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Sunday, September 27, 2020

Severe Ankle Pain after Working Out: Email Advice pre-flying internationally

Hello, Dr. Blake -

I have been reading your blog quite a bit lately.  It’s very informative, thank you!  Unfortunately I’ve got some pretty debilitating pain in both of my feet.  I noticed the pain about 3 weeks ago.  I woke up one morning, and on my way to the bathroom I felt a pop! in my right foot and it was quite painful to walk.  I went back to bed and thought it was just a strange thing that happened.  When I got up for the day, I again felt some pain, but it went away quite quickly as I walked around the house.  I routinely do High Impact HIIT classes at home and the day before I felt this pain, I did a workout that I have done many times before but with a different pair of shoes. (Long story short, they were the only shoes I had).  

After that, I stopped any working out that required standing up, jumping or weight-bearing.  However, I did not stop walking or standing.  As time went on, my movement has been more and more restricted.  I am using crutches to get around.  I do not walk anywhere except to the bathroom, bed and kitchen.  It is awful.  I use ice, NSAIDs and rest, rest, rest.  I tried some ankle braces, but they feel too tight now.  The pain started in the inside of my foot, below the ankle.  I notice inflammation and warmth in that area after use.  

I cannot walk normally on my right foot and if I do, I feel it in my arch.  I do not even attempt a one leg lift.  The pain started in my left foot (same area, below ankle near arch) about a week and a half or 2 weeks after the right.). The pain has at some points in time migrated to other areas, such as below the arch, above the ankle bone on the inside of the leg and even an almost pinching sensation on the outside of the ankle.  I have also had pain at the top of the ankle when I step (upon waking up) and shin splints pain on the left leg, soreness in the ball of the foot and even on the heel.  At times my calves feel pretty tight, but I have stopped doing stretches because I don’t want to aggravate anything.  I am pretty sure it is PTTD, but I need to go to the doctor for a proper analysis. 
Dr. Blake's comment: It sounds like some version. Do you have a history of flat feet? Or a history of other foot problems? Can someone take a photo of both feet standing, that I will attach to this post, one from the front, the inside arch and one from the back of the heel? And, while you are at it, a good photo of the original injured ankle area? 

We are currently abroad but flying back to the US in 3 days.  Once we return, all doctor’s offices require 14 day waiting period (Coronavirus requirement) before coming in.  So I just have to be patient.  I have two young children and am a stay-at-home Mom.  I am physically fit and normally very active.  I am so incredibly frustrated that I have admittedly started crying.   I am trying to be patient.  My question is, what can I do in the next few weeks before my appointment to try to improve the situation?  How can I manage an international flight with 2 toddlers, crutches and luggage?   Is there anything I can do beyond RICE? 
Dr. Blake's comment: Yes, try to get a below knee boot for the worse side and the posterior tibial tendon dysfunction brace by aircast for the other side. You have to carry things evenly on your back with a backpack, and walk slow if you can. You could switch to hiking poles from crutches. A local pharmacy may have the boots, but maybe Amazon can rush them. 

Oh, I just bought new shoes yesterday that are softer on my feet than the ones I was wearing.  (I tried to get the Brooks Ariel that you had suggested in a separate blog, but they did not have it.  I just bought the type of shoes I was working out in before I switched.). Also, while the past few days I have noticed that the pain/swelling is occurring earlier and earlier in the day and will come back sooner, the pain has remained localized near the arch of the foot.

I went to urgent care here in Switzerland.  They said it did not appear to be a bone issue, that I would likely need an MRI for proper diagnosis.  She said it is possible there is a very small fracture, but that is all speculation.  She did say it was concerning that it was worsening.
Dr. Blake's comment: During the flight, swelling can increase your chance of blood clots. Get some 20-30 mm Hg compression hose to wear on the flight and keep your feet up and moving up and down at the ankle 20 times every hour. If you went to an urgent care, maybe call them for any other advice. Get some form of baggie, and apply ice (that the plane will have) 15 minutes every hour to hour and a half to the ankles. Maybe plan on going there one more time the day before you leave for advice. Ask the crucial question if you should fly in the first place. 

At this point I feel like I will never walk again. 😩  I am so afraid that it is degenerative and I have already done too much damage that I will not be able to reverse.  Any recommendations or even words of encouragement would be extremely helpful.
Dr. Blake's comment: It is rare to have a permanent situation days after doing high level workouts. I think you have not immobilized enough, first phase of rehab, so get to it. It is something you can control. I await the photos, etc. Rich 

Thank you so much,

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.