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Sports Medicine

Severe ankle pain on top of ankle -- knee



I am training for a several half and full ironman competitions this summer and fall. I`m a very fit 42yr old athlete and have been on a very methodical training regime since December -- anywhere from 2 - 4 hours a day with appropriate rest days, etc.... everything has been going fantastic.

After a 3hour LSD run 4 days ago (8 min pace , heart rate down around 120) everything felt fine but after resting for about an hour I noticed a very very sharp pain on the front of my ankle where the tibia comes down. I`m seeing a PT guy and a doctor and at first we thought it was "shin splint" type injury. However, if I massage behind my knee, my ankle releases. So is it a "locked" joint? nerve pinch? would my chiropractor be able to do anything?

I know that this type of advise over the Internet is a little "funky" but after 3 solid days of ice, stretching, etc... the pain is no better whatsoever. sharp pain radiates up my leg whenever I walk, but I can strech my calves, feet with no problem



The pain in front of your ankle could be due to a problem involving the ankle region (such as the ankle joint surfaces or lining, or a tendon crossing the joint), or could be "referred" to the ankle region from elsewhere (for example, from a pinched nerve in the lower back). As to why massaging behind your knee causes your ankle to "release"... the reason for this is uncertain, but it could possibly be due to you unknowingly massaging an "acupressure point," and not necessarily indicate your ankle pain is due to a problem arising from behind your knee. The term "shin splints" typically refers to pain along the inner aspect of the lower leg just behind the tibia, not to pain in the front part of the ankle.

The fact you have pain which is worsened by walking, along with the fact you've been training for these upcoming ironman events, raises at least the possibility of a stress fracture, although pain in front of the ankle would not typically be due to a stress fracture. A physical examination would help determine if X-rays (and perhaps later, an MRI scan) of your ankle would be worth considering....

Appropriate treatment for your condition - whether this be chiropractic treatment, physical therapy, etc. - would be dependent on the diagnosis. I hope this response helps guide you and your physician.

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Response by:

Brian L Bowyer, MD Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University