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Cyclist's ankle (or foot)?

Old 10-29-20, 11:28 AM
  #1  
CoogansBluff
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Cyclist's ankle (or foot)?

In the last 2-3 months, I've twice had the experience of my foot/ankle becoming swollen the evening after an afternoon ride. For the first, I sent a picture to my doctor, who insisted it was an injury, even though I couldn't remember hurting it and couldn't feel or locate any pain in the ankle. Just swollen. After a week or so, it was OK. Now, it's happened again, only this time a little more swollen, a place on the fop and bottom of the foot that's a little tender to the touch. Called to get an appointment with doctor, but without seeing me, he referred me to an orthopedic specialist.

Well, I hope that's all it is, a minor injury. But my question for this group is -- Is this an occasional thing that happens with cyclists, that they get mild to moderate foot injuries from pedaling or biking without knowing it until later in the day? Especially when the rider is in his late 50s?
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Old 10-29-20, 11:39 AM
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If you tore a tenon or a muscle that would certainly cause pain and swelling. I do get them from time to time from biking.
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Old 10-29-20, 11:40 AM
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Any primary care physician who refers you to an orthopedic surgeon just for ankle swelling without even a physical examination is just plain incompetent or lazy or both. As an orthopedic PA you can tell him I said so. Anyhow, diagnosing stuff like this over the Internet is near impossible. Could be the onset of ankle arthritis, ligament or tendon injury, cardiovascular disease, shoe fit, etc. Go see somebody else.
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Old 10-29-20, 04:40 PM
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Have you had a bit fit. You could have a problem with foot ailment
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Old 10-29-20, 10:03 PM
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My seat was up too high after a maintenance interval one long time ago. That caused some over reaching of the legs & extremities. Hurt for a few days. Thankfully I was able to be miserable at work during most of the recovery time. Was back to normal & ready for the following weekend with the corrected height adjustment.
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Old 10-30-20, 12:11 AM
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Your PCP is a hack. You need another opinion from another. The symptoms you are experiencing is called edema. There can be any number of causes which need to be promptly evaluated. https://www.mayoclinic.org/diseases-...s/syc-20366493
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Old 10-30-20, 09:57 AM
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whoa whoa whoa . . .

Slow down. I'm no defender of the medical profession, but y'all are making the same kind of baseless ( let's say "evidence free" ) judgment you accuse the doc of making. We don't know what else he knows about the patient, or whether he did a video consult or got a compate description. In any case, what he did not do was even more appropriate: he did not prescribe a course of treatment without an examination. It seems to me that his referral to an orthopod was appropiate. Though it would be better to be a referral to someone who understands soft tissue, like a physiatrist or even a PT.

That said: your reactions are all Pre-Covid World reactions. Now everybody in the medical arts is finding excuses not to do in-person appointments. It's annoying but you've got to be sympathetic: every in-person encounter could be risky. Nobody can evaluate the risks except the anti-maskers. None of the medical people signed up for combat duty. This is the way of the Brave New World, unfortunately. Ultimately some good will come of it- - we'll develop better tell-health tech.

My suggestion to the OP: if it's along your instep, it could be tendinitis. I'm just starting to develop it. I assumed it was shoes, not cycling. PT appointment on Monday.
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Old 10-30-20, 10:07 AM
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Definitely get it looked at. I get swelling in one of my feet/ankles, but its from DVT blood clots cause by a genetic abnormality. My PCP recognized it immediately when he walked into the exam room and saw my feet dangling over the edge of the exam table. Not saying you've got clots, but as others mentioned it could be edema that's causing fluid build-up or a muscle injury that's not healing properly. Get it checked out.
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Old 10-30-20, 10:17 AM
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My saddle was tipped 0.1° from optimal, and look what happened:


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Old 10-30-20, 10:18 AM
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Originally Posted by Elbeinlaw
Slow down. I'm no defender of the medical profession, but y'all are making the same kind of baseless ( let's say "evidence free" ) judgment you accuse the doc of making. We don't know what else he knows about the patient, or whether he did a video consult or got a compate description. In any case, what he did not do was even more appropriate: he did not prescribe a course of treatment without an examination. It seems to me that his referral to an orthopod was appropiate. Though it would be better to be a referral to someone who understands soft tissue, like a physiatrist or even a PT.

That said: your reactions are all Pre-Covid World reactions. Now everybody in the medical arts is finding excuses not to do in-person appointments. It's annoying but you've got to be sympathetic: every in-person encounter could be risky. Nobody can evaluate the risks except the anti-maskers. None of the medical people signed up for combat duty. This is the way of the Brave New World, unfortunately. Ultimately some good will come of it- - we'll develop better tell-health tech.

My suggestion to the OP: if it's along your instep, it could be tendinitis. I'm just starting to develop it. I assumed it was shoes, not cycling. PT appointment on Monday.

I do know that at least one of the people you're scolding here is an actual medical doctor, so I think I'd probably go with his judgment on whether this referral was appropriate over yours, COVID world or not.

There's too many things this could be to assign it to a particular specialist without it actually being examined. Also, I can't speak for OP, but where I am, getting in to see a specialist of any kind takes a long time. I'd be super-pissed if I waited a month or more for an ortho appointment, then have the ortho decide it's not an ortho problem.
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Old 10-30-20, 11:05 AM
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Originally Posted by Elbeinlaw
It seems to me that his referral to an orthopod was appropiate.
We simply don't know.

My sister developed swollen ankles. The cause was chronic myelogenous leukemia. Would an "orthopod" pick that up?
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Old 10-30-20, 11:22 AM
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Originally Posted by wgscott
We simply don't know.

My sister developed swollen ankles. The cause was chronic myelogenous leukemia. Would an "orthopod" pick that up?
An orthopod would take about 94 seconds to establish the fact that there was nothing musculo-skeletal going on and refer back to the primary care doc.
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Old 10-30-20, 12:07 PM
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Originally Posted by MoAlpha
An orthopod would take about 94 seconds to establish the fact that there was nothing musculo-skeletal going on and refer back to the primary care doc.

Like I said above, though, in the meantime, the person might have waited several weeks to get that 94 seconds.

I agreed with you above when you implied that the PCP needs to screen for other causes BEFORE they make the referral.
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Old 10-30-20, 02:54 PM
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Originally Posted by Elbeinlaw
. It seems to me that his referral to an orthopod was appropiate.
This is not appropriate. Orthopedic surgeons like to do....surgery. They don't want to see people in the clinic with non-descript ankle swelling all day long and at the end of the day, not have anyone signed up for surgery. It's a waste of their time. Additionally, it prohibits those with real pathology to be able to get an appointment. Primary care needs to do at least something. Examination, x-ray, NSAIDs, physical therapy, ....something. Furthermore, if an in-person examination is a risk due to Covid, which of course it is, you're expecting the Orthopedic surgeon to the the in-person examination instead? Telemedicine, is convenient and safe, but has significant drawbacks regarding examination. At some point somebody has to touch the patient.

Last edited by Jicafold; 10-30-20 at 03:20 PM.
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Old 10-30-20, 03:50 PM
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Elbeinlaw
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Well, Jicafold, you have a right to your opinion. But you don't have a right to your own facts. And the fact is, that the OP said explicitly that his doctor referred him to an "orthopedic specialist," which in the modern Western world means many things beyond an orthopedic surgeon. In the orthopedic practice I use, there are orthopedist generalists, non-surgical-intervention specialists, physiatrists, soft tissue specialists, pain management specialists, and surgeons, among others that I've never had to think about. Now maybe you just misread what he said, maybe you made an assumption, or maybe you're doing what we trial lawyers do: creating a straw man when you can't beat the actual argument on the table.

I don't really care, and I don't care to have a stupid argument about it. You want to win badly enough to make stuff up? OK. You win. I surrender. You're smarter and more knowledgeable than I am and you're probably wealthier and better looking. Bully for you. Congratulations.

Now lets turn back to the real issue. It's the OP's pain and his request for input on that issue. People who post here are in some kind of trouble and need help, not peoples' stupid arguments about extraneous stuff. Maybe you could respond to that, not your opinion about my opinion about someone else's critique about what the doctor (who knows more about the OP's situation than any of us) did.
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Old 10-31-20, 08:57 AM
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Well, I am pretty good looking. Thank you. It is extremely likely, like 99%, that "orthopedic specialist" was meaning orthopedic surgeon. A safe assumption beyond a reasonable doubt.. You don't send someone to pain management or soft tissue specialty, or physiatry right off the bat. They are not the gatekeepers of the clinic. However, a FACT still is that the primary care provider should still do something. It's not their job to refer everyone out and not do any real work. As an employee in an orthopedic practice, the central focus of that practice is surgery. Amongst them are general ortho surgeons as well as specialty surgeons. The primary focus is not only to get a proper diagnosis but also separate the wheat from the chaff. Surgery or no surgery. Then at that point you may consider pain management, etc. I work there, help patients, and know first hand how it works. I don't sit back in a comfy chair and sue those providing that service.

Furthermore, I already provided him advice to see another different primary care provider. I imagine you skipped over that in your cursory read. Myself and other contributors to this thread were all on track here until somebody said "whoa whoa whoa", like they were chasing an ambulance.

An update from the OP would be nice so we can put our minds at rest and find his diagnosis.

Last edited by Jicafold; 10-31-20 at 06:23 PM.
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Old 10-31-20, 10:38 AM
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I have occasional ankle discomfort, usually as a result of a heavy cycling load over consecutive days. It was diagnosed as the tendon or ligament (I forget) that runs in front of the inner ball of the ankle being inflamed. It responds to 15 minutes of ice when it is acting up. I’d try that first.
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