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Tuesday, October 1, 2013

Ankle Pain Unknown Diagnosis: Email Correspondance

Dr. Blake,

Over 2 months ago I started experiencing some pain in my left ankle after yoga. Got it checked out. I was told tendonitis/sprain. I did RICE for 4 weeks. Then put it in a boot for 2 weeks. But it still didn't heal.

About a week ago, a new doctor told me I have posterior tibial tendon insufficiency. My pain is also in the surrounding areas, on both sides of my ankle. She told me to get some shoes (I used to wear flip flops 99% of the time) and I also got an orthodic inside (New Balance). 

I'm 23 years old, relatively healthy and fit, and haven't been able to workout in over 2+ months. Now, after doing the smallest things (i.e. driving, stairs, etc) my ankles start hurting. Both my left and right hurt now.

I am confused and frustrated, and don't know where to turn next. I've seen 3 doctors and the pain still isn't gone. Can you give me some advice? I'm happy to return the favor in anyway I can, please help me, this has me really down, please e-mail me back.


Dr Blake's comment: 

    First of all, you need to verify the diagnosis. MRI is a useful tool to help in that direction. I am hopeful you just bruised the back of the ankle, or something else minor, that may take time but will heal completely. Without the MRI, there are too many possibilities to give this much further direction. You are still in Phase I of Rehabilitation without a solid diagnosis. Phase I is the Immobilization/Anti-Inflammatory stage. Use ice twice daily around your ankle for 15 minutes and do one formal contrast bath every evening. Place yourself back in the boot, you may need a lot for the next 3 months, for any situation that produces over level 2 pain. Remember to create a pain free environment as best you can keeping the pain between levels 0-2. Read my blog post on Good vs Bad Pain and memorize. I hope this helps. Rich


  1. Wow, thank you for posting Dr. Blake! I have 3 questions:

    1) Contrast bath - how much time in cold, how much time in hot, total time for both?

    2) What did you mean by this "you may need a lot for the next 3 months"

    3) When you said it could be minor, I felt very good - but the doctor I met with said it is PTTD and made it sound a bit serious. But, she never did an MRI. Just heel/toe raise test. I wonder if she is right or guessing, confused...

  2. Contrasts are explained in the link below.

    Without the MRI to really put a label on it, it may be PTTD, you can just try to go off what your body is telling you. Listen to your body. Create a pain free environment. If that requires you wear the boot during the day, or for certain activities, do it. See if you can go to a PT to really evaluate the ankle. Let me know what they find. Rich

  3. The posterior one connects the heel to the fibula, and the anterior one connects the fibula to the talus, the top bone in the foot.


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.