62 year old female presents to the center complaining of ankle pain. Patient states that she has difficulty walking, standing and she can not do much at all. As she sits there is no pain but as soon as she puts weight on her left foot things start to hurt.

The onset of pain has been gradual and she states that if she wears a brace on the ankle the pain lessens.  Her past medical history except for obesity is otherwise non contributory, she takes no medications. On her exam she has edema (medical lingo: swelling) and  extreme point tenderness upon palpating the inner ankle (in the picture around where the middle finger is touching)
           

Discussion:

This is not an uncommon problem. The tibialis posterior tendon (located in the inner side of ankle ), has the  primary action of stabilizing the joint. The few times that I have seen this tendon damaged, patients reported their pain gradually occurring without any report of trauma and a review of the literature suggests the exact cause of the disorder not known, researchers suggest that tendon degeneration is the primary cause. Another words as you are getting gray hair in your head you are getting gray hair in your joints, tendons and ligaments. This problem is mostly seen in females over 40, however young athletic people are reported to develop this predicament as well.

The best means of diagnosis is an MRI.

     R.I.C.E. may help:

1. Rest and shoe modification (arch padding).

2. Ice and ultrasound with physical therapy with muscle strengthening.

3. Compression and taping.

4. Elevation.