So you woke up this morning with an annoying pain along the inside or outside of the ankle.  Or you were running, playing basketball, power walking, or bouncing on the power stick and there was this sharp pain behind one of the ankle bones.  It doesn’t feel like Achilles tendonitis, you didn’t twist the ankle, and despite what your coworkers and your Mom told you, it’s not gout.  Well then, my NYC podiatry patients, what is it?

There are two sets of tendons that run along the inside and outside of the ankle.  The first is the posterior tibial tendon, so named because it runs behind (posterior) to the tibia.  This tendon can be felt along the inside of the ankle and it inserts into the navicular bone, which is rather prominent within the arch of the foot.  This tendon is very important in maintaining and supporting the arch in a standing position, and lifting the foot when walking or running.  The second set of tendons is actually two tendons, the peroneus longus and brevis.  These tendons run along the outside of the foot, behind the fibula and the brevis inserts onto the base of the fifth metatarsal- the prominent bone along the outside of the foot and the longus runs under the arch to the middle of the foot.  The peroneal tendons are very important in pulling the foot away from the body in walking and running.

Ok, now for the more interesting part.  Running, walking, playing ball, standing, and regular daily activity can strain these tendons.  Initially there is pain and swelling which can be treated with rest, anti-inflammatory medicine, bracing, and physical therapy.  Left untreated this type of tendonitis can lead to tears in the tendon, collapse of the arch, and permanent structural damage to the foot and ankle.  It’s important to determine the underlying cause- is it overuse, or perhaps related to the underlying structure of the foot.  If it’s the latter, acustom orthotic, or even ankle-foot orthosis can provide the long term support that is lacking.  Most cases heal very well, and in my NYC podiatry office every case is examined on an individual biomechanical basis to develop a long term, workable treatment plan that keeps feet and the patients attached to them active, pain free and performing at an optimal level.

So if your ankle is painful, swollen or otherwise not just right, and you’re a weekend warrior, lunchtime walker, marathoner, or a regular guy or gal, don’t wait for it to just go away.  As I tell my NYC podiatry patients, little problem=little downtime.

See you in the office.

Dr. Ernest L. Isaacson