Ankle or Foot Pain with Running?
Your hip and core may be the cause.
I see the scenario over and over and over. Plantar fasciitis, shin splints, Achilles tendinopathy, peroneal tendonitis, posterior tibialis syndrome, calf strains, ankle sprains… you name it. These common injuries pop up, seem to go away or chill out with simple targeted rehab, you get back to running, and then BAM - something slightly different pops up.
The body is smart. I like to think of pain or even irritation as an alarm - signally us to do something about it. If we don't, it finds a way to work around it until something else becomes irritated. What should we do about it? A full and thorough assessment can point us to movement deficits that are seemingly unrelated but can help to fix the root cause.
Why could another area be the cause of my pain or irritation?
The body often works in “chains” and “slings”. The posterior chain, lateral chain, anterior chain, oblique slings, etc. What that means is a group of muscles, tendons, and other
tissues along a certain line of the body will work together.
Think of a machine - when one part is not working, another one is disrupted, overloaded, or taking on the stress. The area taking on the stress ends up being the area that screams - NOT always the area that is not working correctly. So when we treat a local area, say the foot or ankle, and neglect the rest of the machine, we’re really most often just putting a bandaid on it. Hence something else pops up injured or irritated in the future.
Outside of the foot and ankle, what would you assess?
Looking specifically into the ankle and foot, it is important to test how the glute muscles are functioning in all planes, how well the hip joint is gliding, where the pelvis is sitting, how controlled your core is during your activities, and so on. Every person and athlete is different, but tendonitis in the ankle may be strongly affected by poor control of the glute max into extension, external rotation, or the glute medius into internal rotation - each of which can cause the foot to compensate to keep you appropriately balanced when running. This may mean some kind of core work, glute activation, hip mobility, etc.
Will my targeted rehab to the ankle and foot help?
All of this to say - you still have to treat the ankle and foot! Traditional exercises like rolling, heel raises, calf stretching, and others may still be important for short term relief and calming an area down. Working muscles of the foot and creating a solid foundation is sometimes important as well. Long term, it is important to find the root cause of the problem to keep it from popping up regularly. Exercises should ultimately be chosen based on your specific deficits.
What should my rehab look like?
Your rehab should include:
Thorough assessment that ideally happens every visit
Exercise that targets not only the area involved but other areas that may be contributing but seemingly unrelated
Hands on treatment when necessary to “reset” and calm down your tissues or improve joint mobility
Progression back to running - including single leg strengthening and speed to appropriately load the injured tissues
Do I have to stop running?
Most often, when tended to early enough, you can keep training at modified intensity, speed, or mileage without issues. More traumatic scenarios or stress fractures may require a pause in running. In my opinion, it is almost never necessary to pause from exercise all together; rest can calm irritation but will often not fix it from coming back once resuming running. As a therapist that loves to run, I know the feeling and will do my best to keep you in the training game without having to take a break!
If you’re dealing with pain or irritation in your ankle or foot, let us take a look and assess what other areas may be contributing! Reach out here for a free consultation to get started.