Foot & Ankle pain

January 12, 2014

Freya asked The Guru for the following Physiotherapy Advice:

I have run intermittently for years though just casually. Earlier this year (Marchish) I began to run further and my foot (top of the foot/ lower ankle) began to hurt and I rested it for several weeks which turned to months and I soon got out of practise.

To get back on it I went on a camp recently that trains you in fitness and hill sprinting really brought it back and exacerbated it.

Some backpain followed too..? However on a flat treadmill it feels fine. When examining my foot after a long run that involves some hill work the lower ankle is sometimes swollen but Ifeel little to no pain when I press on the top of foot/ flex toes… total mystery! Im getting frustrated that everytime I get back to running my foot starts to hurt. Its a dull pain that I can run through but still is pretty strong following lots of hills. Help – I love my hills! Any ideas? Thanks Guru,Freya

January 12, 2014

Poor you!

Going up hills changes everything – and not just in your ankle. We’ve got to look at you from the foot up or the waist down…I’m going waist down because of your back pain comment.

To run up hill you lean forward, increase your hip flexion, call up more hip extension, flex your knee and need more ankle dorsiflexion (pulling your foot up). If there is a restriction OR too much movement somewhere along this chain then you’ve got probs (potentially).

I think what’s wrong is easy – something along the lines of an anterior ankle impingement. Why is the tricky bit, but I’d have a punt at having a stiff hip when pulling you leg backwards, not forwards.

Here’s why. The restriction at the front of your hip forces your thigh to roll in excessively when the other foot hits the ground (or when this leg is behind you). This can be due to just the restriction of the lack of gluteal control. Either way the force transferred down your leg equates to you letting you foot roll in too much, without enough control. Going up hill needs lots of dorsiflexion (toes up), which usually happens at a joint called the talocrural joint (where foot becomes ankle!) if all the motion is taken up here and more is needs then foot rolls in to accommodate this (at another join called the subtalar joint)……now there’s some anatomy, but it’s the front of the ankle gets it in the neck

Long story short, get you back, hips and gluts assessed [try a physio sport therapist] – don’t just focus on getting more and more ankle movement

…..I’d leave the hills alone until you’re sorted 🙁

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