clicky ankle

Question
I am a 31 year old male, who has spent most of his life playing soccer and hardly ever gets injuries.  I recently started running in my lunch hour, three times per week.  I normally run 4 miles in approx 35 mins, and i have no problems.  When I step up to 6 miles (approx 55 mins),I have no pain or swelling, however, when I arrive home in the evening and walk up stairs I get a 'clicking' noise between my heel and calf.  I can feel something click when I fully extend my foot up and again when I return my foot at a 90 degree angle to my leg.  I get no pain or swelling, but something feels wrong.  The 'clicking' leaves after 24 hours and normally I rest for a few days after.  When I run again I have no problems with a few miles, but the 'clicking' returns when I complete 6 miles.  I have tried Asics Gel and Etonic running shoes but the problem persists.  I stretch my calf by leaning against the wall with my foot pushed back and by squatting over my calf, as I have been instructed to do so an RAF Physical Education Instructor.  When I do these stretches I an feel the muscle stretch.  I have asked several keen runners and my local Physio Doctor for their opinions but none of them have heard of the problem before.  Please help, M Chaney (UK)

Answer
Hi Michael
More than likely you have have a subluxating peroneal tendon.Surprised your doctor couldn't figure this out.It occurs when the peroneal tendons are dislocated from their normal groove behind the fibula component of the ankle.This is probably the snaping your hearing,the tendon moving in and out of the grove.I had this myself years back.Instead of me explaining to you your situation which would take a lengthy typing session,type peroneal tendon in google and you can get easy reading and priscription to correct it.I just don't think i could get my thoughts across properly so that you would understand and be able to impliment accordingly.I copied a page for your convience with a picture,but take a look at others.If you have anyother questions get in touch Michael.You will be fine,so don't worry.

The very best to you
in the uk.
Paula radcliffe a friend
trains here in albuquerque
all the time.

John
www.rentacoachinternational.com



Peroneal Tendon Injuries
What are the Peroneal Tendons?
Types of Peroneal Tendon Injuries
Diagnosis
Treatment



What are the Peroneal Tendons?
A tendon is a band of tissue that connects a muscle to a bone. In the foot, there are two peroneal tendons. They run side-by-side behind the outer ankle bone. One peroneal tendon attaches to the outer part of the midfoot, while the other tendon runs under the foot and attaches near the inside of the arch. The main function of the peroneal tendons is to stabilize the foot and ankle and protect them from sprains.



Types of Peroneal Tendon Injuries
Peroneal tendon injuries may be acute (occurring suddenly) or chronic (developing over a period of time). They most commonly occur in individuals who participate in sports that involve repetitive ankle motion. In addition, people with higher arches are at risk for developing peroneal tendon injuries. The following are the three basic types of peroneal tendon injuries:

Tendonitis is an inflammation of one or both tendons. The inflammation is caused by activities involving repetitive use of the tendon, overuse of the tendon or trauma (such as an ankle sprain). Symptoms of tendonitis include:

Pain
Swelling
Warmth to the touch  
Acute tears are caused by repetitive activity or trauma. Immediate symptoms of acute tears include:

Pain
Swelling
Weakness or instability of the foot and ankle
As time goes on, these tears may lead to a change in the shape of the foot, in which the arch may become higher.

Degenerative tears (tendonosis) are usually due to overuse and occur over long periods of time梠ften years. In degenerative tears, the tendon is like taffy that has been overstretched until it becomes thin and eventually frays. Having high arches also puts you at risk for developing a degenerative tear. The signs and symptoms of degenerative tears may include:

Sporadic pain (occurring from time to time) on the outside of the ankle
Weakness or instability in the ankle
An increase in the height of the arch
Subluxation occurs when one or both tendons have slipped out of their normal position. In some cases, subluxation is due to a condition in which a person is born with a variation in the shape of the bone or muscle. In other cases, subluxation occurs following trauma, such as an ankle sprain. Damage or injury to the tissues that stabilize the tendons (retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation may include:

A snapping feeling of the tendon around the ankle bone.
Sporadic pain behind the outside ankle bone.
Ankle instability or weakness.
Early treatment of a subluxation is critical, since a tendon that continues to sublux (move out of position) is more likely to tear or rupture. Therefore, if you feel the characteristic snapping, see a foot and ankle surgeon immediately.


Diagnosis
Because peroneal tendon injuries are sometimes misdiagnosed and may worsen without proper treatment, prompt evaluation by a foot and ankle surgeon is advised. To diagnose a peroneal tendon injury, the surgeon will examine the foot and look for pain, instability, swelling, warmth and weakness on the outer side of the ankle. In addition, imaging studies such as an MRI or ultrasound may be needed to fully evaluate the injury.

An ankle sprain may sometimes accompany a peroneal tendon injury. The surgeon is trained to look for signs of this and other related injuries. Proper diagnosis is important because prolonged discomfort after a simple sprain may be a sign of additional problems.


Treatment
Treatment depends on the type of peroneal tendon injury. Options include:

Immobilization. A cast or splint may be used to keep the foot and ankle from moving and allow the injury to heal.  
Medications. Oral or injected anti-inflammatory drugs may help relieve the pain and inflammation.
Physical therapy. Ice, heat or ultrasound therapy may be used to reduce swelling and pain. As symptoms improve, exercises can be added to strengthen the muscles and improve range of motion and balance.
Bracing. The surgeon may provide a brace to use for a short while or during activities requiring repetitive ankle motion. Bracing may also be an option when a patient is not a candidate for surgery.
Surgery. In some cases, surgery may be needed to repair the tendon or tendons and perhaps the supporting structures of the foot. The foot and ankle surgeon will determine the most appropriate procedure for the patient抯 condition and lifestyle. After surgery, physical therapy is an important part of rehabilitation.