In late 2017, one of my columns addressed whether you can determine if your joint issues are related to being active, normal aging, or diabetes (DiabetesInControl.com). The answer was that you really couldn‘t determine the exact cause(s), but any or all of them may be contributors. Does it matter more if you know the underlying cause if you can figure out the best treatment? Let‘s discuss this more in the context of my recent injuries.
Over the past three years, I have continued to have nagging joint injuries or develop new ones, all while being as physically active as possible (and still aging and having type 1 diabetes). For example, I had an acute painful issue with the plantar fascia (arch) of my left foot after walking (with shoes on) on the beach for miles, which forced me to hobble around on the outer edge of that foot for weeks afterward and led to a stress fracture in my fifth metatarsal (outer foot bone) that took the usual 6-8 weeks to heal. I assumed it would be fine after healing, but when I resumed my normal 5-mile walks (on pavement, not the beach), I started experiencing pain around the outer side of my left ankle and foot—which I have been dealing with off and on now for close to three years. What do you need to know about dealing with similar chronic, nagging injuries? The following points are relevant:
#1: Determine the underlying issue
Even if you do not know the cause of your problem (such as aging or diabetes), it helps to understand the underlying issue. In my case, my ankle/foot pain was due to inflamed peroneal tendons (peroneal tendinitis), which I first self-diagnosed and then had confirmed by a podiatrist. X-rays and other tests may be able to determine if you have arthritis in joints and allow you to rule out other issues. My current finger issues recently were identified by a hand doctor as a Dupuytren‘s contracture and a trigger finger, both of which I could be more prone to due to genes, injury, or diabetes (1).
#2: Find the best treatment to fix the problem instead of just treating the symptoms
I tried many different remedies on my own to deal with my ankle/foot symptoms for years, including the traditional R.I.C.E. (rest, ice, compression, elevation), occasional ibuprofen, different shoes, supports in my shoes, and walking less far or less frequently, depending on the level of pain and inflammation. None of these treatments worked long-term. More recently, I revisited my podiatrist for a referral to a physical therapist—who finally helped me fix the real problem (and it was not the ankle inflammation). I had weak muscles in my lateral foot and a severe lack of flexibility in my calves and ankles; the tendinitis resulted from the way these problems made me walk.
#3: Most treatments involve both stretching and strengthening exercises
Although I thought I was doing plenty of regular stretching to stay flexible (since we are losing flexibility as we age, and diabetes can accelerate these losses), fixing my chronic ankle joint pain required going beyond the regular exercises I had in my repertoire. This is where the physical therapist helped tremendously. From here, I learned that I had not been stretching effectively, neither long enough nor focusing on the right areas. In older age, people likely need to hold each stretch closer to 60 seconds total rather than just 15 to 30 seconds, and I had to do stretches other than my normal ones to overcome the tightness in my calf muscles. Not being able to dorsiflex my ankle normally due to inflexibility when walking was contributing to the problem. Even just typical loss of motion around joints with aging can interfere with people doing normal daily activities, and diabetes and physical inactivity can contribute to inflexibility. Especially in older individuals, some decreasing flexibility may be related to nerve dysfunction and not just to structural changes in the muscle-tendon unit (1-3), but stretching still helps regardless.
One other important aspect of overcoming my joint issue was learning the appropriate strengthening exercises to do. I have been consistent with resistance training for most of my adult years, but my compensatory bad walking techniques had caused me to lose the strength needed to keep my foot from rolling out when it came to my left ankle and foot. I had to learn and frequently practice many exercises targeted at restoring my foot and ankle’s strength to walk properly (heel to toe) and reduce my ankle tendon irritation.
Adequately strengthening the muscles in various areas of our bodies is critical to managing and preventing many joint issues and pain. Working to strengthen weak back and core muscles can reduce and prevent low back pain; exercises strengthening muscles around affected joints can lessen arthritic pain, and even Kegel (pelvic floor) exercises can help control urinary incontinence. In the case of an issue like Dupuytren‘s contracture or trigger finger, too much stretching may aggravate the condition. However, it still helps me to keep the surrounding muscles strong with targeted finger and hand exercises.
#4: Seek out expert help for solutions (if you need to)
It took a physical therapist to set me on the right path to overcome my ankle/foot problem, even though I consider myself to be quite knowledgeable about exercise, so don‘t feel bad if you need to seek out expert help in learning the right exercises to do. Just keep in mind that disuse is the greatest contributor to muscle atrophy and weakness, although being too active (and bad form) can sometimes cause problems. In general, it takes regular (and specific) training exercises—for both flexibility and strength—to stay on top of joint and muscle health. In most cases, it is not just aging or diabetes alone that causes your joint issues.
- Broekstra DC, Groen H, Molenkamp S, Werker PMN, van den Heuvel ER. A Systematic Review and Meta-Analysis on the Strength and Consistency of the Associations between Dupuytren Disease and Diabetes Mellitus, Liver Disease, and Epilepsy. Plast Reconstr Surg. 2018 Mar;141(3):367e-379e.
- Hirata K, Yamadera R, Akagi R. Associations between Range of Motion and Tissue Stiffness in Young and Older People. Med Sci Sports Exerc. 2020 Oct;52(10):2179-2188.
- Nordez A, Gross R, Andrade R, Le Sant G, Freitas S, Ellis R, McNair PJ, Hug F. Non-Muscular Structures Can Limit the Maximal Joint Range of Motion during Stretching. Sports Med. 2017 Oct;47(10):1925-1929.
- Konrad A, Tilp M. Increased range of motion after static stretching is not due to changes in muscle and tendon structures. Clin Biomech (Bristol, Avon). 2014 Jun;29(6):636-42.
Sheri R. Colberg, Ph.D., is the author of The Athlete’s Guide to Diabetes: Expert Advice for 165 Sports and Activities (the newest Diabetic Athlete‘s Handbook). She is also the author of Diabetes & Keeping Fit for Dummies, co-published by Wiley and the ADA. A professor emerita of exercise science from Old Dominion University and an internationally recognized diabetes motion expert, she is the author of 12 books, 34 book chapters, and over 420 articles. She was honored with the 2016 American Diabetes Association Outstanding Educator in Diabetes Award. Contact her via her websites (SheriColberg.com and DiabetesMotion.com).