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Question

Winter time means many athletes are taking to the basketball courts or heading inside for a warmer workout on a treadmill. Unfortunately, I’ve developed ankle pain with a change in running surface and the new pair of indoor shoes. So, what is going on with my ankle?

Answer

Cody Osborne, MS, ATC, LAT

It is common to have some form of foot or ankle pain as we adjust exercise routines or change the surface that we have been repetitively running on. Initially we must rule out more common overuse running injuries, such as achilles tendonitis, plantar fasciitis, and ankle sprains. After that, we must dive deeper into foot and ankle anatomy to find the source of the problem. Further evaluation of some patients may reveal that they are flatfooted. Some people are naturally flatfooted and are completely symptom free during all activities. However, active aging patients can actually develop what we call “adult acquired flatfoot disease.” This is a result of posterior tibial tendon dysfunction and may actually lead to degenerative changes in this tendon. Dysfunction of this tendon leads to tenderness and swelling below the inner ankle. Foot weakness may also be observed and if untreated a slow progressing deformity of the foot may develop (Bubra, Keighley, Rateesh, & Carmody, 2015).

Ankle and foot pain resulting from posterior tibial tendon dysfunction is usually a gradual pain and worsens with activity. Fortunately, if we can diagnose this injury in the early stages of dysfunction it is easily managed. Immobilizing the foot in a walking boot initially can provide relief with eventual return to orthotic shoe inserts. Providing arch support for the patient’s foot is often helpful when reducing pain. Finally, achilles tendon stretching and tibialis posterior strengthening exercises have proven to be successful in returning to full activity (Bubra et. al., 2015). Consult your doctor if you have concerns about posterior tibial tendon dysfunction and get back into action whether you’re inside or outside this chilly season.