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Ankle Pain which type of doctor?

RDCLK24

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I skied for years but stopped 10 years ago due to ankle pain with boots. I want to see a doctor and get back into it. I have no ankle pain day to day, but if I put on a pair of ski boots and flex forward, I get an intense pain at my ankle. Should I see a Podiatrist or an Orthopaedist? I'm guessing it's peroneal tendon slipping or something similar. I live in NJ if anyone has a recommendation.
 

Prosper

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Welcome to SkiTalk. You can see either. If you decide to see an orthopedist make sure its someone who specializes in ankles and feet. An ankle and foot orthopedist has significantly more training than a podiatrist. With that being said, I’m not sure either will have much to offer in regards to diagnosis or treatment. Tendon slippage under only one specific type of situation is pretty difficult to definitely diagnose. You can’t get a MRI while wearing ski boots. If it is something like suspected tendon slippage maybe physical therapy could help. I can’t imagine that surgery would be offered as an option. I think finding a really good bootfitter might serve you better.
 

Ron

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there are several nerves that run through your foot as well as many ligaments and tendons so I wouldn't say its def' a peroneal issue unless thats been the diagnosis prior, that's possible but did you try on different boots to see if you had the same pain? that can also be the bones that comprise the rear foot as well. I would see a Ortho with an ankle and foot speciality. But try on different boots if you didnt already.
 
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Ron

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Aw, man! If my boots hit that spot, there's definitely going to be some pain. :geek:

LOL! that would be something quite different! Damn autocorrect.. PERONEAL. now, that's better :). its still showing as the incorrect spelling BTW
 
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ted

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As someone that works in the foot and ankle world,t here are good and bad in each profession. It’s more about the individual. And almost none know about mobilisation modalities that, if needed provide a dramatic improvement in symptoms.
 

snwbrdr

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I skied for years but stopped 10 years ago due to ankle pain with boots. I want to see a doctor and get back into it. I have no ankle pain day to day, but if I put on a pair of ski boots and flex forward, I get an intense pain at my ankle. Should I see a Podiatrist or an Orthopaedist? I'm guessing it's peroneal tendon slipping or something similar. I live in NJ if anyone has a recommendation.
Depends on your insurance. HMO: you need to see your primary doctor first.

PPO: then you can go straight to a specialist. Keep in mind, if it only happens with ski boots, ortho or podiatrists are not boot fitters. You'll have to find a good boot fitter. North Jersey and Midtown Manhattan has good bootfitter
 

KevinF

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I had ankle issues earlier this year (peroneal tendinitis). I was wondering the same thing; the podiatrist I called flatly said that "I don't do ankles" and the ortho I called said "when were you looking to come in?".

I'm sure there are podiatrists that will look at ankle issues, but -- point being -- your decision might be made for you.
 

ted

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Any chance of having that unpacked, at least a bit?
Gladly, my soapbox.

If you have someone dorsiflex your ankle hard without letting the foot compensate with pronation or supination(knee extended) and you don’t feel stretchng in your calf, there is likely one of two issues. The first is you have a bony blockage at the ankle joint. The second is that it is locked up and needs mobilization.

I work fitting orthotics, ankle braces, and ski boots.
I check everyone for this as if it isn’t resolved I suffer as the patient comes back for endless adjustments either because the device hurts or is inefffective.

Here is a link to the procedure,-


This is out of my scope of practice so I refer people out.

The presenter above is a Podiatrist, but I don’t know any personally that do this.

Ideally, it should be done when the patient goes to PT(which all patients with limited ankle motion need) but IME this rarely happens.

Also, IME almost all foot problems have a component of limited ankle dorsiflexion,whether it is simply tight calf muscles or need for mobilization. Usually the bony blockage ones are complete disasters.

I do know some PTs who are very thorough and do address it though.

I’ve found the most reliable practitioner to refer to is a Chiropractor who works on Extremities.

In my near 20 year career, I’ve referred more than 100 people out for this and for all but one the results were dramatic.

I lucked into learning this from a video, ironically from another podiatrist, who was likely taught by the presenter above.

It certainly wasn’t taught in Pedorthic school.

End rant.
 

ted

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I had ankle issues earlier this year (peroneal tendinitis). I was wondering the same thing; the podiatrist I called flatly said that "I don't do ankles" and the ortho I called said "when were you looking to come in?".

I'm sure there are podiatrists that will look at ankle issues, but -- point being -- your decision might be made for you.
That’s strange, most podiatrists happily address ankle issues.
 

ted

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I skied for years but stopped 10 years ago due to ankle pain with boots. I want to see a doctor and get back into it. I have no ankle pain day to day, but if I put on a pair of ski boots and flex forward, I get an intense pain at my ankle. Should I see a Podiatrist or an Orthopaedist? I'm guessing it's peroneal tendon slipping or something similar. I live in NJ if anyone has a recommendation.
Where is the pain?

if your old boots had too much forward lean/too little ramp for your ankle dorsiflexion, it could be as simple as a heel lift and a more upright boot.

Why do you think it is a peroneal tendon issue?
 

Henry

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I know a skier with very stiff ankles--very little dorsiflexion. He told me about one chiropractor he has visited who "pounds" (his word) on his ankles to get them to flex much better, but it isn't permanent. Perhaps some PT follow up was needed. A great bootfitter told him that she would put him into cabrio boots (he needed new boots anyway) for more room for a heel lift plus a shim under his heel bindings, as much as he needed to get centered with his stiff ankles.
 

KevinF

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That’s strange, most podiatrists happily address ankle issues.

That's what I would have thought; the receptionist though asked "is it the ankle or the foot" and I was basically like "I'm not sure what the strict medical definition of an ankle or foot is" to which she said "you need an orthopedist".

Ok! Fine by me! I received my treatment, so I was happy. Maybe they were just hopelessly busy?
 
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RDCLK24

In the parking lot (formerly "At the base lodge")
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Where is the pain?

if your old boots had too much forward lean/too little ramp for your ankle dorsiflexion, it could be as simple as a heel lift and a more upright boot.

Why do you think it is a peroneal tendon issue?
I’ve worked with 3 boot fitters and tried over a dozen boots in several stores. I had severe pain in all of them when flexed.
 

oldschoolskier

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I would suggest an orthopedic surgeon (OS) whether or not surgery is required is a question only they can answer but they will determine which solution(s) are required to solve the issue by pulling in the required additional specialists for the best outcome.

A few years back my wife broke a bone in her ankle (one that cause pain but nothing else), she was treated by the hospital, walking boot and crutches and sent to a OS to ensure no other problems ensued. Physo and monitoring by the SO to ensure it heel correctly. No surgery, no after effects.
 

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