Once in a while I feel a bit…clairvoyant. Not like the psychic in NYC who recently took someone to the tune of $700,000. (I’m no genius, but when they offer a bridge of gold, it might be time to walk away.) Anyway, it’s more like divining the diagnosis, like when I see pain in the side of the ankle on the intake form in my NYC podiatry office.

There are a lot of important structures on the foot and ankle, and I can name most of them. One of the most important is a tendon that runs behind the tibia or leg bone, appropriately named the posterior tibial tendon. This tendon starts as a muscle on the back of the leg and becomes a tendon close to the ankle, where it courses behind the ankle bone on the inside of the leg, and inserts onto a bone on the inside of the foot, as well as onto most of the bones on the bottom of the foot.

While standing, this tendon helps to lift up the arch. When walking, the tendon helps to move the foot up and toward the other leg. So this tendon is firing at all times while the body is upright, and therefore subject to a lot of stress. Hang in there, I’m getting to the exciting conclusion. If the tendon is overworked in an acute situation – a long walk, a hard run, a vigorous Zumba session, it becomes inflamed and painful. If the tendon is overworked on a chronic basis – an unsupported flat foot, loose ankle, or anything that places particular pressure on the inside of the ankle joint, the fibers can start to fray and become loose, much like a rope that loses its tension, leading to a condition known as adult acquired flatfoot.

So what is the treatment? That I can answer in one word – tradition! Ok sorry, couldn’t resist. The answer is supported. In an acute case, the condition is treated with an appropriate brace, rest and possibly physical therapy. Long-term and chronic treatment may include orthotics, ankle braces or even surgery in severe cases.

So, if you are experiencing swelling and pain in the side of your ankle, I already knew that. I also know what you’re thinking, and no I won’t stop placing annoying and obscure pop references into these blogs.

See you in the office.

Ernest Isaacson