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Old 02-20-08, 05:22 PM   #1
creepingdeath
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what's wrong with me?

I just got done with an approximate 200 mile tour in 2 1/2 days, and I can barely walk because of my ankle. I stand up a whole lot when riding, mainly because my ass gets sore from the uncomfortable seat and riding position of my bike, and it bothers my knees if I sit too much.

My ankle is swollen some, red, and is very warm like it has fever in it. The top of my foot has some pain too, but it's mainly my ankle. It hurts so bad that I can barely put my shoe on, have trouble walking, and have almost fell down a few times while standing too. My right ankle is the only one affected.

This sort of thing happens to me on every tour, but never as bad. Usually, my feet swell up because of the way I stand while coasting and it squeezes my toes into the tip of my shoes, and I've had to buy a size bigger pair of shoes on tour before. My right ankle is always the one that gives me problems as well, but after a good night's rest the swelling subsides and I can still function good enough to keep going. My feet didn't swell up this time, but my ankle is hurting so bad that I want to curl up in the fetal position and die.

My aunt broke her ankle a long time ago, and since then, it still swells up depending on how active she is. I've never broken my ankle, but I've talked to other bike tourers, and none of them have had this problem. Is this a fairly common thing for cyclists, or do I possibly have some other unknown physical problem? Any other advice for curing this or avoiding it in the future?
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Old 02-20-08, 05:29 PM   #2
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I am not a doctor. But I think you should see one. If you enjoy cycling, and are fit enough to be able to ride 200 miles in 2.5 days, this kind of pain is abnormal, IMHO.

One clue is in the first sentence of your post ("...the uncomfortable seat and riding position of my bike.").

If I were you I would (a) see a doctor about the acute pain you're suffering now and then (b) see a professional bike fit specialist to figure out why biking is causing you so much pain.
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Old 02-20-08, 05:56 PM   #3
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^^^ +100

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Old 02-20-08, 06:02 PM   #4
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not a doctor, but that sounds similar to my friend's torn achilles. I second the bike fit tip. they'll also be able to diagnose any mechanical issues with your bike that may be contributing to the problem (bent bb spindle, twisted crank arm, bent pedal spindle).
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Old 02-20-08, 08:13 PM   #5
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*MEDICAL* bike fit.
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Old 02-20-08, 09:33 PM   #6
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Sounds like a plain old "overuse" injury to me. Perhaps combined with some mis-alignment. Take some anti-inflammatories or aspirin and see the doc. If you ride higher mileages regularly this would be unusual, but if this is significantly higher mileage than what you normally ride, any slight bio-mechanical issue (alignment, etc) will get magnified. The same thing used to happen to me when I would first run 10 or 12 miles after the winter short runs - I would inevitably hurt myself and be in considerable pain for a few days.
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Old 02-20-08, 09:42 PM   #7
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not a doctor, but that sounds similar to my friend's torn achilles. I second the bike fit tip. they'll also be able to diagnose any mechanical issues with your bike that may be contributing to the problem (bent bb spindle, twisted crank arm, bent pedal spindle).
While it may be a torn achilles tendon, I can say that the description provided in the original post does not describe either torn achilles tendons I suffered (I've torn both my achilles tendons). Both of my tears were complete and required surgery (left to their own, healing would have been much prolonged compared to surgery); for neither was there much swelling or pain (just an ache). No doubt, however, there is some muscle or tendon problems you are facing there.

If you have a road bike that is causing so much discomfort, maybe you should consider a more upright bike with an uncut steering tube (like the Surly LHT) to get the bars equal to or higher than the seat. And get a seat that does not cause that kind of discomfort -- many will suggest Brooks (b17 or b67, for example), but I'm sure there are others that can help too.
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Old 02-20-08, 09:56 PM   #8
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It is essential that you see a doctor as soon as possible. Without an accurate diagnosis, there is no telling what is really wrong. So run, or at least hobble, to your nearest sports medicine specialist, and be prepared to explain exactly what you were doing, and how you were doing it, when the problem arose.

At the same time, start looking around for somebody who can assess your riding position and bicycle fit. Many bicycle stores have somebody on staff with this kind of expertise. Personally, when I had knee pain from riding, I made an appointment with a kinesiologist who also a bicycle racer. She made a number of very small adjustments to my bicycle, and made suggestions on improving my pedaling technique. I found that these tiny adjustments made a tremendous difference. You need somebody with an experienced eye to be able to spot small problems that become magnified into larger ones. (For example, she rotated one of my cleats just a couple of degrees to bring my knees into better alignment.)

Most injuries to get better with proper treatment and rest, so be optimistic! I did a number on my knees 25 years ago from doing improper stretching, and although I still have the occasional flareup, I am still able to do multi-day bicycle tours, pain-free. For me, at least, the two keys have been good medical care, and proper bike fit/riding technique.

As well as being optimistic, be patient. Many injuries get better, but it may take time. As one of the sports medicine physicians said when sending me for physiotherapy, I would need to do the exercises for several months before I would begin to see improvements. He was right!
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Old 02-20-08, 10:21 PM   #9
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Also, maybe you don't have low enough gearing? Maybe?
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Old 02-20-08, 11:06 PM   #10
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I am not a doctor. But I think you should see one.
I am a doctor. I think you should see one.

Also a bike fit pro and a cycling coach.

Sounds like you have serious issues with bike fit and technique that need to be looked at after you recover from the current problem.
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Old 02-21-08, 01:52 AM   #11
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#1. It's not overuse ... you've only done 200 miles.

#2. You DESPERATELY need to get your bicycle professionally fitted. Urgently. Right now. Your butt hurts, your knees hurt, and your ankle hurts ... this is absolutely NOT normal. Cyclists can ride a 1200 km randonnee (that's 750 miles in 3.5 days) and not be in as much pain as you are right now.

#3. You NEED to see a Dr. right now. I'm not a Dr. but I have torn my Achilles tendons, and it sounds like that could be what you've done. If it is, you could be off your bicycle for the next 6 months ... all because you didn't set your bicycle up correctly.

#4. You are aware you can change your saddle, right?

First thing in the morning, go and see a Dr. When you get out from seeing the Dr, contact the Oregon Randonneurs: http://www.orrandonneurs.org/ to see who they would recommend as a bicycle fitter in your area.
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Old 02-21-08, 02:56 PM   #12
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I should've rephrased my question, because I already know my bike doesn't fit me as well as it should, and that's probably a big reason it's causing me so much pain on longer rides. The main thing I was trying to find out is what might be medically wrong with me; shin splints, cowardness, etc.

I can't afford to go to a doctor since I have no insurance.

I'm 5'9", and my bike has a 22" frame, so I think it's probably too big for me anyway, but most of the time it doesn't bother me at all. Tours are the only time it messes me up really, and I figure a big part of that is simply because of the fact that I'm going from 25 mile rides unloaded, to 65-100 miles a day with a bunch of crap strapped to me and my bike. My butt, feet, knees, and ankles always hurt the first three or four days of any tour, but then it usually subsides and I can ride the rest of the time in relative comfort. This is the only time where I hurt this bad though, and I've still got some swelling and am hobbling around like a hunchback in a bell tower, but it's not as severe as it was yesterday, so there's hope yet that I won't be doing my next tour in an electric mobility chair.

I'm staying off my bike and feet as much as possible for a few more days at least (I'll starve if I don't get back to work though), but if I'm still this messed up a week from now, I'll go ahead and sell a kidney or some sperm or something so I can go to a doctor.

Hopefully, this summer I'll have the money to get a nice touring bike that fits me, but I'm stuck with what I got till then. Money aside, I'm not getting rid of this one till I get 20k miles on it anyway(I'm still about 3.5k miles away), even if it means I'm sterile, impotent, and crippled by the time I achieve that goal. I've got too much time, money and pain invested in it to quit now, and like I already said, most of the time the bike fitment doesn't bother me at all.
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Old 02-21-08, 04:49 PM   #13
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The main thing I was trying to find out is what might be medically wrong with me; shin splints, cowardness, etc.
All we can tell is that you need to see a doctor. There is no way you can get anything even remotely resembling "quality medical care" from a web forum.


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I can't afford to go to a doctor since I have no insurance.... Hopefully, this summer I'll have the money to get a nice touring bike that fits me, but I'm stuck with what I got till then.
I'm a big fan of buying a nice touring bike, but in this case I think you need to forget about the bike and figure out how to pay to see a doctor.
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Old 02-21-08, 04:55 PM   #14
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There's a good chance you've pulled or torn your Achilles Tendons. Look up Achilles Tendonitis ... look at the medical sites, not the advertizing sites or Wikipedia.

For now, rest, ice, elevation (I hope that since you don't have insurance and can't visit a Dr. that you've at least got your first aid certification) ... walk as little as possible, and stay off the bicycle for the next couple weeks. If you can't afford to see a Dr., I'm betting you can't afford surgery either. How soon can you get insurance or save up enough to see a Dr?

Before you get on the bicycle, make the necessary adjustments to get it to fit. Achilles tendonitis is generally caused by a saddle that is too high, although on occasion it can be caused by a saddle that is too low. Where do your knees hurt ... that could be a clue as to whether your saddle is too high or too low. Read over the following two articles. Most issues can be fixed by a few simple adjustments, even if your frame is the wrong size.

http://www.peterwhitecycles.com/fitting.htm
http://www.cptips.com/knee.htm

You can also change your saddle, as I mentioned before, and it doesn't have to cost you a whole lot. That might help some of your issues.

If you heal and decide to do another tour (on a properly set up bicycle this time), I would strongly recommend gradually building up your distances. Don't go from 25 miles to 60-100 miles all at once. Instead do some 35 mile rides, a little later do some 45 mile rides ... give your body a chance to get used to it.

Last edited by Machka; 02-21-08 at 05:02 PM.
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Old 02-21-08, 05:20 PM   #15
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Money aside, I'm not getting rid of this one till I get 20k miles on it anyway(I'm still about 3.5k miles away), even if it means I'm sterile, impotent, and crippled by the time I achieve that goal. I've got too much time, money and pain invested in it to quit now...
You may get your wish on the "crippled" part, and just to reach the goal of racking up 20,000 miles on your bike? If you insist on riding a poor-fitting bike another 3,500 miles, you may end up in a position where your current bike is the last one you can ride. Based on what you've written -- for starters, the fact that your bike fits so poorly that you "coast" a lot -- I would suggest you learn about fit, and either sell your current bike on Craigslist or scrounge up the parts required to make it fit better.

I'm sympathetic to the difficulty of affording good medical care. However, I believe you should take responsibility for the fact that you may be doing yourself serious damage. It's a bad situation to be in if you're uninsured.

Listen to Machka.
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Old 02-21-08, 07:25 PM   #16
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I can't afford to go to a doctor since I have no insurance.
You're in the world's richest country - surely there's some sort of public clinic you could go to?

What about a teaching hospital (ie. one that a medical school is attached to), do they have clinics?
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Old 02-21-08, 10:13 PM   #17
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Go see a doctor, you need to prioritize what's important here. Your health should be at the top of your list. By the way, are you married? if so tell her how bad off you are and she should make sure you go.

And the next thing you should do is get a recumbent bike. LOL

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Old 02-21-08, 10:45 PM   #18
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Do you wear shoes that are too big? Or too small? Too narrow? Too wide? NO?!?
Obviously bike does not fit you. Sell it and get one that fits.
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Old 02-21-08, 10:55 PM   #19
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Is there any kind of creaky feeling in your ankles?

I too think it sounds like tendonitis or some variation on that. Perhaps you just need to take it easier on your tours?

When we first started our trip, the third day in I had to go to the hospital because I was in so much pain from my ankles, which had a creaky feeling to them and were swollen as well. We had cycled about 100km a day for the three days.

I couldn't walk let along cycle, going up and down stairs was a nightmare. The doctor laughed at our plans to bike around the world (take a bus, he said) and loaded me down with painkillers and anti-inflammatories. We did continue but a lot slower, taking the drugs and stopping frequently to elevate my ankles and put them on ice. With training, my ankles got used to cycling and don't bother me anymore, although if we do a long day I can feel them start to hurt slightly, a warning sign not to do too much.

If you are using clips or powergrips or anything else like that, make sure they are adjusted correctly and not causing the problem.
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Old 02-21-08, 11:27 PM   #20
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You're in the world's richest country - surely there's some sort of public clinic you could go to?

What about a teaching hospital (ie. one that a medical school is attached to), do they have clinics?
Medical clinics still charge. Gotta pay for the football team's steak dinners somehow.
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Old 02-21-08, 11:33 PM   #21
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There's a good chance you've pulled or torn your Achilles Tendons. Look up Achilles Tendonitis ... look at the medical sites, not the advertizing sites or Wikipedia.

For now, rest, ice, elevation (I hope that since you don't have insurance and can't visit a Dr. that you've at least got your first aid certification) ... walk as little as possible, and stay off the bicycle for the next couple weeks. If you can't afford to see a Dr., I'm betting you can't afford surgery either. How soon can you get insurance or save up enough to see a Dr?

Before you get on the bicycle, make the necessary adjustments to get it to fit. Achilles tendonitis is generally caused by a saddle that is too high, although on occasion it can be caused by a saddle that is too low. Where do your knees hurt ... that could be a clue as to whether your saddle is too high or too low. Read over the following two articles. Most issues can be fixed by a few simple adjustments, even if your frame is the wrong size.

http://www.peterwhitecycles.com/fitting.htm
http://www.cptips.com/knee.htm

You can also change your saddle, as I mentioned before, and it doesn't have to cost you a whole lot. That might help some of your issues.

If you heal and decide to do another tour (on a properly set up bicycle this time), I would strongly recommend gradually building up your distances. Don't go from 25 miles to 60-100 miles all at once. Instead do some 35 mile rides, a little later do some 45 mile rides ... give your body a chance to get used to it.
He's got to be very careful about seeing a doc and remember the "pre-existing condition" clause. If he's uninsured, goes to a doc for a diagnosis, then gets insurance, he's in the "pre-existing condition" situation and will have to wait or will never get that condition fixed by insurance. Basically, it means that the condition was happening outside of insurance coverage, ergo, they don't have to pay. If the condition occurs while he's on insurance, and has had insurace non-stop since, then, it's not a "pre-existing condition".

In CA, Blue Shield of CA is now asking/ordering physicians to report all pre-existing conditions to them. This is TOTALLY against doctor/patient privacy issues. Not sure where it will end up, but, you have to be VERY careful out there.

Meanwhile, if you can't get insurance, stay off the bloody bike. You could end up without a foot.
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Old 02-21-08, 11:35 PM   #22
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Ooops, sorry all. I "replied with quote" in the wrong post. I didn't mean to quote Machka. (what she said has little to do what what I wanted to say.) Apologies!
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Old 02-22-08, 12:36 AM   #23
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He's got to be very careful about seeing a doc and remember the "pre-existing condition" clause. If he's uninsured, goes to a doc for a diagnosis, then gets insurance, he's in the "pre-existing condition" situation and will have to wait or will never get that condition fixed by insurance. Basically, it means that the condition was happening outside of insurance coverage, ergo, they don't have to pay. If the condition occurs while he's on insurance, and has had insurace non-stop since, then, it's not a "pre-existing condition".

In CA, Blue Shield of CA is now asking/ordering physicians to report all pre-existing conditions to them. This is TOTALLY against doctor/patient privacy issues. Not sure where it will end up, but, you have to be VERY careful out there.

Meanwhile, if you can't get insurance, stay off the bloody bike. You could end up without a foot.
Actually, it is doubtful if he goes to a medical clinic for one or two visits, that his diagnosis will ever be accessible to an insurance company a year or two later. Medical records are not stored in a single large database and they do not automatically follow a person - you have to request them if you want a doctor in a different medical group to see them. And assuming he heals, it will be fine. The types of pre-existing conditions that one needs to worry about are the biggies that don't get better - heart and kidney disease, cancer, etc.

And FYI on the Blue Cross/Blue Shield thing, they rescinded it the next day due to all the flak they received over it. Wasn't worth the negative press and ill-feelings from the doctors.
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Old 02-22-08, 01:11 AM   #24
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I wonder a little about a vascular problems though I doubt that would cause the pain you are decribing. If there is a predisposition to varicose problems in your family, it might be worth noting. You can cycle with elastic support if required.

It is really weird to need to stand as you suggest you are. You probably don't need (or can't afford) a pro fitting. Just go to one of the online fitting programs, and read a few fitting articles. See if you can find a trade for your bike. You might as well stretch yourself on the rack as ride on a frame that is as big as you describe. Then when you get whatever properly sized bike, drop a plumb bob to line up your knees over the pedals. Work incrementally and slowly on your seat height and set back.

Never, never, never, ride past structural pain. If it is hurting you, find the problem first. It is when you feel the first whisper of discomfort that you need to work on your adjustments. If you push through to further injuries you are ruining the opppotunity to sort out your problem by just lumping others on top.

Set some appropriate goals, and the first important goal when riding a bike is to keep it comfortable, or you just burn up the engine.
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Old 02-22-08, 01:33 AM   #25
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I can't afford to go to a doctor since I have no insurance.
(snip)
I'm staying off my bike and feet as much as possible for a few more days at least (I'll starve if I don't get back to work though), but if I'm still this messed up a week from now, I'll go ahead and sell a kidney or some sperm or something so I can go to a doctor.
OK, seriously, this is messed up. Medical care should NEVER be a commodity on the open market (to say nothing of body parts or fluids). I'll go back to my idealistic socialist corner now but I can never read/hear things like this without squawking in alarm and then swearing a lot.

First, you should look into all possible avenues for getting proper medical attention. Emergency room, clinic, whatever - if there's a chance you may have done serious damage, you MUST get checked out or you could end up in a far worse position later. Borrow money from friends and family, whatever it takes. Hell, come to Canada and go to an ER. You'll wait ten hours and have to pay a fee for not being a resident, but it'll still be cheaper.

Second, you need to be absolutely vigilant about staying off that foot and keeping it iced and elevated so that you do not do any MORE damage, for several days at least. (Talk to someone about alternating heat and cold - that is good for some types of overuse injuries because it increases blood flow through the area and flushes out all the torn up bits of cells and such, but you have to be really careful about the timing on that. Coaches would know, as would chiropractors, physiotherapists, and (don't laugh) large animal veterinarians (they use it on horses all the time)).

Third, get rid of the bike before you destroy your knees, ankles and hips. 20,000 miles is an admirable goal, but it's an arbitrary number when you come down to it. Continuing to ride a bike that does not fit for 3,500 miles to reach that arbitrary goal is just plain stubborn, if not stupid. Sell it and get your ankle looked at. You can worry about getting another bike later.

Fourth, if you are doing *anything* and it hurts, that means STOP DOING THAT. Seriously. All the people who said "no pain, no gain" in the 80s are using walkers, or have had hip and knee replacements, or are freaking DEAD now. Pain is a feedback mechanism that protects us. There is a case study in one of my textbooks that talks about a young Canadian woman who was born without the ability to feel pain. She died of accumulated injuries and bone infections before she reached 30. Her joints were completely arthritic because she never felt the discomfort of standing or walking in awkward ways, so she just kept doing more damage.

*smacking you over the head with a Nerf bat*
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