Ask The ST Run Expert

Don't let ankle problems be your Achilles' heel

Runners are prone to ankle trouble owing to repetitive impact on the legs. A better-known condition is an Achilles tendinitis.
Runners are prone to ankle trouble owing to repetitive impact on the legs. A better-known condition is an Achilles tendinitis.THE NEW PAPER FILE PHOTO

Q I am an active 38-year-old man, and I've always enjoyed running. I run about three times a week, usually about 5km on two weekdays and a longer 10km run during the weekend.

I have been feeling pain at the back of my ankle when I run and it lingers on even after my run. My family doctor gave me some painkillers and advised me to stop running until the pain gets better.

I have stopped running for a month now but the pain has not got much better. What is the problem I am suffering from? And what can be done to treat my ankle pain?

A Thank you for your query. I see many runners in my practice and I am a runner myself, so I can identify with your frustration at not being able to run owing to your ankle pain.

Running puts a lot of repetitive impact on your legs and runners are prone to develop problems affecting their ankles.

There can be many issues that affect the ankle. This varies from ligament injuries to cartilage damage to tendon injuries.

The pain in your ankle is at the back of the joint and there are two common causes for this.

The better-known condition would be an Achilles tendinitis. Achilles tendon pain is common in runners and is due to micro-damage to the tendon with associated inflammation.

This can be precipitated by a change in running shoes or style of running. Too rapid an increase in mileage can also cause Achilles tendon pain to flare up.

In many runners, tightness of the Achilles tendon and calf muscle can be a contributing factor and treatment frequently includes a stretching programme and a course of anti-inflammatory medications.

The less well-known condition that also frequently causes pain at the back of the ankle is a posterior impingement syndrome. This would cause pain deep at the back of the ankle joint, typically deeper than the Achilles tendon.

Flexing the foot downwards while running will tend to make the pain worse. Sometimes, the pain would persist for a few days after your run too.

Posterior impingement is frequently due to an injury to an accessory bone fragment at the back of the ankle called an "os trigonum".

This accessory bone fragment causes pain as it gets pinched at the back of the joint every time the ankle joint flexes downward. This is a motion that repeatedly occurs during running.

The good news is that a keyhole or minimally-invasive removal of the bone fragment is usually associated with relief of the pain and a fairly rapid return to running without much downtime.

I would suggest that you visit a orthopaedic sports doctor so that he can assess your ankle to determine the cause of your pain and recommend a course of treatment to get you back into your running shoes soon.

Dr Tan Ken Jin

Orthopaedic surgeon at Mount Elizabeth Novena Hospital

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A version of this article appeared in the print edition of The Sunday Times on April 24, 2016, with the headline 'Don't let ankle problems be your Achilles' heel'. Print Edition | Subscribe