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Slowtwitch Forums: Triathlon Forum:
Side ankle pain above arch - stress fracture?

 

   


Zone11

Mar 26, 12 15:32

Post #1 of 5 (4595 views)
Side ankle pain above arch - stress fracture? Quote | Reply

Did the obligatory search and read all 3,502 threads it seems on various ankle related foot problems.. and still left wondering what I am experiencing; dont' think its the PTT or PF issues that I've come across. I just moved to Belgium so I am trying to figure out how to get to see a podiatrist, so in the meantime...


What: Dull ache that is quite painful when I push on the inside of my foot, feels like I blocked a slapshot with the inside of my foot. Specifically, the hard (Navicular?/medial cuneiform? see link below) bone above my flat arch, about midway between heel and toe. It is the portion of the foot that seems to extend furthest medially, toward the centerline of my body, but not the round pointy ankle bone (being technical here). Icing does not seem to get much relief compared to soft tissue issues. Definitely on the side of the foot, not on the bottom.


http://www.myfootshop.com/images/anatomy/bone_medial_mod_labeled.jpg


When: I feel it when standing, especially after I wake up and after sitting for long periods, but not running. I can run for 2 hrs+ no issue; its just sore afterwards. Walking is bearable after a first few hobbles.


Why: I'm concerned its a stress fracture due to my elite Googling skills and Internet Diagnosis degree. Basically, my layman's interpretation of what I'm feeling. I do not have history with stress fractures, only severe ankle sprains.


History: My running background, I am 6'1", 176 lbs and been focusing on only running with two new kids in the last two years. I run 6x/wk 40-50 mpw consistently, year round (my times say otherwise). I have been focusing on ultra marathons the last few years and have 4 (50k-50mi) in 12 months under my belt with no injuries. My shoe of choice is Mizuno Wave Elixirs 3-6 and on my 11th pair. I use black superfeet as my insole. I used a Rx insole for years before ditching them slowly for SF last year (and did a 50mi since). I'm fashionable since I strike midfoot quite naturally despite my what flat arches would indicate if I heel struck.


I first started feeling the pain after a mtb ride after little/no mtb. Figured it was my mtb shoe being too tight; and I crashed once so thought I may have bruised it against the crank. It is obviously not keeping me from running, but just painful after the runs and I'm worried I am going to do more damage if I continue. During my recovery weeks and running 3x/wk the pain is substantially less. I am doing a training marathon in a few weeks I don't care about, but doing a 88k in June and a 98k in Aug.


Thanks for any insight, let me know if I can clarify anything.


RollinRoc

Mar 26, 12 18:01

Post #2 of 5 (4563 views)
Re: Side ankle pain above arch - stress fracture? [Zone11] [In reply to] Quote | Reply

Could be insertional posterior tibialis tendonitis at the navicular attachment, usually felt when initially bearing weight on the foot. Could also be a stress reaction/early stress fracture of the navicular itself; a good exam, x-rays, and possibly an MRI should get you to the definitive answer. Good luck to you.


rroof

Mar 26, 12 18:28

Post #3 of 5 (4554 views)
Re: Side ankle pain above arch - stress fracture? [RollinRoc] [In reply to] Quote | Reply

RollinRoc wrote:
Could be insertional posterior tibialis tendonitis at the navicular attachment, usually felt when initially bearing weight on the foot. Could also be a stress reaction/early stress fracture of the navicular itself; a good exam, x-rays, and possibly an MRI should get you to the definitive answer. Good luck to you.

x2 for insertional PT tendonopathy. Navicular stress fx would be a bit more unlikely, but in the differential. Important differentiation since treatment is vastly different, esp if trying to train through or an "A" race looming.
____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD


Zone11

Mar 27, 12 10:49

Post #4 of 5 (4502 views)
Re: Side ankle pain above arch - stress fracture? [RollinRoc] [In reply to] Quote | Reply

Thanks for your input and for taking the time.


Zone11

Mar 27, 12 10:50

Post #5 of 5 (4499 views)
Re: Side ankle pain above arch - stress fracture? [rroof] [In reply to] Quote | Reply

Interesting and thank you for your time to reply. Earliest appointment I could get is 3 weeks away. So for the moment, the question then becomes how to differentiate between a stress fracture vs. tendonitis as rroof suggests to get an idea if Iím making things worse.

- Presentation: Sore when not running, fine when running. Pain is not extreme or intense. Dull ache otherwise. I have to push on the side of my foot with my hand for it to really smart.
- History: none for stress fracture
- Running surfaces are hard packed dirt and asphalt, 50/50. Daily AM runs on asphalt, longer weekend stuff on trails. No hills here.
- Biggest recent change is I became a morning runner in Dec. perhaps starting a little slower at first may help. I do not stretch before, only maybe after.
- Icing has some short term relief, though it is an area that does not have a lot of soft tissue

Lay interpretation is tendonitis, particularly because the pain is not sharp, but more dull and achy, particularly if I just jump up/down, dull discomfort is in pushoff and not on impact. Any thoughts?