Tendon Trouble

During Bull Run Run 50 Miler, my calves and anterior tibialis were cramping and quivering late in the race -- most noticeably on the downhill sections. This is pretty common in my experience (and completely expected given my low training volume). I had no pain during or after the race. In fact I was pleasantly surprised at how little soreness I had afterward. 

I didn't notice any issues until a leisurely hike/run with friends last weekend, cruising on a long downhill section. Suddenly, the front of my ankle felt sore, as if I'd bruised the front of my ankle area. At first I thought I'd tied my shoes too tightly, but it soon became obvious something else was going on.  

Where it hurts. Image from http://home.comcast.net/~wnor/ankle.htm

My first guess was anterior tibialis tendonitis, but that pain tends to diminish as it warms up on a run, whereas mine definitely hurts more the longer I run. Now, I'm leaning toward Lower Extremity Tenosynovitis.

Lower extremity tenosynovitis is a condition affecting the tendons of a lower limb. It also affects the lining of the sheath around the tendon. Tendons are cords of tissue that connect muscles to the bones. With lower extremity tenosynovitis, the sheath and the synovium of the flexor muscles become inflamed. The tendons may become thickened and have a hard time moving through the swollen covering. This can cause pain and tenderness when moving the affected foot, especially the ankle and heel areas. Lower extremity tenosynovitis usually affects athletes, ballet dancers, and people of middle age or older.

Symptoms include redness, swelling, or pain in the affected leg or foot. The pain or tenderness usually occurs when you move or bend the affected part, such as while running or walking. Over time, the pain may become worse and may be present even at rest. You may also have:

•     Clicking, locking, or snapping of ankles. YEP. But my left ankle clicks too. Hmm.

•     Develop a flatfoot. Not yet.

•     Grating sound or feeling when the leg or foot is touched or rubbed. Mmm-Hmm.

•     Nodule may be present or toes may look like sausages. Nope, thank goodness!

•     Stiffening of the leg, ankle, or foot. No noticeable stiffness.

•     Weakness and limited movement of the affected part. So far, none of that.

Since I only have a couple of symptoms, it's in the very early stages, or I'm an incompetent doctor (obviously). The treatment is to minimize movement of the affected area. That means no running, biking or even much walking. I'm hoping I won't need an air cast or other immobilizing contraption, but that's probably overly optimistic, considering that I have to walk some in my job (and also to get there).

I'm hopeful that I'll only have to rest it a week or two. Right now it doesn't hurt at all unless I'm running.

What I'll be doing a lot of. image from http://www.eatrunread.com/2010/04/mollie-rant-pools.html

I really don't want to run my next two races under-trained, and the steep and plentiful climbs and descents on both courses will cause problems if this isn't completely healed. Everything I've read about this condition indicates that training through the pain will aggravate the area and may cause it to become chronic.

Looks like it's rest, Bikram yoga and pool running for me!

And if you've had tendon issue before and have any advice, I'd love to hear it.


P.S. I just got an appointment with my podiatrist for this afternoon -- check back next week to guffaw at my misdiagnosis.