UKH

Just wondering if anyone has any experience with tendon inflammation from wearing mountaineering boots/any boots with a high ankle I suppose. I recently wore Phantom Guides for a long day out (mostly walking on flat, hard ground - yes, they were a bit unnecessary!) and noticed pain in the inner ankle around the bony lump (medial malleolus, apparently) where the inside of the boot narrows to support the ankle. I ignored it thinking it to be just another hot spot in the boot, but it started to get quite severe. There was slight swelling but not too much the next day. This was about 2 weeks ago now and since then I can't wear ski boots or other softer boots which come above the ankle. Climbing shoes are surprisingly OK due to their lower rise. The pain is pretty sharp when I press on the tender point.

I saw an osteopath and we both seemed to settle on posterior tibial tendon inflammation. Has anyone experienced this or similar? It seems to be associated mainly with runners. I'm trying not to aggravate it with boots but it does hurt when I point my foot outwards and raise the foot up and down. 

It feels like it may be a tricky one to rest completely and heal up! Any advice/experience shared would be appreciated!

Cheers!

The TP tendon runs down the calf and under the medial malleolus. Most commonly in runners you get pain in the calf, along the ligament and stretching over the side of the foot. Reading the internet can be very worrying as you will read of dropped foot syndrome and surgical reconstruction. However as an acute injury, trigger point therapy, massage and strength exercise is very useful and sorted me out (I do still do my specific exercises) It is one of the few injuries with a good evidence base for orthotics. You should not run through this injury.

I would seek out a sports physiotherapist or depending on the situation in France an orthopaedic opinion. Your history doesn't fit with my knowledge which is lay and based on lots of reading and what the physiotherapist told me (so hardly authoritative). 

I hope this is useful and good luck.

I've no idea about the diagnosis and the anatomy, but I had a similar problem when I first got the boots. I just assumed it was a bruise on the bone surface. Anyway, it took ages to heal fully but I managed to keep climbing by walking with the boots done up very loose for the walk in and out, and only doing them up tighter for climbing. This is a good general principle for all types of climbing boots, only have the boots tight when actually climbing and don't be lazy about loosening them after finishing the route. Sorry if you know all this before and your problem is different.

Yeah that's exactly what it felt like at first so I wasn't too bothered by the pain. It's definitely not a bruise as such after two weeks and there wasn't any discolouration really. I had them on for a very long time that day and even ran a bit in different boots for 10 mins or so the following day which probably exacerbated it. Interesting that you had the same pain from the same boots.

I've worn them many times over the last few years and never had an issue. Perhaps it was the way I did them up, having them on too long, or walking on hard ground as opposed to soft snow. Equally I wondered if skiing more had thickened the tendons around the ankle and made the fit different. I can't put a ski boot on for more than a second or two just now as it presses right in on the sore spot and the pain is pretty intense!

Steve - thanks for the advice. I did look it up and was scared by the flat foot/surgery blogs. Osteopath said I had unstable rear and mid foot on right foot so an orthotic and exercises should help. My pain doesn't run far up the calf so hopefully it's purely pressure point inflammation rather than an overuse thing.

I've seen a lot of tibialis posterior injuries in my job as an orthotist, plus I'm currently recovering from a tibialis posterior injury. 

First thing, check you can do a single leg heel raise on the affected leg. If you can't then speak to a doctor asap. Tibialis posterior is going to be ruptured to some extent. If it's just painful or a bit weak then that's ok. If there is any asymmetry in foot posture when weight bearing then also speak to a doctor asap. Tendinopathy (essentially tendon degeneration) is the most common form of tibialis posterior injury. 

Worth trying to find a physio who is trained to perform an ultrasound scan on the painful area so as to check there's no partial rupture. It's quite a delicate tendon verses the job it does. Else whoever else can do a scan. A scan isn't totally essential but it helps confirm the degree of injury if there's any doubt. 

The strongest evidence for conservative treatment are eccentric exercises + orthotic intervention. Sometimes orthopaedic fracture type boots are needed initially. It all depends on the degree of injury. A good physio who is familiar with this of injury is key. 

In case you're Googling - provided there's no asymmetry between feet - it will be stage 1 posterior tibial tendon dysfunction (PTTD), which is the mildest form. 2, 3 and 4 involve progressively more deformity so don't be alarmed!

Edit: I've never heard of this type of injury stemming from boot ankle support. My guess is you've injured the tendon by other means (maybe just overuse) and the subsequent symptoms are more apparent in the boots (eg due to the pressure they cause over the painful area) . 

The simplest answer then is that you happened to do them up too tight and then had a long day. Which was unlucky. With mine, the pain slowly eased over the winter but was fully better after a summer not wearing the boots. Now I'm really careful about how tight I do them up, and am willing to loosen during the walk-in if I'm feeling any discomfort. And I love the boots.

I've had problems with my Achillies tendon on one ankle. Although stretching and exercise have largely cured it, it does, and can flare up again, if I have high ankle boots tied too tight when walking.  Like Andy said, loosening them the minute you notice your tendon getting sensitive, or changing the laceing helps prevent worsening.

Hi Natalie,

                I've had exactly the same problem with phantoms!  Time sorted it out  - several weeks where boots hurt.  Reticent wearing the boots now.  It's really odd as I'd worn them for lots of climbing & mountain days with no problems, but problem arose on a walking day - relatively flat and on good paths.  I assumed it was down to me lacing badly, but the I've a vague suspicion that the spacing of the eyelets creates a pressure / irritation point that is exacerbated but lots of continuous flat walking. 

Cheers,

Stu

Thanks everyone - reassuring/worrying to see that others have experienced it with the same boots! I think it has a lot to do with walking/standing around on hard flat ground as Stu says. I have started taking some Glucosamine & Chondroitin to see if that helps as I seem to be susceptible to soft tissue inflammation. I've also had a tendinopathy on my Achilles from a pair of Vapour climbing shoes. The time it took to heal is what concerns me about this. I might try and get a scan if it doesn't improve this week.

Thankfully climbing shoes don't aggravate it at the moment!

Great help, thanks. I wonder if wearing my ski boots are the root cause of this. I vaguely recall having some tenderness in the same spot occasionally but just putting it down to a hot spot/bit of bruising.

Osteopath said I have overpronation of the right (affected) foot but that he couldn't see a good reason why just one foot was affected. Today the pain feels reduced but I have a sore spot on the top of the foot towards the inside, sort of where the midpoint of the length of the foot is. Perhaps I'm overcompensating by walking a bit funny and it's aching. Might go for a scan this week if it persists.

I’ve had exactly the same issue from Phantom Guides, although bizarrely the problem seems to have resolved itself. At points the boots have been almost unbearable, and I resorted to doing walk ins/outs with the laces fully undone.

Generally this would improve after a day, but sometimes drag on for longer.

Recently I’ve just been walking in with the boots done up as normal and oddly it’s been fine. Am aware that this has all already been mentioned on this thread, however I do know several others who have had similar issues, which have simply cleared up.

I get this same problem whenever I wear Scarpa boots. They just aren't the right shape for my foot. A friend was complaining about the exact same thing just yesterday. Try boots from a different manufacturer!

Some useful info here 

https://www.ukclimbing.com/articles/features/20_people_you'll_meeton_the_uk...

particularly Number 4....

Lex

I've had exactly the same problem for years and it's what has turned me from a walker into a cyclist because no matter what I do, wearing my leather boots presses on the tendon that runs down to the bony lump on the outside of my ankle and causes inflammation and pain, within a mile of setting off. 

When we retire to Scotland I plan to do a lot more walking so that's when I shall try some modern synthetic boots in the hope that they won't cause the problem. Until then, after every walk I rub on Ibuprofen gel and rest.

I'm not sure there's anything I can tell you that you probably don't know already, or is actually applicable to you, but here goes. I've now had 11 years of disruptive winters because of foot problems. In my case it started from going over on my left ankle, which led to a gradual loss of dorsiflexion and eventually (after 4 years) very painful swelling along the top part of the bottom of my foot. The foot only swelled when wearing my winter boots, supposedly because the lack of ankle flexibility, combined with the rigid sole of the boots, forced my toes to claw at the ground with every step (the brain sensing instabilities). This repeated clawing obviously aggravated the fatty pad area below the toes resulting in swelling.

This current winter is the first time I've had no swelling in that foot but it did take 1,540 consecutive days of physio exercises to correct it (yes, I became pretty obsessive over it!!!). The kick in the teeth in my case is that the other foot began to swell this winter!!! I could have cried when it happened! This new swelling is because my right side is tight (upper back - lower back - calf) and is affecting my right foot now. As unrelated or coincidental as this new swelling might sound, it did actually come about because of that initial lack of dorsiflexion in my left ankle. My plantar fascia became affected, which tightened my hamstring, which contorted my back and led to a back injury on my right side. After a few years of that it had affected my upper back on the right side (and in turn now the right foot).

Everything is obvious in hindsight but often there were no alarm bells indicating something was amiss under the surface. I've seen many different specialists over the years and unfortunately the majority of the advice has been poor: "do nothing, sore backs have a way of healing themselves"; "try buying a new pair of boots"; "it's just the way you're built". Then last year I saw a physio about the tightness in my right upper body, which had just occurred. He was brilliant and the exercises he gave me have helped massively. I'm still working on it but there's constant progress, which bodes well.

Like I said at the beginning, none of this may be relevant to you, and I certainly don't want to scare you with my convoluted history. Think about possible injuries you may have had in the past and whether there's any imbalances or tightness anywhere else in your body, however unconnected they might seem. The fact that you've worn your boots many times before without issue suggests something has changed. My boots, past and present, have felt like both slippers and medieval torture implements - it's not the fault of the boots! Switching to more flexible footwear/rock shoes has always helped me. I had two months this winter doing mountaineering days in trekking boots and my right foot was fine. 1 day in my winter boots and the swelling came on.

I would try and establish some time frames for getting better. It's easy to bury your head in the sand and hope it goes away - it's often upsetting to address injuries head on and accept the limitations they place upon you. It sounds like you're addressing it quickly though. Don't be afraid to get opinions from other specialists, especially if you feel there's no progress with current advice. Many injuries are stress/overuse related and rest is the best medicine but you'll be the best judge of that, not a medical professional. I really hope it's something simple and you get better soon.

I had this, it was quite bad, I changed my boots, Scarpa, to Nepal Sportiva, no more problems. I should add that I had Sportivas before the the Scarpas with no issues, it was definitely using boots, which didn't suit my feet, and lacing them tight, which caused the issues. 

Thanks Patrick! It does seem like a slight imbalance in the feet can cause total chaos. At the moment my anterior tibial tendon is aching, presumably from walking funny and overcompensating. I noticed today how insecure my right ankle was whilst bouldering on a move where most of my weight was on a right foothold - it was wobbling, possibly because that foot is sore, obviously, but it is definitely weak overall. I did go over that ankle about a week or two before I wore the boots but there was no pain afterwards. I had tried to stand up after a long period of sitting still and my foot was numb and I just keeled over.

The tendon is probably just weak and a bit tired from having ski boots and then the Phantoms pressed up against it.

Can't quite believe how common this is. Maybe there's an article in it!