Increasing your cycling mileage too quickly can lead to ankle problems

Q. I’m an active 55-year-old man who works out regularly. Recently, I have gotten into cycling and have gradually increased my mileage weekly. This weekend, I rode at an increased pace and when I finished I noticed pain in the back of my heel. This worsened over the last two days and I have had difficulty sleeping and walking. I don’t know if it is my Achilles tendon but I am worried. What should I do?

A. There are several possible causes for pain in the back of your ankle. Since you have significantly increased your activity this is likely an overuse injury. Inflammation of the Achilles tendon, which stretches from your heel to your calf, can result in pain and stiffness at the back of the ankle. This is usually treated with anti-inflammatory medication, rehab and flexibility exercises.

A stress fracture from overuse can produce significant pain in the heel but would be unusual to occur from cycling. Catching or rubbing of the soft tissues between the bones in the back of the ankle, or “posterior impingement syndrome,” can produce pain with movement, catching and stiffness. This, too, can be treated with antiinflammatory medication and physical therapy.

Occasionally, a cortisone injection at the site of the impingement can be effective in relieving symptoms. I recommend you see an orthopedic surgeon or foot and ankle specialist to determine what your diagnosis is and the proper treatment for a speedy recovery. Once better, an exercise and flexibility program to prevent recurrent symptoms should be initiated.

Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital. Send your questions to HarlanS@baptisthealth.net