Tag: ankle pain

Does Running Cause Arthritis?

Is it a foregone conclusion, that if you run for years, you will have arthritis? Many of my patients are concerned that the aches and pains that are inevitable from distance running are actually harbingers for the future aches and pains of arthritis. This fear is even strong enough to get older runners to quit and start a lower impact exercise regimen like swimming and cycling. Is this a reasonable fear? Yes and No! Running by itself does not cause arthritis; improper biomechanics coupled with the rigors of running can cause arthritis.

Consider the stress of running on the joints for a minute. The foot hits the ground and the bones and joints experience force up to six times the runner’s body weight at impact. The joints are being asked to move and glide efficiently and smoothly while enduring this stress. In the event of a misstep or stumble, the joints need to continue to be stable to maintain their perfect alignment.

Osteoarthritis, a.k.a. “wear and tear arthritis”, is what runner’s dread. This is degeneration of the articular cartilage which absorbs shock, distributes stress and allows the joints to glide smoothly. The ability to run pain free depends on the health and integrity of this cartilage as we age. In osteoarthritis, the surface of the cartilage becomes roughened, fissured and even starts to shred into small fragments. These fragments “float” around the joint and cause more damage. The bone tries to protect itself by producing small bony prominences called osteophytes which actually in the end make the joint damage and pain worse.

Any kind of sports participation can increase the incidence of osteoarthritis due to increased twisting forces, high impact, muscle weakness or over-development and joint instability which causes abnormal peak pressures and greater stress in certain areas of cartilage which can lead to osteoarthritis. Nevertheless, for normal joints , there is no scientific evidence that simply the action of running, even over a long period of time, causes permanent joint damage or even a predisposition for osteoarthritis.

What is the risk of osteoarthritis in runners? Many studies of long-term runners show no increased incidence of osteoarthritis in these competitive runners. Some studies did show more evidence of osteophytes, but no correlation with joint pain or instability. Confusing the issue for many runners are the numerous incidents of misdiagnosis of repetitive stress injuries like patella-femoral syndrome as arthritis. This is reversible and caused by abnormal tracking of the kneecap, which is treated with physical therapy and orthotics.

Joints are in fact strengthened by activity and damaged by inactivity. Studies have shown that the articular cartilage actually thins and becomes more fragile with inactivity, therefore increasing the risk of arthritis. Joints adapt to the stress of exercise and become stronger and more able to endure the long term stress of running. Remember the doctor saying to increase slowly? This is why. Ligaments and muscles, which support the joints, are strengthened and reinforced by the stresses of the running activity, improving joint mechanics, if the joints are properly aligned.

Here is the truth about foot biomechanics. Proper biomechanics during the strengthening process is essential for joint health. Improper biomechanics can increase the stress on the joints in an abnormal fashion and actually increase the incidence of osteoarthritis and hasten joint damage.

Bottom line? Running does not increase the incidence of osteoarthritis unless the lower extremity biomechanics are faulty. In fact, almost 75% of Americans over the age of 65 experience some symptoms of osteoarthritis. This is not increased in runners. In fact, running may actually help with the symptoms of osteoarthritis.

The benefits associated with long distance running profoundly overshadow the risk of osteoarthritis. In runners, orthotic devices to correct their biomechanics early in their training may actually decrease the stress associated with increased osteoarthritis. If you have joint symptoms, see a sports medicine podiatrist today and have your gait realigned. Your joints will thank you. Remember, your feet are meant to carry you for a lifetime. Don’t let the fear of osteoarthritis rob you of the joy of a lifetime of distance running!

Posterior Tibial Tendon Dysfunction (Adult-Acquired Flat Foot)

Noticed that your foot is getting flatter and more painful? Do you have difficulty walking or performing exercise activity without leg and arch pain? Have you heard the term “fallen arches”? All of these things refer to a condition known as posterior tibial tendon dysfunction. This is an inflammation and overuse syndrome of one of the long tendons that pass from the leg around the inside of the ankle and attaches to the inside arch of the foot. The posterior tibial tendon’s job is to help support the arch and allow for more efficient gait.

PTTD is most commonly seen in adults and referred to as “adult acquired flatfoot”. Symptoms include pain and swelling along the inside arch and ankle, loss of the arch height and an outward sway of the foot. If not treated early, the condition progresses to increased flattening of the arch, increased inward roll of the ankle and deterioration of the posterior tibial tendon. Often, with end stage complications, severe arthritis may develop.

How does all this happen? In the majority of cases, it is overuse of the posterior tibial tendon that causes PTTD. And it is your inherited foot type that may cause a higher possibility that you will develop this condition.

Non-surgical treatment includes rest and reducing your activity until the pain improves. Orthotics or bracing help support the tendon to reduce its pull along the arch, thus reducing pain. In moderate to severe cases, a below knee cast or walking boot may be needed to allow the tendon to rest completely and heal. Physical therapy is an integral part of the non-surgical treatment regimen to reduce inflammation and pain. Anti-inflammatory medication is often used as well. Many times evaluation of your current shoes is necessary to ensure you are wearing appropriate shoe gear to prevent re-injury.

For those patients with PTTD that have severe deformity or have not improved with conservative treatments, surgery may be necessary to return them to daily activity. Surgery for PTTD may include repair of the diseased tendon and possible tendon transfer to a nearby healthy tendon, surgery on the surrounding bones or joints to prevent biomechanical abnormalities that may be a contributing factor or both.

Posterior Tibial Tendonitis

Many people have begun a vigorous exercise program to start their New Year’s resolution of losing weight and getting in shape. But with this, comes unexpected pain that stops the workout sessions and ultimately prevents them from fulfilling their goal. Most often this is due to “too much, too soon, too fast” syndrome.

Pain along the inside of the ankle that extends to the inside arch is often due to strain of the posterior tibial tendon. The main job of this tendon is to prevent overpronation of the foot and stabilize the arch and ankle. Overuse of this tendon, particularly in people with flat feet, causes the tendon to swell and become painful so that exercise activity is not possible. Ultimately, this type of injury can lead to tear of the tendon and possible surgery. The pain is often sharp, stabbing and radiates along the course of the tendon. Often the entire ankle will be swollen.

Treatment for this begins with rest. This doesn’t mean you have to stop exercising, but no weight bearing exercise until the pain subsides. Ice daily and apply compression to reduce swelling. When pain is gone, then gradual return to an exercise program with appropriate shoes and brace as needed.

A complete lower extremity exam will help determine what types of shoes are best for your workouts and what type of inserts can prevent recurrence of the pain. Often with flat feet, custom orthotics are the best devices that support the ankle and arch and prevent overpronation, thus reducing the likelihood that the pain will return.

If left untreated, posterior tibial tendonitis leads to tear of the tendon (a.k.a. Adult-onset flat foot) and often extensive foot and ankle surgery. It is best to treat this pain as early as possible.