Days 27-61: Obla di obla da

It has been awhile since my last post. In an attempt to finish my master's thesis, I have been absorbed in my work for the past few weeks... The good news is that my mad-dash to the finish took my mind off of being in a cast and boot.

Three weeks ago I got my cast off. It was a happy and scary day. I was nervous of what sorts of pains I would feel once had to walk on my foot again. The cast removal process was not as graceful as when they put it on... Nonetheless, it eventually got taken off. My foot and lower leg was pretty gross. Still had caked on blood from the surgery, and there was lots of dead skin. You would be amazed at home much dead skin cells people shed every day. When those skin cells aren't able to escape onto the couch, bed, desk, etc... they start to build up. I made sure when I got home to take a long shower. I think I washed my leg and foot over a dozen times. It was a great feeling. Anyway...since then I have been booted. The boot and I have a long lasting relationship, which goes back over a year. This is my fifth time being in a boot for over four weeks. In terms of bootage (unit of measure I use for the # of boots), I am on my fourth boot... if this blog doesn't work out, I may be able to start another blog reviewing the makes and models of the various boots I have utilized. I actually did have a in-depth discussion with a woman telling her the pros and cons of the boot I was wearing and how it compared to others... believe me, it was a riveting conversation. I think it would be an equally exciting conversation piece at parties in the future. For the first week in the boot, I had to use crutches and put little weight onto my booted foot. After a week, I found that I could walk OK in the boot without much pain (mainly just soreness). I have worked my way up to walking around the grocery store and even Walmart. Focusing on the later of these two places, I have received great joy being among the great people that grace Walmart with their mullets, bellies, and most of all American flag t-shirts. Walmart society is complex but intriguing, and I have gone to Walmart twice now just to bear witness to its almost mystical qualities (I get bored). Although I hobble more than walk, it is a great accomplishment for me. I can't describe how nice it is to be able to get around somewhat normally again. I will need to start doing some physical therapy soon. My left leg and calf has atrophied by about half its original mass.

Rather than show boring gross pictures of my foot, I have included a picture of my cat as well as a new dog member to the family named Maya (gf's dog pictured below). Just having the company of both of these pets has helped me out more than any crutches or boot.

Days 19-27: Over the hump

I am past the halfway point. My cast will be sawed off two weeks from now. Of course I will have to wear a boot afterwards, but I would take a boot over a cast any day. I have been staying sane by going out every once and awhile to the store or to my office. However, I don't do a lot besides sit in my house and work. There is not really much else you can do with crutches. It is just too difficult and takes too much energy to orchestrate doing anything more. On a positive note, my immobility has allowed me to get a good bit of work done... so that's good. I also got pushed around the grocery store by my gf. A big thanks to her for putting up with me.

Days 15-19: Pumpkickin

Made it over a third of the way now... at least in terms of splint and cast time. Unfortunately, my meager physical state and tight deadline for my thesis completion has kept me inside my dark cave of an apartment for the majority of the past few days. This has been a bummer since late October and Halloween is one of my favorite times of year. It's a weird thing to spend a whole day without ever breathing outside air or having sunlight hit you. I can't go outside now unless it's dark or I will start to fry. This may be my calling to become a vampire... True Blood on crutches coming Fall 2015. I at least got to carve a pumpkin with my gf (left in picture). I would consider my pumpkin a little more rustic than refined. The mouth turned out the way it did as an attempt to recover from some breakage.
     My foot is feeling pretty good. Toes are less fat and doesn't hurt that much if I bump into stuff. Frodo Baggins feet are fading away. One peculiar thing I have learned is that dogs love to lick my toes. I don't find it annoying, but I would like the dogs to realize that my toes are probably pretty gross. They only receive a rudimentary washing every few days. Maybe that's why the dogs like them... I am not to judge. My cast is getting some signatures and personalized art work. It could be a good idea to hang my cast on the wall as a piece of art after it gets removed. Of course, I will encapsulate it in a glass box...for preservation and containment of smell.

11-14: Cast me baby

The days of bed rest are over. The past few days I have returned to 'normalish' life. Of course, I still mostly stay at my home, but I do venture out every once in  awhile to be part of society. I can mostly take care of myself now, except for doing major things like laundry and taking out the trash. My foot does not really hurt anymore unless I bump it against something. I went on Tuesday to get my splint off and get a cast on my foot. After they took off the splint, they left my lower leg and foot exposed for about 15 mins as the surgeon talked to me and the nurse prepped for the cast. My foot was still considerable swollen. Could have just been from the poor circulation with the splint. Either way it looked like they swapped out my foot for Frodo Baggins's during surgery. I wanted so bad to stretch and bend it, but I couldn't. If I tilted my foot the slightest deviation from ninety degrees, it didn't feel so hot.
     The surgeon said the wound was healing up well. He also talked to me about the surgery, and told me the injury I have is called a proximal variant lisfranc. Presumably, this is an injury that is just now becoming recognized. Since it presents with subtle deformities in ligamentous and bone anatomy of the foot and symptoms are similar but not the exactly same as a common lisfranc injuries, many orthopedics aren't aware of it. Lucky for me my surgeon is one of the up and coming doctors recognizing and completing surgery to fix this injury. Anyway, the surgeon said he is very happy with the turnout and expects a good recovery. After I talked with the surgeon, I got my stitches removed and got a nice short leg cast. The nurse put it on well, so it is not too tight...which is clutch. I like the cast better than the splint. It is more protective (i.e. if I bump into anything) and doesn't go as far up my leg. Also, it lets my toes and a good portion of my leg below the knee breath. Past experiences with a cast have shown me that breath-ability is imperative...not only for itches but also for minimizing post-cast nastiness.

Luna being weird on top of my cabinet 

Day 8-10: The sun

The last three days have gone by in a blur. I literally did not leave my room except to go to the bathroom for 48 hrs at one point. After stepping outside into the sun, I felt like one of those Indian children from 'Indiana Jones and the Temple of Doom'. Today was my first day of feeling like a real person in a week and a half. I went out this morning, with the help of my gf, and got a handicap parking pass...I'm totally legit now.

Even better, I went and read in a park by a river this evening. I know it doesn't seem like a big deal, but going from laying in my dark room with only my computer or TV for company to the fresh air and sun is a big deal for me. It definitely puts me in a better mood and lets me appreciate the simpler things that I would sometimes let go unnoticed. There was one point when I was at the park that I stared at the moon for 10 mins. I was mesmerized. I couldn't get past the thought that I was staring at a big hunk of rock orbiting around the Earth... and people had stood on it! I have been reading 'The Martian', so planets and space travel have been on my mind. The book is about an astronaut that gets left behind on Mars after a botched mission. The thought that people can be sent up to the moon in a small metal vessel with on-board computing power equal to or less than my flip cell phone is amazing to me. Of course, some people think the Apollo Lunar missions were all a hoax....just a giant conspiracy to cause the Soviet Union to go bankrupt (from interstellar...even doped up I still remember a few things). I was ranting about all this to my gf in the car on the way to Chipotle. She wanted me to shut-up, but I think she really enjoyed it. Two more days to my cast.

Of course I had to include some pictures of my cat. Definitely keeps me entertained.

Day 5-7: Last day of hookie

It has been one week since my surgery. Day by day I can feel the swelling decrease in my foot and the soreness increase. The intense pains of day 1-3 have passed. Sunday was my last 'official' day of hookie. I told myself I would really get back to working by Monday... let's see how that's is going to pan out. My mom left Monday morning along with my dog Eddy. I was bummed they left because I enjoyed their company, but I at least got to see my mom for a few days. The pain medicine has gotten me in a real funk. I swear one minute I was having hot flashes and the next I was about in tears after realizing I had watched every episode of 'Trailer Park Boys' on Netflix. I am starting to decrease my dosage even more. I think I could be off of it and just use Advil as needed by the end of the week. Focusing on work is difficult, and I am overwhelmed with the things I have needed to do that have piled up. Next week I go back to the doctor so they can take off my splint and bandages and put a hard cast on me... it will be like old times. In the mean time, I am trying to take advantage of having to stay sedentary and get work done.

Day 4: Cats vs. Dogs

It was the stereotypical fall day. A cool crisp morning gave way to a sunny and warm afternoon with clear skies. Pretty much perfect weather. Unfortunately, I couldn't get out an take advantage of it. I told myself that if I took care of myself now I would be able to enjoy these type of days in the future. I felt better today. My nausea was less and the pain in my foot is a little more subdued. Overall, the day was good because I accomplished two major goals. First, I took a shower and second I was able to go to bathroom. The second accomplishment may be TMI, but it was a big deal since the medication I have been taking is like the Hoover damn when it comes to staying regular.

By mid-morning I didn't feel so crappy, so I got ambitious and decided to take a shower (I hadn't in 4 days). The shower bench and shower handle saved me. If I didn't have these pieces of equipment, I would have definitely not been able to take a shower safely. I felt great after washing away 4 days worth of grime and food particles stuck in various places. That morning before my shower was another watershed moment. My mom got me Miralax. I won't go into detail, but this is what led to my second accomplishment later that day. A tip for anyone who has to ever take pain meds... start taking something to keep you regular at the very beginning. For lunch, me and my mom ate out in my backyard. It was great to get outside for awhile and have the sun shining on me... really boosts morale. Finished watching another season of 'Great American food truck race'. The show cracks me up. There is a certain recipe (no pun intended) to these reality food shows, and I almost got the formula down. Eddy and Luna were going at it again. They fought under my bed for 30 seconds, and Luna came out as the victor. Eddy wouldn't even come out from under the bed for 10 minutes because he was scared. Luna was pissed and went up to her perch. She looked like a gargoyle/the Grinch.

On a different note, the swelling of my foot has decreased and I have more feeling in my toes. Still keeping my foot propped. I did bang my foot up against a wall when I was scootering to the bathroom. That hurt a lot. My mom has been kind enough to take care of me, and of course she insists on cleaning my entire house. Fortunately, she couldn't find too much to clean because I cleaned my house before my surgery. For dinner, my girlfriend came over and we all had thai. I find that the biggest things I look forward to during the day are meals. After I am done eating one meal, I immediately start thinking of what I want for my next. Hopefully, I don't end up like White Goodman at the end of the movie Dodgeball...

Day 3: Mama's boy

So far each night after my surgery I have been sleeping better. However, I have started get nauseous from the pain medication. I started cutting back on my dosage, hoping that will help. Most of the day went on as usual. I have finished 3 series on Netflix now...luckily there is an endless supply of top notch movies and television to watch. I probably should be sleeping more, but I am terrible at taking naps. My foot still kills but is slowly hurting less. The biggest problem is actually having to move my leg around a bit to get the blood flowing to my foot. Otherwise, it starts to tingle and then burn and then hurt really bad. To alleviate that pain, I dangle my foot off the bed for 10 mins at a time to let the blood circulate. Then I go back to propping it up on the pillows. My appetite is peculiar. I am hungry but not hungry at the same time. Actually, I just want to eat salty and fatty food for some reason. Almost like I have a hangover. Could be because of all the food shows I have been watching. Luna has been keeping me company, and making me laugh by doing weird stuff. Today my mom came. She brought up my dog Eddy too. Luna an Eddy do not get along... at first Eddy couldn't find Luna but then stumbled upon her and got a wack in the face. Luna then proceed by jumping up on the kitchen cabinets and staying up there the rest of the night. Since my mom is here it gives my gf a brake from taking care of me (probably a good thing if I still want to have a gf at the end of this). We had our favorite Indian food for dinner, and chilled. I was pretty tired so falling asleep shouldn't be too hard...except for my foot 'falling asleep' every 30 mins. Hopefully my foot will be even better in the morning.

Day 2: Interstellar

I slept better than the first night, but still had to wake up every 4 hours to take my medication. My scooter has been working well. It definitely is difficult to navigate around my small house and bathroom. Luckily it has brakes, or I would have killed myself multiple times. Interstellar was the movie choice of the day...probably not the best movie to watch on pain killers. I was definitely trippin. After Interstellar, I decided I needed something a bit lighter and less complex to watch...so I went back to my roots and decided to watch Food Network shows. Specifically, 'Great food truck race' and 'Worst cooks in America'. They fit my easy watching criteria and made me hungry. Since I upped my medication intake the pain has been less, but the swelling of my foot makes it very tender. If anything touches my toes, or even if there are vibrations it hurts. Luna has been acting unusually friendly. She was once a stray, so she gets scared easily. I have left the window open in my room all day, which she seems to love.

Day 1: Lead foot

Didn't sleep well. Had to wake up every 4 hours to take my pain medication. I was hungry for breakfast, so that was a good sign. I took a look at my x-rays from the surgery. Figure on the left shows the doctor trying to pop my first ray and cuneiform to the right... you can tell by the light coloration that he succeeded. In other words, this area of my foot was unstable (not really being held together). He put in a dorsal plate and horizontal screw to stabilize the joint complex. Throughout the morning I could feel my nerve block wearing off fast. A deep crushing and burning feeling flooded over my foot and ankle. To subdue the swelling, I had been icing my foot with a new ice pack every 20 mins. However, this was not sufficient and as my foot swelled inside the splint and bindings the pain worsened. I figured out after awhile how to re-position my foot to make the pain less, and that I could take additional pain medicine. Most of the day I just watched Netflix or worked on my computer. I had good company from my gf and my cat Luna.

The day has come

The day of my surgery I was anxious. I woke up and did any last minute chores to prepare my house for the impending doom. The weather was beautiful, so I took that as a good omen. In order to take full advantage of my last few hours of freedom, my girlfriend picked me up and we went to pick apples at a nearby orchard. Unfortunately, I couldn't eat any of the apples we picked because of my upcoming surgery. We had great time apple picking and then headed to the hospital. The first two and a half hours at the hospital were comprised of getting registered and being prepped for surgery. I got to change into a very fashionable gown, which even had ports built in to hook up for hot or cold air circulation.

After getting an iv, a team of anesthesiologists came to give me my nerve block in my leg. No more than 15 minutes later, my left leg was completely numb. Another 30 minutes and I was wheeled into the OR. About 8 doctors and nurses were scrambling around me in the surgery room. The last thing I remember were two nurses hovering above me. They were trying to pronounce my last name and giggling about it. Then one said she was giving me the sleepy medicine.

I woke up in the same room they prepped me for surgery in. I was very groggy at first, but woke up fairly quickly. There was two nurses in the room who were talking to me. I don't remember the conversation. My girlfriend then came in the room, and then shortly after was followed by my surgeon. My surgeon told us the surgery went well, and then proceeded with showing us x-rays of my foot throughout the surgery. The last few x-rays showed my foot with four screws and a plate over my mid-foot. The thought of metal screws in my foot was a bit disgruntling, but also kind of cool. After changing back into my street clothes, I got in a wheel chair and the nurses wheeled me out to my girlfriends car. I was fairly coherent at this point. When we got to my house, I crutched inside and to my bed. I had planned ahead and had already laid out pillows to prop my leg up. My girlfriend has been nice enough to stay and take care of me the first week or so of my recovery... without help I really don't know how I would get by. I started taking my pain meds right when I got home. The doctor told me I better start taking them as early as possible. Once the nerve block goes away in my leg, he told me I would be in immense pain. I don't like taking pain medication, but I think it is necessary in this situation. The thing I needed most when I got home was food. I hadn't eaten anything all day and I was pumped full of drugs. Had some spaghetti and donuts for dinner (thanks to my gf). Went to bed with my leg completely numb.

Preparation

I had been organizing and cleaning my house all week in preparation of my recovery from surgery. Having had a cast and crutches once before, I learned how to organize my furniture so that I would have the safest and most efficient pathways to travel around my house. I also prepared by buying a shower bench and shower handle. These were two items I wished I had last time on was in a cast. Taking a shower in a tiny stall with a slippery bathroom floor is no fun on one leg. In essence, I organized and outfitted my house as if I were remodeling to accommodate an 85 year old man. So my house was cleared and approved for geriatric use... but I wasn't quite keen on going another 6 weeks on crutches again. Instead of going full crutches after my surgery, I decided to get a better mode of one legged transportation. I ended up buying a steerable knee scooter with brakes off Amazon (not so surprising that a knee scooter was significantly cheaper online than going through my insurance). I ordered this piece of equipment about a week ahead of my surgery. This gave me some time to test the scooter around my house. Last but not least, I did a mega grocery run. I bought food to last me a least a week and a half. I also made sure to get my girlfriend some food for when she stayed over to help me out. Leading up to the day of my surgery I was nervous and anxious. I almost couldn't believe I was actually going to finally have surgery. It has been such a long struggle.

The 'Gap Sign'

During the whole period I had the cast on, my left foot hurt…and it hurt bad at times. When I went to go get my cast off I had little faith that my month long stint of cast life had improved the state of my injury. I told my doctor about my pain in the cast, and she recommended that I continue to wear a walking boot for another 4 weeks. I attempted to convey to her that walking around in a boot was going to do nothing for me. I wanted a more aggressive treatment. She offered an injection of Tormidal (NSAID) after 4 weeks if my foot did not feel better. I agreed and went on my way. Ironically, my foot hurt significantly more after the cast was taken off than before. 

The next three weeks were miserable, but the abnormal pains in my foot slowly began to recede. By week 3 though, my original injury still hurt. I scheduled a doctors appointment and got the injection into my joint. The injection was very painful and did not guarantee anything. I left the doctors hoping that the injection would relieve the pain at least till I could figure out my next step. Fortunately, after seeing that all possible conservative measurements failed at helping my foot, my doctor referred me to a foot and ankle surgeon. Finally! But of course I had to wait 3 weeks till the next available appointment. I waited and in the mean time the injection proved to subdue the pain in my foot somewhat. When the day came to go to my appointment I was so anxious that I was trembling. To make sure I provided a good case, I brought photo comparisons of the left and right feet along with a journal article about the ‘Gap sign’ <The gap sign> (signals a Lisfranc injury). At the surgeon’s office, I first talked with the doctor and told him my story. I then got a few weight-bearing x-rays. The doctor analyzed my past x-rays, MRI’s, and bone scan along with the new x-rays. He explained some key features he noticed in the imagery and then said he believed my tarso-metatarsal joint complex was unstable due to injury to ligaments between the bones in that area. Specifically, he told me the weight bearing x-rays showed a slight gap between my first and medial cuneiform. This was a tell tail sign of some variation of a Lisfranc injury. His words were like music to my ears. What he said to me was what I had been preaching to all the other doctors. I told him everything that I had been thinking about my foot: gap between my big toe, clicking and popping, and feeling of instability whenever I walked. He listened and agreed with most everything I said. Even going as far as corroborating my story with the x-rays and MRI. At that point, he told me that he suggested surgery as a viable option to fix my foot. Surgery is by no means something I was excited about, but I knew from the very beginning it was the only way to save my foot. I talked with the doctor about my options and I went ahead and scheduled surgery 4 weeks out.

I left the surgeons office pumped full of adrenaline. I couldn’t believe that a doctor finally gave me the diagnosis I had been saying all along. After some careful consideration and more research, I decided to get a second opinion. I was commended to a surgeon by a fourth orthopedist (yes fourth) that I saw. The visit with the second opinion went even better than the first. Not only did he clearly see that I had some variation of a Lisfranc injury, but he also was one of the leading surgeons in that area of research. He gave me his tentative plan for surgery and possible recovery outcome, and then without hesitation I scheduled surgery with him for 4 weeks out. Of course I called my first surgeon to let him know of my choice. He was in no way bothered or offended. The four weeks leading up to my surgery date were uneventful as far as my left foot pain goes. It wouldn’t be fun or interesting if my right foot didn’t start to act up though, right? Well that’s what happened. I was able to keep my right foot under control enough to go ahead with surgery as planned, and hat is where I am now.

The cast

By the end of May my pain still persisted, and I was at my wits end. I went to another orthopedic doctor in hopes they would figure out what all others failed at. Two words… déjà vu. This doctor referred me to get another MRI, which I cringed at paying for but thought this could once and for all show the doctors what was going on. I got my third MRI in 13 months the first week of June. Went back to my first orthopedic doctor (yes I know confusing) who told me that the MRI showed bone marrow edema in my first tarso-metatarsal joint. These MRI results were very similar to those back in November. Considering all the conservative treatment options I had gone through up until that point (e.g. boot, injections, orthotics, more boot time, more orthotics, and of course rest), she decided to put a hard non-weight bearing cast on me. I kind of felt like this was going to come at some point, so I wasn’t too surprised. However, I was in no way prepared to go home that day with a cast and crutches. The doctors logic was that with a non-weight bearing boot I would completely rest my foot and the bone marrow edema would be able to dissipate. I was not totally convinced a cast would solve my problem. Mainly because I still believed my injury was of the Lisfranc variety, and the only way to heal that injury was surgery. But as with most things human, hope can be a powerful tool. What little hope I had left, I placed in my doctor and my cast.

For anyone who has never had a cast and crutches, be aware that the first few days to week is extremely awkward, frustrating, and at times dangerous. Crutches make everyday tasks 20 times more difficult or in some cases down right impossible. After about a day of having my cast, I realized that it was put on too tight. It was so tight in fact that it cut off my circulation in my foot. Luckily, I was able to go back to the doctors to fix my cast. In some of the most unnerving 10 minutes of my life, I watched as the nurse (who was clearly ill trained for the job) sawed away at certain pieces of my cast. There were numerous times when her unsteady hand sawed too deep or drifted nipping my foot. With my cast loosened, I continued adapting to crutch and cast life. Making food, carrying things, taking a shower, and laundry were a challenge. Taking a shower on one leg may be one of the most difficult things ever. Especially if done without slipping or falling over (which did happen).

I find that nothing I do can ever be just straightforward. I somehow usually make things harder then they need to be for myself, and being on crutches was not spared. In an ironic series of events, I ended up hurting my right foot while on crutches (remember it is my left foot with the cast). It happened because I thought it was an ok idea to hop on one leg across my kitchen. I did this because I wanted a fast way to carry my plate from the counter to table. Hopping on my foot is never a smart choice, as it puts all the force through the bones and ligaments of your one foot. This is of course what happened to me. The top of my right foot began to hurt shortly after my little stunt. Like my left foot, the pain began slowly and then progressed into a deep throbbing pain after a few hours. The injury to my right foot nearly put me over the edge. I almost lost my mind. The thought of having injured my right foot similar to my left could have easily given me a stressed induced heart attack. What I feared most was happening…both of my feet were in pain. At first, I could hardly handle the anxiety, but fortunately I had (have) a great girlfriend who helped me out. For about one week, I just laid up in bed and prayed that my right foot would get better. I eventually went to the doctor who referred me to get a bone scan. The bone scan results showed that I had soft tissue damage on the top of my foot and a possible bone contusion on my heel. My right foot did start to feel better after about a week. However, the pain would come and go for months to come. Additionally, my stunt caused me to have plantar fasciitis.

Desperation

At my wits end and pretty much desperate, I decided to go see a chiropractor. The source of my injury was being over looked by orthopedics, so giving into desperation I thought maybe a chiropractor could figure it out. That idea lasted for about a week. The chiropractor did their hokie tests and gave me some half scientific explanation of what my problem was. Believe it or not they told me that the reason my foot hurt was cause my lower back and hips were out of alignment. They thought they just solved my problem. Cutting edge scientific equipment and the best specialized doctors misdiagnosed me, but with the chiropractors sketchy x-ray machine and some poking at my back they solved it? Of course, to really solve this problem they recommended 18 visits to get me back into alignment. How did they magically come up with 18 visits as the right number for me to be cured?... Still trying to figure that one out. I will admit though, pure hope and desperation drove me to agree to their 18 visits. After about the first three, I realized I had made a mistake. Unfortunately, I had paid up front for the visits to get a discount and couldn’t get my money back…chiropractor equals fail.

The chiropractor debacle drove me even further into frustration. The pain in my foot was still present almost all the time. My next step was to go back to where I started… my first orthopedic doctor. It had been six months since I last saw this doctor. I caught her up to speed on my adventures through the foot saga. I had high hopes that this time she would really be able to figure out what was going on. I had an MRI and x-rays which she could use, but my hopes were soon crushed… as always. At this point, my experience talking to doctors was like déjà vu. Every time I would try and convince them to look beyond the obvious diagnosis and treat my foot with a little more aggression. Once again I told my doctor about my theory of a variation of a Lisfranc injury. I even showed her a gap between my big and second toe that would form upon weight bearing. To me, this physical deformity was the key signal that something beyond a bone-marrow edema was wrong with my foot. My thoughts and reasoning for this injury were swept to the side. I believe my doctors saw me a young kid to not be taken seriously. This meant my doctor did not listen to me, and instead thought physical therapy would help. Frustrated, I participated in physical therapy twice a week for two months. I mostly did this to appease my doctor and show her that it would do nothing to heal my injury. Who would have thought, I was right. Physical therapy did nothing, and actually caused me more pain than not. The only thing physical therapy did was make me sound more like a broken record. I told my physical therapist about the gap between my toes, the location of my pain, and what made it worsen. Most of all I told him about my theory of a Lisfranc injury. As always, I got the look that said “yeah…yeah…ok kid. Sorry but you don’t know anything”.

It hurts

Just like the doctor said my symptoms reemerged after about 3 weeks. This time though, the pain was more intense. The onset of pain came after I was at the gym one evening. I was doing some leg presses when I noticed a slight pop in my top mid-foot. Immediately I became paranoid that I had torn something in my foot. At first there was no pain, but similar to the period after the century bike ride, the pain slowly grew in my foot over the next 24 hrs. Some slight swelling and discoloration over the dorsal aspect of my mid-foot appeared in the following days. The pain was a throbbing in nature, and felt as if I had a hot metal rod in place of my first metatarsal and cuneiform. Soon after this injury I made an appointment with the UVA foot and ankle center.

I thought that a new doctor may have some insight into my problem. After about two weeks, I had my appointment in mid-November. The doctor that saw me did not seem worried about my injury. He gave me a tentative diagnosis of a stress fracture or stress reaction. I tried convincing the doctor that this problem felt unlike a stress fracture and needed more thought. To appease me, he referred me to get an MRI. As much as I knew an MRI would cost me, I did not care. I knew that an MRI would be my best option to get a comprehensive diagnosis. I got the MRI about two weeks after my doctors visit, and returned to the doctor for a follow up a week later. The MRI showed that I had bone marrow edema in my first cuneiform, tarso-metatarsal joint, and first metatarsal. The MRI results were to no surprise to me. They actually explained my pain profile well. However, the imagery and my doctors interpretation did not provide a mechanism for causing the bone marrow edema.

Going back two weeks before my MRI… I had been reading some medical journal papers in an effort to get a rough diagnosis of my injury. I found many articles on an rare and commonly misdiagnosed injury called a Lisfranc injury. Many of the symptoms presented in patients in the case studies were similar to mine. In fact, even the physical deformation of my foot was in line with the deformity of a Lisfranc injury. 

Now going back to the doctors office… I asked the doctor what he thought of my injury being some variation of a Lisfranc injury. Almost without hesitation, my doctor and his resident (who was sitting in) brushed off that “absurd” idea. Because I did not have a classic mechanism of a Lisfranc injury (high impact) and since the MRI showed my Lisfranc ligaments intact, my doctor did not give any more thought to this idea. Personally though, I believed that I had some form of a Lisfranc injury. But what do I know? I am not a doctor. With hesitation I trusted my doctors diagnosis and accepted the treatment options he gave me, which were comprised of getting stiff soled orthotics with an arch support. Of course I had not faith that orthotics would help me any, and I let the doctor know this. Nevertheless, he told me that it was just bone marrow edema and would go away with time…I called bull crap.

The rest of November, December, and January I lived in pain. The orthotics did jack. I went back to the doctor approximately four times in that period. Every visit I explained to the doctor how I was having no progress and we needed to reevaluate my diagnosis. Instead, he thought I did not purchase the correct orthotics… After purchasing three different types of orthotics, I still had no progress. I was frustrated and mad by the beginning of February. The physical pain and psychological wear and tear was taking a toll on me. Everyday tasks became too painful for me to do. This made me depressed, anti-social, and unmotivated.

Autumn

After the pain in August, I decided to stop running for an extended period. Kept to stationary biking and road biking for exercise. These exercises did not pose a problem, and the pain did not reemerge. On Setp. 14, I participated in a 100 mile road bike ride. I wore clipless pedals for the duration of the race. I didn't explicitly notice any pain in my foot while riding. I also do not remember any specific incident that would draw attention for injury. After the bike ride though, my left foot began to hurt again. It started very slowly at first, and did not become a problem until about 24 hours after the end of the bike ride. My foot showed slight signs of swelling and discoloration over my top right midfoot region. I assumed I had reinjured my past stress fracture and immediately put the walking boot back on. I wore the walking boot for the remainder of Sept.

After wearing the boot and experiencing pain in my left foot for 3 weeks, I decided to go back to the orthopedics. I explained my situation and the doctor was perplexed. She said it was not a re-injury of my second metatarsal stress fracture (as it is near impossible to get a stress fracture in the same location as a previous fracture). Her diagnosis was that I was experiencing some sort of inflammation or arthritis in my tarso-metatsal joint. This diagnosis mainly stemmed from my MRI results in May 2015, which showed degenerative changes in this joint. My doctor suggested that to relieve the pain, and hopefully shut down the inflammatory process, she inject a cortisone shot into my joint. Being that I had no other options, I agreed. She continued with the procedure and told me I could experience some initial soreness and pain for a few days to a week, but that I would most likely experience relief of symptoms for 2-3 weeks. After that period, she said that my symptoms may reemerge. Then we would need to reexamine my foot to find an alternate prognosis.

About me and some background

At present, I am a graduate student pursuing a masters. I have been an avid runner for 8 years and biker and hiker for 6 years. In high school I ran cross country and continued running un-competitively through my undergrad. I stuck to 5 k's and an occasional 10 k. In 2013, a little less than a year after graduating from undergrad, my habits changed. Starting in February (very cold) I hiked from Springer Mtn., GA to Bennington, VT by June on the Appalachian Trail. The story that goes along with that is for another blog.

After hiking the trail, my conception of what was a short walk/run or long walk/run was altered forever. Having used my feet to go everywhere along the trail and in towns, I began to love the freedom of walking or running gave me. I finally realized that walking and running was an actual form of transportation. With this thought in mind, whenever I ran I just ran and ran. Exploring the woods or different towns and cities with my feet. I noticed that not only could I run further after my hike, but my legs were also strong (especially up hills). After only a few weeks of running, I my mileage went from the classic 3 mile run to 10-12 mile runs. The craziest part was that I was less tired after my long 10-12 mile run than my when I used to finish my 3 mile runs. 

A few weeks after I came home from the trail I moved to attend graduate school. I continued running and actually increased my mileage the end of that summer and fall. Eventually I began to run 10 k's regularly and then ran a marathon by the end of the fall of 2014. I not only finished the marathon feeling pretty great, but my time (2 hrs 57 mins) qualified me for the Boston Marathon. I was pumped that I had qualified for the Boston Marathon and that I had done so in my first Marathon. My running regime continued through the winter and early spring. I ran a 10 miler and a half marathon, and was pleased with my times. Then it happened... like most people I always felt like "no, no...it won't happen to me. I run right, I take care of myself...etc.", but it did happen. It caught me off guard and surprised me. It was a beautiful late April day. I did a short hike with some friends, which wasn't eventful. I should have taken more heed though... because I felt a sharp pain in the top of my left mid-foot at one point. This should have sent an an alarm off in my head, but it didn't. Instead, since I felt like the hike wasn't enough exertion for one day, I decided to go for an hour long run when I got home. The majority of the run went fine. It was not until the last 10 mins that I noticed the sharp pain re-emerge on the top of my left foot. Every time my foot hit the ground a sharp pain sprang from my foot up my leg. At this point, I knew I had screwed myself. When I got home I continued to walk around on my foot. Up until that point, I usually just powered through pain thinking that something will pop back in place and it will be better by morning...not so much. The pain grew through the night and the next day until my ignorance and naivety wore off and I accepted that my foot needed real help. Over the course of the two months:

• Orthopedic diagnosed me with stress fracture to my second metatarsal
• wore walking boot for 6 wks
• got walking boot off
• slowly began to get back into walking and running
• First did a few mins of walk jog around track. 
• After 2-3 weeks out of the boot I began to take short runs. 
• Progressed from 15-45 min runs by the end of July.
• Ran in 4-miler race at the end of July. 
• Noticed after the race I had a slight twinge in the top of my foot. Afraid I got another stress fracture. 
• The small sign of pain subsided after a day. 
• Didn't run for a few days after race. Continued running regime for about a week when two days after a run in mid-August the top of my foot began to hurt. 
• The pain increased over the course of 48 hours. Mild swelling and discoloration presented itself. Wrapped foot in ACE bandage and endured the pain with NASIDS. 
• Continued cross training without much of a problem. Pain subsided after 10 days.

And this is where my story starts now...

My story

An injury can be a physical and psychological burden, especially when presented over a prolonged period. My left foot has been a source of pain for over a year now. Over the course of the past year, numerous doctors have been unable to diagnosis my problem successfully. This has meant I was put through the gambit, as far as a orthopedic medical treatments are concerned (some very expensive), and unfortunately none provided any resolve. However, in the past month I may have finally found an answer to my problem. It is not an easy solution...it may actually be the least appealing, but from almost the beginning I knew it is the only solution. That's where I am now.