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.