Ankle Pain: Chronic Tendonitis and Treatment Options

Ankle pain

Hello, Dr.
Pan...
About three years ago, while playing basketball, I landed on my left foot and accidentally stepped on someone else's foot, resulting in an ankle inversion injury.
I had an X-ray at that time, and although there was no major issue, I was part of the volleyball team and couldn't afford to let the injury heal completely.
I mostly wrapped it with an elastic bandage and continued to play, thinking I could rest completely after graduation.
After graduating, due to a lack of sports environment and opportunities, I rested for nearly two years.
Recently, I realized the benefits of having a regular exercise routine and started to enjoy jogging.
However, every time I run 1500 meters, my left ankle becomes numb and painful (with swelling in the ankle tendons), and the muscles on the left side of my left calf also feel very stiff and sore.
But after resting for 30 minutes, I can walk freely again.
I would like to ask the doctor: 1.
Is this what is referred to as chronic tendinitis? 2.
Should I see a traditional Chinese medicine practitioner or a Western doctor? What would the treatment be? (I visited a doctor who just told me it was tricky and would heal on its own, which felt like a waste of the 100 NT dollars I spent on the consultation...) 3.
Can I continue jogging or exercising? Sorry for the lengthy message, and thank you for your patience, Dr.
Pan.
I hope to clarify my doubts.
Thank you...

Xiao Cheng, 20~29 year old female. Ask Date: 2002/12/02

Dr. Pan Yingda reply Rehabilitation

1.
First, assume that your jogging posture is correct and that you have adequately warmed up and stretched (if not, please make adjustments).
2.
Generally, if you have previously experienced a more severe sprain that was not properly managed at the time, you may encounter the following situations: a) habitual sprains, b) normal conditions but swelling and pain after intense exercise (let's assume you are the latter).
This typically lasts for several days.
Thirty minutes may be sufficient, but it could indicate inadequate warm-up and stretching, as well as insufficient muscle endurance, leading to muscle fatigue.
It is recommended to extend the warm-up and stretching time and shorten the running distance.
3.
If you are experiencing situation 2-b, it may be due to local adhesions formed after tissue injury.
The treatment method is deep, strong massage.
Locate the painful points in the previously injured area and apply firm pressure (to the bone).
Keep your hand close to the skin without rubbing, and massage in the direction of the ligament.
The area may swell during massage; you can reduce the pressure but should persist until the pain subsides.
4.
Start with DIY methods, and if you want to consult me about Western or Traditional Chinese medicine, I would certainly recommend Western medicine, specifically the rehabilitation department.
Treatment may include hydrotherapy (or heat therapy), electrical stimulation, ultrasound, stretching, and training for muscle strength and proprioception.

Reply Date: 2002/12/02

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your ankle pain, which seems to stem from an injury you sustained while playing basketball three years ago. Based on your description, it sounds like you may indeed be experiencing chronic tendonitis, particularly if you are noticing symptoms such as swelling, pain, and stiffness in your ankle and calf after running.

1. Is this chronic tendonitis?
Chronic tendonitis occurs when a tendon becomes inflamed due to repetitive stress or injury, often exacerbated by continued activity without adequate recovery. Given your history of an ankle sprain and the fact that you returned to sports without allowing sufficient time for healing, it is plausible that the tendons around your ankle have become irritated over time. The symptoms you describe—pain after running, swelling, and stiffness—are consistent with tendonitis.

2. Should I see a Traditional Chinese Medicine (TCM) practitioner or a Western doctor? What is the treatment plan?
Both Traditional Chinese Medicine and Western medicine can offer valuable insights and treatment options for chronic tendonitis.
- Western Medicine: A visit to an orthopedic specialist or a sports medicine physician would be beneficial. They can perform a thorough examination, possibly including imaging studies like an MRI, to assess the extent of the tendon damage and rule out other issues such as ligament injuries or cartilage damage. Treatment may include:
- Physical Therapy: A physical therapist can guide you through exercises to strengthen the muscles around the ankle and improve flexibility, which can help alleviate pain and prevent further injury.

- Rest and Activity Modification: It’s crucial to allow your ankle to heal. You may need to reduce your running distance or switch to low-impact activities like swimming or cycling until your symptoms improve.

- Anti-inflammatory Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and swelling.

- Corticosteroid Injections: In some cases, if conservative treatments fail, a doctor may recommend corticosteroid injections to reduce inflammation.

- Traditional Chinese Medicine: TCM approaches chronic pain through acupuncture, herbal medicine, and dietary recommendations. Acupuncture can help alleviate pain and improve circulation to the affected area, while herbal remedies may support healing and reduce inflammation.

3. Can I continue to run or exercise?
While it’s great that you’ve developed a passion for running, it’s essential to listen to your body. Continuing to run through pain can lead to further injury and prolong your recovery. Here are some recommendations:
- Modify Your Routine: Consider reducing your running distance or frequency. Incorporate rest days and cross-training activities that are less stressful on your ankle.

- Warm-Up and Stretch: Always warm up before running and include stretching exercises to improve flexibility in your ankles and calves.

- Strengthening Exercises: Focus on strengthening the muscles around your ankle and calf to provide better support. This can include exercises like calf raises, ankle circles, and resistance band workouts.

- Footwear: Ensure you are wearing appropriate running shoes that provide adequate support and cushioning.

In conclusion, it is advisable to consult with a healthcare professional who can provide a tailored treatment plan based on your specific condition. Chronic tendonitis can be managed effectively with the right approach, and with patience and proper care, you can return to running without pain.
Thank you for your inquiry, and I wish you a speedy recovery and a return to your active lifestyle!
Best regards,
Doctor Q&A Teams

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