OpenHealth Q&A

Persistent Bilateral Ankle Discomfort for Over a Year — Imaging Shows Normal, Possible Impingement but Unknown Origin

Hello everyone, I’m a 30-year-old male experiencing ongoing pain in both ankles for the last 13 months. The discomfort primarily manifests as a burning and aching sensation, occasionally radiating up my shins, resembling the feelings associated with shin splints. The pain toggles between both ankles, intensifying with physical activity, although there are times it persists for days without any discernible cause. Generally, the pain remains constant, though it tends to be somewhat milder upon waking. The source of my discomfort is situated near the tibialis anterior tendon, on the inner front part of each ankle. I have not experienced any trauma leading up to this condition. It appeared after a lengthy bike ride, and subsequently worsened after a protracted car journey. I’ve consulted several medical professionals, including doctors and physiotherapists, but no one has provided a definitive diagnosis. Currently, soft tissue impingement syndrome is the working assumption, yet my symptoms don’t entirely match that diagnosis. Imaging studies, including MRIs of both ankles, revealed no signs of joint swelling, tendon issues, or bone marrow edema. There’s no evidence of osteoarthritis or inflammation present. The only notable findings included minor changes at the talonavicular joint on the right ankle, along with a visible os trigonum there, which is likely just a normal anatomical variation. An X-ray confirmed slight degenerative changes at the talonavicular joint on the right side. I retain full dorsiflexion, and there’s no visible swelling or discoloration present, plus I do not exhibit any instability. A cortisone injection aimed at resolving the suspected impingement yielded minimal relief. I have engaged in comprehensive rehabilitation efforts, such as strengthening my tibialis anterior, soft tissue therapy, and balance exercises, but I haven’t noticed any improvement. At times, the pain feels neuropathic in nature — characterized by burning and radiating sensations extending through my shins. Over the course of my treatment, I have seen four physiotherapists, my general practitioner, a sports medicine specialist, and an orthopedic surgeon. A thorough bike fitting showed no glaring problems. There is no visible inflammation noted, and I continue to feel pain even at rest, whether while sitting or lying down. Currently, I am taking a 12-week hiatus from all sports activities aside from exercises focused on my ankles (since May 10th) to eliminate the possibility of overtraining. This ongoing issue is significantly impacting my daily routine and my primary interest in cycling. I'm feeling quite frustrated with the situation. I have arthroscopic surgery scheduled for September, but I remain eager to explore alternative diagnoses that might be considered given that imaging appears normal yet the pain has persisted for an extended period, affecting both my ankles and legs. I’m open to any clarifications or questions. Thank you for your consideration and insights.

Answers (1)

6/23/2025, 2:20:56 PM

OpenHealth AI

I'm truly sorry to hear about your ongoing bilateral ankle discomfort. It sounds like a frustrating situation, especially after so many evaluations and efforts to find relief. Persistent pain with no definitive diagnosis can be quite challenging, particularly when it's impacting your daily life and activities like cycling.

Key Points:

1. The pain you are experiencing could stem from various sources despite normal imaging.
2. Considering the nature and location of your symptoms, there are a few avenues we can explore for relief.

Explanation:

Your symptoms, particularly the burning and aching nature along with its radiation, can indicate nerve involvement or myofascial pain. Conditions like tarsal tunnel syndrome (involving a nerve at the ankle) or referred pain from the lower back could also be possibilities, especially as symptoms evolved post-activity without direct trauma.

Your scheduled arthroscopic surgery suggests that further investigation is warranted, though it’s understandable to be cautious since the imaging hasn't shown major abnormalities. Sometimes, pain issues may not become clear until intervention is made.

Next Steps:

1. Maintain a Pain Diary: Continue tracking your symptoms, documenting what activities worsen or alleviate the pain, and noting any patterns. This could provide further insight for your medical team.

2. Explore Additional Treatments: While waiting for your scheduled surgery, consider exploring:

   • Physical Therapy Focused on Neuromuscular Techniques: Explore therapists who employ dry needling or other specialized techniques.
   • Nerve Assessment: If not already explored, consider evaluations for conditions like tarsal tunnel syndrome, which might not show clearly on standard imaging.

3. Consider Alternative Therapies: Many patients find relief through complementary methods:

   • Acupuncture: This may help alleviate neuropathic pain and improve overall function.
   • Gentle Yoga or Movement Therapy: This could help release muscular tension around the ankles and improve mobility without overexerting.

4. Pain Management Techniques: Implement strategies like:

   • Cold or Heat Therapy: Applying ice packs or heat can help alleviate discomfort.
   • Topical Analgesics: Over-the-counter pain relief gels may provide localized relief.

5. Review Expectations for Surgery: Before your upcoming arthroscopy, discuss with your surgeon what specific findings they hope to achieve. A clear understanding of potential outcomes can help set realistic expectations.

This situation is undoubtedly complex, and it's important to feel supported throughout. You're doing a great job seeking out solutions and exploring all avenues. If you have further questions or need clarification on any of these strategies, feel free to ask.