Sports Medicine/anke pain

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Question
Hi, I have pain in my right ankle for about two months now.  It first started with a sharp nerve pain in the center of the foot almost all the way to my knee as I jumped off the step bench during a fitness class.  It didn't have a lot of pain in the next few days, but a little swollen on the outside of my ankle.  I switched to zero impact exercise such as biking and elliptical, but the pain persists.  I went to the podiatrist to figure out what's wrong.  The x ray shows no bone fracture, however, he suggested that I have plantar fascia problem and anterior impingement.  I stop all exercises, but now I can barely stand for 5 mins.  I went back to get a MRI, the result shows that I have distal posterior tibia tendinosis with tenosynovitis and moderate effusion first metatarsophalangeal joint.  Any advice to keep pain away so that I can walk normally again?

Answer
Hello Tiffany!

Thank you for writing me about your right ankle problem.  First of all, I had to figure out exactly where the pain originated from even though you mentioned the "center of the foot".  Is that the top or bottom of the foot?  When you explained you had swelling on the outside of the ankle, I could then figure out the injury was on the inner part of the ankle.

Because the X-Ray could not define a fracture, the Podiatrist must have assumed it was a Plantar Fasciitis, which runs along the bottom the foot. That could have been caused by a stretching of the foot, and probably not a twist in the ankle.  Usually, one wouldn't have a swollen ankle with a sharp stretch at the bottom of the foot.


Fortunately, there is no fracture involved.....just soft tissue......and I would highly suggest you find a Sports Medicine Chiropractic Physician, by referral from friends, not the phone book, and make an appointment to see him/her.  Make sure you take your X-Rays and MRI with you so he doesn't have to retake them.

Being in Sports Medicine, he will know how to re-establish the integrity of the foot and ankle, and probably wrap it with an ace bandage.  At sometime during the day, with the ace bandage off,  you should ice the  ankle with  about 5 ice cubes in a baggy, and  cover the baggy with a damp cloth.........never use ice without a damp cloth as the cold will burn the skin.......and leave on the ankle until the ice is almost melted .  Do this as much as you can the first few days, but use NO heat.   You will probably have to go back to the doctor once or twice more, but beware they don't schedule for multiple visits!  You should feel much better after a couple weeks.

Please let me know how you are doing, and don't forget to ice it!  I'll be looking for your reply, and thank you again for writing me.

Dr. Patricia Arthur
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Dr. Patricia B. Arthur, DC, MRC, CST

Expertise

As a 30-year practicing Chiropractic Physician, my specialty was Sports Medicine. For 8 years I had the distinct pleasure of working with the USOC, and traveled the world to care for the athletes in the Pre-Olympic venues for the Summer Games. When I wasn't traveling, I had a private practice, and a hospital practice, in Kamuela, Hawai'i. Questions I couldn't answer usually dealt with pharmeceuticals. This was not my expertise, but the simple questions pertaining to familiar drugs I was able to digress, or refer to someone that was knowledgable in that field. Most Sports Medicine field injuries were familiar to me, but I always aired on the side of caution. In my office practice, I would tend to see more patients with the weekend injuries who would try to self-treat, only making the injury worse than it should have been! Nevertheless, I never took anything for granted, and so it was my conservative approach to the "cause-and-effect" mechanisms that were vitally important to the healing process.

Experience

Following my competitive nature, I knew Sports Medicine would always be a part of my life. After graduation from Palmer University in Iowa, the old adage taught at the school dealt only with the spinal column......anything connected to the spine was outside our scope of practice. To me, this was too simplistic, because the complex body also had arms and legs! From this point, I developed specific technigues which would encorporate the body as a whole rather than haphazard segments. There is nothing traumatic that happens to a single ligament, tendon or joint that doesn't effect a secondary, or possibly a tertiary element in that area. In order for that space to heal, all the factors must be addressed. Volunteering my time teaching referrees, coaches, and interested parents about the realities of probable sports injuries was worth a thousand words!j

Organizations
American Chiropractic Association; Local Emergency Response Committee; Hazardous Materials Response Team; Urban Search and Rescue Team - Operations and Planning; Federal Corps of Engineers Committee; Earthquake Advisory Board; Big Island Wildfire Committee

Publications
Papers published focusing on the importance of proper care of sports injuries; Authored medical columns for the syndicated magazine "The People's Doctor "; Published papers in professional journals on Head Injuries in Sports; Published papers on Drug Abuse in Sports.

Education/Credentials
Robert Packer Hospital - Certified Surgical Technician - CST; Palmer University - Doctor of Chiropractic - D.C.; Wright State University - Masters in Counseling/Psychology; Wright State University - Masters In Couseling of the Severely Disabled.

Awards and Honors
Selected US Olympic Physician -1988; Graduated Wright State University with a 3.75 GPA; Graduated Palmer University with a 3.5 GPA; Faculty Appointment - Palmer University Post Graduate Education; Faculty Appointment- Hawai'i/Kapiolani Community College - Skills Team Tester;

Past/Present Clients
Cincinnati Bengals Football Team pre-season training; Summer Olympic Athletes worldwide; Kona Ironman Triathletes - Finish - line physician

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