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.