. Sometimes it burns. It seems to get aggravated if I try to run....so , lonefrontranger, you think piriformis stretches can help? Because I really really am tired of feeling like someone is shoving a railroad spike up my foot during running flats...
posted by konolia at 12:11 PM on January 25, 2008

Response by poster: lonefrontranger - yes, i have the terrible cyclist trifecta:
1-overpronation (big time)
2-Frequent ITB issues
3-I do have a leg length discrepancy

Since I'm not riding as much, I'm not giving as much attention to my ITB-could that be an issue?

Also, I do a lot of my base on a cyclops sport 100, a spin bike with a 44-lb flywheel-not a whole lot of riding due to single-degree temps. Could the fixed gear+flywheel be causing any harm?
posted by neilkod at 12:18 PM on January 25, 2008

I have something similar in my right foot. If I haven't been on my feet for awhile (such as after waking up) and then start walking, I have foot pain that goes away after a few minutes on my feet. After some x-rays my doctor diagnosed it as osteoarthritis. I suppose as one gets older, it's hard to avoid.

The doctor recommended ice, ibuprofen and range of motion exercises.
posted by ShooBoo at 12:22 PM on January 25, 2008

konolia: yes, yes they can indeed. Women in particular often struggle with this because of the greater q-angle of their hip/knee. That whole train of ligaments connecting to the knee can become involved and inflamed. Strengthen your abs (central and lateral) while you're at it, you'd be astonished how much this helps. The collegiate cyclists I work with are CHRONICALLY lazy about doing ab exercises and I've gotten a reputation for hassling them about it (but they do them in the end, and then find out that ol' mom/lfr was right after all.... *sigh*).

Work on greater hip and core strength and flexibility too. You'd be absolutely amazed at how some yoga ball work, balance board stuff and basic Pilates on your hips/midsection will (positively!) affect stuff going on in your FEET (for heaven's sake!). Also-related: When I started doing upper back and shoulder stretches following a road racing mishap (broken/separated shoulder) it wasn't long before my carpal tunnel magically went away. An unlooked-for, but positively awesome side benefit!

Everything's connected, and one of the things to always keep in mind about cycling (even Spinning) is that the static (and often stiff / poorly-fit or awkwardly-balanced) position many recreational cyclists and/or gym Spinning participants use inherently tends to invite stiffness / shortness and pain in specific triggering muscles / ligaments / nerve bundles unless you are diligent about doing compensatory stretching / suppling workouts as well.
posted by lonefrontranger at 12:26 PM on January 25, 2008 [1 favorite]

neilkod: absolutely the flywheel could be contributing. I ride an 88" fixed gear most of the time, and it can cause flareups in my achy ankle, indeed.

Stick to spinning small gears / freewheel bike until your pain subsides. If you can tolerate ibuprofen, by all means, take it (in moderation) if it means relief.
posted by lonefrontranger at 12:28 PM on January 25, 2008

I'm a runner in my 40's. I don't stretch. Never have. It is a waste of time. I am always pain-free. If you think you are going to have pain because you didn't stretch, then pain you shall have. It's as simple as that.

What is often diagnosed as tendinitis, fasciitis, metatarsalgia, sciatica, or carpal tunnel syndrome is really just an area of soft tissue suffering from mild oxygen deprivation.

This oxygen deprivation is triggered by TMS.

It sounds rude, but it really is all in your head. The awareness (and acceptance) of TMS eventually eradicate the pain. Best of luck in getting rid of the pain (and by any way you do it).
posted by Jay Reimenschneider at 12:33 PM on January 25, 2008

oh and: yes, neilkod, it sounds very much to me as if you should probably concentrate on getting your ITB loosened up again.

I'm really thinking you could have developed a slight touch of osteo on that ankle, but without taking yourself to get it xrayed, that's just speculation. Suppling exercise absolutely will help it out, tho. Shim up your cleats and get your LL addressed too, if you haven't already.

And: if you have the time/cash/ability, I would also recommend that you consider booking an appointment with a good sports massage therapist. It's the best way to get started on the road to better flexibility.
posted by lonefrontranger at 12:33 PM on January 25, 2008

Jay Reimenschneider, with all due respect, you are in a minority, and you might simply be lucky enough to have good 'conformation', no angular deformities and no old injuries nagging at you.

The OP asked how to address his ankle pain. Dismissively insinuating via your link that "it's all in his head" doesn't seem like a helpful answer to me, especially as I've got some education, practical proof, knowledge and many datapoints of experience on my side.
posted by lonefrontranger at 12:36 PM on January 25, 2008

Response by poster: lonefront - shim it up? I'm only seeing the greatest cycling doctor in the world, Dr. Massimo Testa! He diagnosed my patello-femoral pain syndrome last year (other leg). He perfected my fit and position, and also shimmed my shoe.

Thanks for your help! Now here's the hard part-taking it super-easy after just getting a powertap(2.4!).
posted by neilkod at 1:01 PM on January 25, 2008

Wow, LFR, I never thought about abs being part of the deal -makes sense now.

Our spin instructor is good about giving us some piriformis stretches after class but I will go ahead and add some more, and be diligent about them. AND there is an ab class that meets after Spin on Fridays, taught by a friend-I have NO EXCUSE.
posted by konolia at 1:16 PM on January 25, 2008

neilkod: well if you've already addressed your LL issues (sorry, your history wasn't apparent to me) then don't mind me - obviously you've got the fit / shim issues handled. Dr. Testa is no one I would willingly ever gainsay. Have you consulted him about this issue?

Question: when he shimmed you, did he also provide orthotics/footbeds for the pronation problem? If I am uncorrected by my orthotics and shims, I also pronate heavily with the left / 'long' side, and I am told, and have experienced for myself that this also corresponds directly to my knee / ankle pains.

It sounds like your combo of leg length, pronation, fixed (weighted flywheel) riding & stiffness may be contributing to your ankle pain much as it does to mine if I don't correct my angular faults and diligently keep on top of my flexibility / core strength issues. Especially after I turned 35, I have found my flexibility and core strength to be more critical each year to getting a flying start on my spring fitness rampup, without having to deal with "spring knee", joint aches, or other overuse injuries.

Standard disclaimer: Everyone's body is different, with different angular conformity / deformity issues, muscle makeup, and so on. Everyone responds slightly differently to these therapies, but with the added detail you've provided, I'd honestly recommend that you 1) stretch those ITBs (don't forget the rest of it; stretch your hams, calves, shins, ankles, lower back, hip flexors, etc.). and 2) get thyself to a sports massage person, if you are able.

You don't have to make stretching a big long drawn-out deal; just make sure that you always stretch after a short warmup and don't take it too deep, bounce, or force it. You don't need to hold your stretches forever either, just a simple 5 count will do.

konolia: yes, do piriformis. Also, stretch your calves and I'd recommend adding some adductor/abductor, calf raise, and hamstring. Often I see cyclists / athletes with tight ITB where the achilles' has shortened to compensate. Achilles will aggravate PF pain if it's tight.
posted by lonefrontranger at 3:56 PM on January 25, 2008

Have you changed your street shoes in the last six months? Have you been wearing boots for a significant period of time?

Those of us who are very active and have orthopedic problems don't get to randomly pick good-looking street shoes and slip them on our feet without thinking about whether they're good for our feet. Even the best orthotic is no match for the wrong shoe.
posted by freshwater_pr0n at 6:33 PM on January 25, 2008

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