Friday, February 10, 2012

Peroneal tendonitis or Jones fracture?

What you see to my left is an X-ray of my foot.  In the image, it is pretty clear, even to a layperson, that there are no fractures in this foot.

But up until I had this X-ray there was a question of whether there might be a fracture and I was REALLY worried that all my training plans were going to go down the drain.

Because of the X-ray, we have ruled out the possibility that I have a "Jones Fracture".  (Paper clip is pointing to the spot where a Jones Fracture would appear.)  But I do have something, and in the course of this "having something" I have been driving myself crazy, and of course overloading on all kinds of information on Google instead of doing my housework.

But so that my adventure into this area of the foot near the fifth metatarsal does not go so much to waste, I shall relay my thoughts and findings here, complicated though they are.

Here was my Facebook status update  yesterday:
"How to hurt your foot in 3 easy steps: Step 1: Sign up for a race ... Step 2: Stop running 6 weeks before the race ... Step 3: Run the race anyway because you are not mature enough (at 50 years of age) to do the right thing and wait until next time."
So, in order to tell the story right we must go back in time.  Back in time to when I first injured my foot a month ago at Disney's Family Fiesta 5K Race (some nice photos of the race that I did not take on that link)

(My silly attempt to represent time-travel waves)
 Getting Injured
It was the eve of the Disney Family Fiesta 5K Race.  I was having qualms about participating in the race in the morning.  Back in November, 6 weeks before, I had stopped training.  Can't really explain why.  We had a death in the family and the day of the funeral was a scheduled run day, and I didn't go out.  After that, for reasons I can't really explain, I just didn't go out running again. Had killed me not to train because the weather was simply gorgeous. Every day could have been barefoot at a time of year when it might be getting too cold.

So, my Heart and my Head were having a major argument the night before the race, Heart wanting so much to be in the event, and Head having serious reservations.  At least it started out that way ...

"You haven't run a step, almost, for six weeks.  In the interim you have gained a bit of weight.  It is not wise to go out there and undergo that stress under these conditions," warned my Head.

"But I had been running up until that point and was doing pretty well.  Perhaps some of that training is still residing within," argued my Heart.

"Maybe, if you hadn't gained those pounds, it would be all right," said Head, "but you know that overweight people cannot afford missteps.  You would have needed to gradually increase your strength to accommodate the greater load and you didn't.  It would be a bit risky."

Deep down inside, Heart knew that Head was right.  And now Heart was beginning to take up the argument against in a kind of heartish way:

"Well," considered Heart, hoping that Head could not hear her, "I could just do what I want, ignore Head,  and go out there anyway and run the race.  But, ... but, ... what if Head is right?  What if something terrible happens!  What if I get out there and I get a (*shudder*) stress fracture or something?  Then I wouldn't be able to run for quite a while!!  Or, even worse, what if I have a heart attack!!!  I'd better listen to Head and not run in this thing tomorrow."  Heart started feeling very afraid.  (This can start to happen when Heart actually listens to Head, but can also backfire because Heart can take Head's reservations too much to, -- shall we say -- "heart.")

Head, who saw what was happening and also was concerned at Heart being so sad at not being allowed to run the race, stepped in and said,  "Hold on now,  there might be some compromise that could be made.  Perhaps you could just go out there and walk it.  You ought to be able to walk it."

Heart brightened up as she considered this.  "Yeah, and I could even try running a little. Surely I would feel it if it was 'wrong' and I could just stop.  If things didn't feel good I could even just drop out of the race."  Heart actually cheered a little at the thought of how dramatic and fun it would be as she imagined herself being carried away by the Disney medics on a stretcher ...

Head thought about this for a minute, "It's good to be conservative and safe, but there are times when one has to go out and test the waters in order to learn. Sometimes things cannot be figured out ahead of time.  Heads can need to collect practical experiential data in order to make better assessments in the future."

Heart argued, "Yeah ... sometime you have to just go out there and give something a try to find out what happens."

And so it went on, with Heart and Head eventually coming to an agreement.  The strategy would be to begin the race and run as far as I could, and after that point to walk/run the rest of the race or even just walk.

The race was a pleasure, very satisfying to Heart, and I will be writing up a race report at some point.  All seemed to have gone well.

"See, Head," said Heart, "nothing bad happened!"

But about an hour later, there was a horrible pain on the side of my left foot.  It seemed like it was in the bone.  After going back to our rooms after the race, having a good breakfast, showering, we were all ready to meet up in the themepark and walk around.

I was a cripple walking around the themepark.

"Oh no, this is REALLY bad," I thought. "Am I in big trouble?"  What could it be?  Some variant of TOFP (Top of Foot Pain)?  It was pretty painful.  Something worse?  Did I break something?

Took ibuprofin at night, and had a light day the next day, pretty much staying off the feet as much as possible.  Things improved, pain lessened.  It continued on and by the fourth day it had reduced to a mere annoyance that popped up later in the afternoon, after I had been on my feet for a while.

So, I concluded that whatever the problem was, it couldn't be a fracture or anything really serious because it was getting progressively better.  I was sure I would be fine.

In the past few weeks, since coming home from the Disney race, I have been running and training in Kung Fu. But after last Saturday's black sash cycle training class, I experienced the pain on the left side of the foot again.  It seemed to have been reactivated by the class.  Perhaps it was the hopping on one foot, something else which Head had had reservations about but Heart had decided to go ahead with.

Rested a day and it was better.

Then on Monday went out running, and then put myself through a Kung Fu workout.

Monday evening at choir practice I could barely walk.  Almost like the first day when I originally injured it.

Now began the detective work.  It started when I wrote my last blog post and found out the names of the body parts that could have been affected.  A few Google hours later I was convinced I had the answer.  Based on my research I decided it was a case of peroneal tendonitis.

I remembered last year when I had injured my shoulder by practicing too many overhead blocks in a row, my doctor-hubby had given me a special electronic nerve stimulation treatment that -- to me, miraculously -- healed my shoulder in a mere few days.  I had thought the shoulder injury was going to knock me out of my black sash training, and had been so elated when the treatment worked and I was back in commission in no time.

The treatment he had used was P.E.N.S. (Percutaneous Electronic Nerve Stimulation, not to be confused with another type called T.E.N.S)  In the treatment, acupuncture needles are inserted into the shoulder and neck area which are hooked up to wires and a little machine that controls an electric current.  The electric current is delivered to the tissues/nerves and not only produces an analgesic affect, but also promotes healing on the cellular level.  Overall, it's not completely understood how the healing mechanism is achieved. (There is some talk of this opening up and getting "chi" channels to flow, but I'm not sure about that and how it works.)  I can assure you that it worked, and I felt it working as it was working.

So, I thought that maybe that treatment could use to heal the peroneal strain.  Wasn't it a kind of similar injury to my having hurt my shoulder?

After presenting my request to my hubby, he did a little research and came back and told me that before he could treat me for peroneal tendonitis, he would have to rule out Jones Fracture.

"Jones Fracture!!!  What is that?"

"Google it," he said as he walked out the door.
To make a long story short, it was not Jones Fracture.  I didn't go out running yesterday just in case.  But now we are safe to assume that this is tendonitis and can be treated as such.  We are going to begin P.E.N.S treatment, along with some osteopathic manipulation therapy and I shall do some work on a balance board to strenghten my ankle and foot muscles.

Oh, and I'm going to try to shed those extra pounds I gained.

I am VERY happy that I will not have to cease bearing weight on my foot for 8 weeks, as I would have had to if it had been a Jones Fracture.
There is more to tell of this story, and I had ambitiously thought I would be able to put all the information in this single blog post.. However, this is pretty long, so I shall have to continue the rest of the story in subsequent blog posts.

Here are some of the questions I've been pondering and researching and which I hope to address in the next blog post:

Are six weeks off and gaining weight the only factors contributing to the injury? Did I get injured because of running barefoot?  Did I get injured because there is something wrong with my form? Did I get injured because I am overweight?  Did I get injured because I am overweight and barefoot? Did I get injured because I wore shoes for the first mile?  Is there something not right for me in the design of the minimalist shoes I chose to use for the first mile of the race? Did I get injured because of wearing my UGG boots and rapidly walking a distance in them the night before the race?  Do other barefoot runners get this injury?

Stay tuned for part II ...

No comments: