Ankle Dorsiflexion Problem

[Bryce Warren]

Alright, I've had this problem for quite some time, and for the life of me don't even know how to search up what the problem could be. It's my left ankle, and it has very limited dorsiflexion range of motion. When I try and stretch it to increase the range, it's actually painful, like something it blocking my ankle from going any farther. It's like a wall in my ankle, if I push passed it, it feels like my ankle will actually just snap. This stops me from doing certain squatting movements etc because of the low range of motion I have with it and it's incredibly irritating so it's time to find out if anyone else has any ideas.

[thenail01]

Where is it painful? If you can't actually dorsiflex your ankle it could be a peroneal nerve problem in which case you'd probably have numbness and tingling as well over the lateral portion of your foot. You could have an issue with your achilles/gastroc/soleus - if it's spasming or contracted you'll have a difficult time dorsiflexing as well.

Just FYI and in general, when people post about injuries/problems, it's helpful to give your age, level of training, past MSK problems, any associated injuries, any bruising, swelling, how soon this occurred after injury, onset of injury, new training programs/intensities, describe the pain - location and quality (sharp, dull, tingling, numbness, etc), what activities make it worse/better.

Take it for what it's worth - this is just a public forum - it's a combination of limiting the amount of personal details you want to give to the public and taking people's advice with a grain of salt. If something's bothering you to the point where you're considering seeing a doctor, then you should probably see an actual doctor. With that said there's a wide range of quality with doctors, physical therapists, radiologists...

The good news is if you pretty much stay active and don't do what hurts, 90% of the time you'll get better anyway.

[Bryce Warren]

The pain is near the top of my ankle, right where it bends basically. I can dorsiflex my ankle but it has a very limited range. It doesn't hurt if I just actively flex it but if I put my foot on the ground and try to lean into it then it gives me a shooting pain. I have no recollection of why I have this injury, either I didn't notice when I did injure my ankle or it just gradually happened. I'm 21, high level of training but nothing I do in training could cause this problem. I just recently noticed it swells inside my ankle after doing hill sprints because of the angle of the hill that puts more pressure into that dorsiflexed position. No bruising and whatnot, I can just feel the swelling inside of it.

I'm planning on getting back into my soft touch chiropractor to see what he thinks. I know someone who knows how to feel these things out and what to look for would be able to tell me the problem in this situation.

[thenail01]

Sounds like an overuse/biomechanical injury - either too much training without proper adaptation itself, improper footwear, laces too tight, etc. Something along the lines of 'anterior ankle impingement' or footballer's ankle. Can get an XR to look for bone spurs or congenital problems like tarsal coalition. May want to rule out stress fracture depending on the circumstances, and an XR would at least get started, possibly detecting based on age of injury (MRI is most sensitive/specific).

Ice, antiinflammatories, physical therapy. Relative rest (meaning, avoiding high impact activities - like running, definitely plyometrics, probably tumbling). Can do uphill brisk walking (4mph at 8-12% incline) to maintain conditioning and decrease impact.

Chiropractor, eh.

[Nic Branson]

Get it checked out to find out what is happening in there. I do NOT recommend using ice or NSAIDS at all. Move it as much as you are able to keep it loose but without more information I can't advise anything to try and increase your active range of motion at this point.

[Joshua Naterman]

Get it checked out to find out what is happening in there. I do NOT recommend using ice or NSAIDS at all. Move it as much as you are able to keep it loose but without more information I can't advise anything to try and increase your active range of motion at this point.

Absolutely. No NSAID anti-inflammatory drugs. They literally disable your macrophages, which are one of the things that allow you to activate satellite cells and heal. Don't do them.

The only time to use ice would be if you had acute swelling, and even then you should end with some gentle heat afterwards. Ice makes things feel better, but does not make them heal better.

The problem probably has a good bit to do with current ankle mobility (both lack of and an excess of) as a whole, with a large chance that your foot is pronating or otherwise not staying where it should during passive and reactive (as a result of the hill angle) dorsiflexion, and that the improper position is causing a ligament to get caught between bones. Do not ignore that. Instead, if that is part of the issue then fix the way your foot moves and works. That will probably take some professional help to learn. It could be an issue in the hip as well, impossible to assess in a forum.

The other possibilities others have listed are also worth ruling out. A good differential diagnosis is important.

[FREDERIC DUPONT]

(...) Absolutely. No NSAID anti-inflammatory drugs. They literally disable your macrophages, which are one of the things that allow you to activate satellite cells and heal. Don't do them. (...)

Have you got a link to some resources on that Joshua? I'd like to look deeper into it.

Thanks

[Nic Branson]

http://www.caringmedical.com/sports_injury/nsaids.asp

simple link for NSAID's

[FREDERIC DUPONT]

Thanks nic, very helpful

[Nic Branson]

There are several for the Ice as well but most are more in depth not sure how deep into it you wanted to go. Easy to search for though.

[FREDERIC DUPONT]

There are several for the Ice as well but most are more in depth not sure how deep into it you wanted to go. Easy to search for though.

Thanks Nic.

I like to understand the what and the why, but I rather follow a prescribed protocol for the how... I very much admire people like yourself or Joshua Naterman that are at a level of understanding that allows to derive a proper method, but I entertain no illusion that I could do that with a good chance of success.

It's okay, my interests lie elsewhere; I enjoy the training.

[thenail01]

You guys are awfully quick to jump on any advice that is not your own. The point of NSAIDs and ice is to help relieve inflammation which is a source of pain. Maybe you can find some obscure internet reference that "anti inflammatories" don't relieve inflammation and link that.

With improved pain and less inflammation, you can now work on fixing the underlying biomechanical problem.

Swelling after hill sprints sounds acute to me.

[Nic Branson]

The statement is not about acute swelling it is about chronic use. Swelling is also a natural response by the body. I'm not making the statement based on a whim here. For acute pain yes it has uses, but for healing it is not ideal, not by far. Tissue treatment is a part of fixing the mechanical issue. It was also stated to get a professional hands on opinion.

We're just offering our thoughts on the matter. Not jumping on yours. My apologies if you feel that way.

[Joshua Naterman]

You guys are awfully quick to jump on any advice that is not your own. The point of NSAIDs and ice is to help relieve inflammation which is a source of pain. Maybe you can find some obscure internet reference that "anti inflammatories" don't relieve inflammation and link that.

With improved pain and less inflammation, you can now work on fixing the underlying biomechanical problem.

Swelling after hill sprints sounds acute to me.

Pain is not an injury, and is not always a good guide. Are you familiar with the concept of "treat the source, not the symptom?"

A simple example is muscle soreness, which (for the same reasons we are clearly suggesting no one use NSAIDS for inflammation) can be treated with NSAIDs but not only results in lack of adaptation but also strength LOSS due to lack of satellite cell activation. Satellite cells (SC) differentiate into fibroblasts as well as myoblasts. Fibroblasts are what turn into mature connective tissue, which is how these injuries (chronic OR acute) heal in the end. IN the case of strength, the same lack of SC activation causes the muscles to a) not adapt to the exercise and b) slowly lose their strength after repeated workouts due to the inability to heal properly.

Why, knowing this, would you ever recommend that someone take these drugs? You can take a non-NSAID for the pain if you really need it and have your cake and eat it too. Acetominaphen comes to mind. Not saying that's perfect, but it's a much better alternative when looking at injury recovery.

Does our position make more sense to you now?

[Quick Start Test Smith]

There are several for the Ice as well but most are more in depth not sure how deep into it you wanted to go. Easy to search for though.

Thanks Nic.

I like to understand the what and the why, but I rather follow a prescribed protocol for the how... I very much admire people like yourself or Joshua Naterman that are at a level of understanding that allows to derive a proper method, but I entertain no illusion that I could do that with a good chance of success.

It's okay, my interests lie elsewhere; I enjoy the training.

Well stated, Fred!

[Hallberg]

Sometimes there are a loose body inside the ankle joint or an osteofyt that block the movement. It gives no pain in rest but can give sharp pain when it's provoked. When provoked to much it also gives inflammation.

It´s an internal derangement wich can be shown on x-ray but more likely on MRI.

I have seen this a couple of times in practice

Physioterapist

[FREDERIC DUPONT]

Interesting... How do you usually deal with that Hallberg?

[Joshua Naterman]

Sometimes there are a loose body inside the ankle joint or an osteofyt that block the movement. It gives no pain in rest but can give sharp pain when it's provoked. When provoked to much it also gives inflammation.

It´s an internal derangement wich can be shown on x-ray but more likely on MRI.

I have seen this a couple of times in practice

Physioterapist

Yes. Very true!

As far as I am aware, surgery is the only way to deal with something like this, right?

I hope this guy goes and gets checked out. Joint mice (that's what we call loose bodies in American slang) are no fun but are easily removed and recovery is nearly always excellent.

[Andrew Graham]

This couldn't be a more ideal time for me to butt in here!!..A friend of mine has just been diagnosed with the same thing as the symptoms you are discribing.

 

For weeks his ankle has got worse and worse with a very limited ROM in dorsi flexion! he does scuba diving so you can imagine with the resistance of the water and wearing big fins the pressure on the ankle is quite uncomfortable for him!

 

He went to the physio and they did a few stress tests and ROM tests and they then X-ray'd him. They found that his ankle joint was being obstructed by excess synovial fluid that had solidified around the joint preventing dorsi flexion.

 

Because this had been happening over a period of time, obviously the guy hadn't really noticed it until he felt pain BUT because of the lack of flexibility and ROM his bio-mechanics changed in his foot which led to bone spurs growing behind where the synovial fluid was obstructing the joint.

 

He is due for surgery in january and is expected to make a full recovery following his rest and rehab

 

If your problem sounds anything like this, Please go and see a well trained physio or sport therapist. These type of things are best delt with sooner rather than later!

 

cheers