Left medial ankle pain

by Kris
(New Baltimore, MI)

I am a runner and have new orthotics in my shoes. About 2 weeks ago I had a sudden onset of pain in my medial left ankle after a run. I am about 5 months out from a left distal tibial stress fracture. I have had a few stress fractures, this pain is different. It is a constant burning mainly in the medial portion of the ankle, but also on the anterior tibia. I also have occasional tightness in the calf on the same leg. Ibuprofen does not touch the pain. Any ideas or suggestions? By the way, there is no swelling or bruising.

RESPONSE

Hi Kris,

The first thing that comes to mind is a connection between your new pain and your new orthotics.
I am making the assumption, perhaps falsely, that you are in orthotics because of your history of stress fractures in your leg.
If that is the case then I think you need to have the orthotics looked at.
I say this because you probably have a thickened orthotic for running, which helps to absorb shock and in turn would help prevent another stress fracture.
The possibility exists that the orthotic is over correcting the foot and changing your gait which could then cause ankle pain.
For example, if the arch is too high that will cause a jamming effect on the medial side of the ankle (as well as a stretching effect on the lateral side of the ankle).
This jamming effect could be causing the type of pain that you are experiencing on the medial side of the ankle.
If your foot alignment is over corrected by the orthotic that too may create problems in your lower leg.
This would occur by either creating an abnormal alignment in your ankle joint or perhaps causing the muscles in the lower leg to over work, due to the change in gait from the orthotics and that could then cause the additional pain that you mention.
Additionally, if the orthotic is over correcting your foot that too may account for the pain in the calf muscles.
I do not know if you fall into this category, but people with a tight heel cord (equinus) generally need to pronate in gait when walking and running. This means the foot needs to be able to flatten out during gait in order to move or run from point A to point B.
So, if you do suffer from an equinus, the orthotic may actually be working against you. I assume you have a running orthotic but I do not know how your particular orthotic is constructed which of course, does not allow me to know if this is part of your problem or not.
Sitting here on the other side of the internet does not afford me the option of making an exact diagnosis, but the first thing I can think of is a connection between your pain and your orthotics.
The smart move would be to go back to the doctor who prescribed the orthotics, tell he or she about your pain and let them see if there is a connection or not.
If it turns out it is not an orthotic problem at least the doctor can further investigate the source of your pain.

Marc Mitnick DPM
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