Ankle injury: MRI report and prognosis
Well I'm not a regular poster to the medical forum but my time has come…
As many of the January OS crew knows, I slipped on the ice during my Sunday run and landed on my ankle. It felt bad enough that I had to take a taxi home. On Monday it wasn't much better and it really hurt walking through the couple of airports I had to navigate. So on Tuesday I was back in Chicago and made a doctor's appointment, got sent for an MRI, and then today had another appointment to get the MRI results.
Below I'll describe my injury, the doctor's assessment and the treatment advice I received. If you all have any advice / suggestions / second opinions / etc I'd love to hear them. Also if you all have a viewpoint on what I can expect in terms of recovery time I'd value that, since I'm re-tooling my season plan in response to this situation.
I have attached the radiologist's report to this post (accessible from the link at the bottom) because it has lots of technical terminology that may be of relevance. Feel free to read it if you like (hopefully I was successful in blocking my identifying information from the PDF before posting it for the world!!). Actually I have a link to download a zip file with the MRI images plus a reader application if anyone is really eager…PM me and I'm more than happy to send it.
In any case, the good news is that the MRI shows some pretty clear things and the doctor is pretty confident of the diagnosis. She read it then looked at the radiologist's report and what she saw matched up pretty well. The other good news is that there is nothing of "major" concern, everything that is wrong is "minor", no fractures or torn ligaments or tendons or anything like that.
The bad news is that the injury will for sure slow me down in terms of training this season. The report lists 7 things but the most problematic one is an edema in the "talar dome", which as I understand it from her is basically where all the weight comes onto when you land on your foot. So she wants no weight bearing for 4 weeks and has fitted me with a walking boot to ensure the weight is kept off the foot. There is also some fluid and inflamed tendon and ligaments from the general trauma and a very slight edema to the fibula, but the main issue is the "talar dome". The situation based on her assessment looks to be as follows:
- Walking boot for 4 weeks, then an appointment to assess progress
- After 1 week in the boot, begin strengthening exercises with a resistance band to mitigate the loss of strength when in the boot
- No running for 6 weeks
- Biking – it is not hugely weight bearing but she doesn't like it. Her overall position is that with the bone edema situation it needs to heal before you stress it a lot, and biking will stress it and prevent healing. She said after one week if I could bike and felt no issue at all, zero pain or feeling of anything abnormal, then we can add it, but she doesn't seem so enthusiastic about it. She is a sports-focused doc, but this is where I need some input and advice from people who know about these things.
- Swimming – same as biking (because of kicking and foot movement). I was not planning to swim in any case, but if swimming were permissible I might change my training approach to add it since it is SOMETHING.
Clearly this is a big setback because not only is it a loss of 4 weeks where I expected to make forward progress in fitness, but I will clearly see a lot of backward progress as my muscles weaken (the doc said if I do all the strengthening it should be minimal, but wearing this boot at the moment I find that tough to believe).
In terms of implications for the races this season, if the healing is "as advertised" I believe I can recover and train up for a great race in Grand Rapids in early June. If progress is slower I will target Racine or, if things are really slow, maybe Silverman. Florida 70.3 in early April seems a much more remote possibility. That said, I'm already signed up for it so if I'm training at 100% effort by mid February and I feel my running is progressing back to where it should be AND I end up starting swimming early due to the injury, maybe I go anyway and use it as a training "big day" (although preserving some of that capital on the homefront for other races might be the better option in that case…tbd).
So that's my situation. I guess I better learn to curtail my eating in the coming days…
Comments
Sorry about your injury Matt
I am a radiologist. I read the MR report. I would trust your doctor and be conservative and let the marrow edema subside. Worst case scenario it progresses to avascular necrosis or there is an osteochondral fracture hiding in there and both of those things could go on to chronic problems. The walking boot would also allow your ligament injury to heal with minimal scarring. It sucks but you do not need chronic foot pain. All the best.
I have no comment about the diagnosis or recommendations for time off. But I will say, based purely on my own experience with trauma, that I learned several things, which probably also apply to you:
And stay away from those 2000 calorie steak dinners!!!
Not uncommonly, you can return to closed chain kinetic exercises sooner than running. (ie, you may be able to do an elliptical or bike sooner than run)
You might ask about that too.
Also, consider sports psychology information on recovery from injuries to beat the natural and understandable short term depression that can come after an injury.
I have some mp3 resources if you want to PM me I can send them to you as a download link.
So I'm not too worried, although I am disappointed that my racing plans are probably trashed for this summer. I remain hopeful I can get a later-season race on the calendar. If the recovery doesn't progress as advertised then I may try to focus on swimming – get some coaching/lessons. More immediately, I need to figure out something somewhat active to do, or I'll end up gaining a bunch if weight and not fitting into my clothes…
sorry to hear about your ankle, i hope you are healing up quickly. let me know if you need help with anything.
-david