Back from the Podiatrist...
As the NOS group knows some small nagging pain in my foot turned pretty severe after yesterdays run. This morning (24 hours later) I still could barely walk or put any pressure on my foot so I decided it was time to go to a doctor.
The good news is, nothing is broken and everything is in the right place.
The bad news is I'm basically on bed rest until get to see him again next week. How ironic that my 31 week pregnant wife is doing great, but I'm on bed rest.
After taking x-rays and then poking and twisting my foot while I jumped out of the chair and grabbed the arms with a a death grip he determined that it is both neuropathy and tendonitis. He wanted to give me cortisone injections but because it's not isolated to one aera he basically couldn't figure out where to start.
So I'm on a 6 day cortisone prescription and then get to go back to have him figure out if I need the injections as well and where to give them. Not only did he say no running, biking, swimming but he wants me to walk as little as possible and recommended I stay at home and keep my foot up as much as possible.
BTW, This pain started after my swim instructor had me to a 5 x 100 kicking sprints in fins last Wednesday. The doctor definitely agrees that is likely what started it, which would make it the third time in the last year I've been injured swimming. Maybe I should just be a duathlete or at least drink the Kool-Aid and stop swimming in the off-season.
I'm bummed that I am going to have to miss the EN Holiday Run challenge and after the Power Hack test and my 4 x 1mi @TP yesterday I was looking forward to testing next week.
However, I'm also really glad that this happened in Dec and not in the spring or fall. I'm also glad that it is not a break as with the amount of pain I am in I was pretty sure I did much more damage.
Comments
What a bummer, Matt. Perhaps all that bed rest will be a good time to catch up on triathlon reading?
Aw {{{Mattt}}}, very sorry that happened. But the silver lining, as you say, is the time of year. Heal up HARD, and thoroughly so you can get back to it sooner rather than later.
And as far as kick sets are concerned--never, never, ever do them! They are like a triathlete's worst nightmare, IMO! Tell the coach you'll do one-arm drills or catch-up instead.
It's what I do. Kick sets--shiver!!!!
Tell Theresa from the rest of the women here--having a laid up husband at 31 weeks gestation...we feel her pain. (Teasing
)
Hi Matt,
Gosh, so sorry to hear you are in so much pain. Glad to hear it is not fractured. I know resting is hard for us all especially at this time of year and with all that is going on here in the house but we are still here for you my friend. Training and FTP and TP intervals will be here when you get better. Take a deep breath and relax. Rest is good. Let your foot heal. Enjoy watching your pregnant sweetie run all around. Try as best you can to find joy in this next week.,being bummed out is no fun for you or those around you. I'll do my best to keep you laughing and smiling daily.
XO Carrie
So what's the diagnosis given my the Podiatrist?
1. Is the pain in a pinpt location or whole foot?
2. Is it tender to touching on a bone...where?
3. Is it tender to pressing between the toes?
If he thinks it's tendintis then steroids are OK, but if a stress reaction (i.e. early stress fracture) then don't want to do steroids?
Need alittle more info.
First off thank you everyone for the positive thoughts. I'm trying to look at this as just a short holiday break and I'm actually not as bummed as I thought I would be because I was pretty sure I was going to be out for at least 6 weeks with a fracture. At least now I may have a chance at being able to slowly ramp back up in a few weeks if it recovers.
Michael, he did a ton of poking and pulling all over the foot and here is what he found:
1. Is the pain in a pinpt location or whole foot? - the pain is on the top (mainly) and bottom (not quite as bad) of the foot around the three middle metatrasals(sp?). Big toe and little toe ones are fine.
2. Is it tender to touching on a bone...where? - he touched everywhere and there was no pain to the touch, I can push on any spot and there is no pain. Their was significant pain when he pulled any of the three middle toes out. The was also a fair out of pain when he flex the toes up or down. Again the pains was mostly felt on the top of my foot by the metatrasals.
3. Is it tender to pressing between the toes? - he did push there and there was no pain
He was pretty confident it was not a stress fracture but did two xrays just to check. He looked at them and compared it to a prior xray he had of my foot and said everything looked prefect.
He felt it was a combination of both tendonitis and neuropathy becuase of the way it is a shoting and severe pain when he pulled out on the toes or flexed them, but when he pressed on any spot on the foot there was no pain. Because it the pain was spread across three metatrasals and triggered by three toes he did not want to do multiple cortisone injections and instead wants me off my feet for a week and to take the oral cortisone for a week and then see him again to see how the pain is and re-evaluate.
I definitely am insterested in any other feedback or questions you have.
Glad to hear it's not a fracture! I came down with achilles tendinitis 5 weeks out from IMWI last year. I went on a Medrol Dosepack and used a boot for 7 days. I was running the following week! Hopefully you have similar results.
Vince
You are doing the right thing caring for your body now vs sacrificing it all for short term gains / desires. Get well!!
P
A few other thoughts:
- I'm really glad that this happened now and not two months earlier or two months later.
- I doubt I will be returning to this masters swim program, as in the 2 month, I've been injured twice from the kicking. I'm never again doing any kind of workout that involves "sprint, kick, and fins" in the same line. Trying to pick up a few minutes in the swim just cost me at least a week of running and biking...maybe I should have listened to the coaches in the first place.
- I'm getting to catch up on sleep now that I don't have to get up at 5 to get the workouts done. I'm sure I can use the extra sleep when the baby comes.
- Right when my foot hurt last week I noticed that I was cold all the time. Since then I have been constantly freezing, I wonder if it is at all related.
Tendonitis...I can see that. And neuropathy? I'll be interested to see what Jayhawk has to say about that. Were you wearing fins during the kick sets?
Oh Matt, sorry this happen to you! But you're absolutely right about the timing of it: early in the season and during the holidays when it's good to climb out of our pain caves and hang out with family. I'm sending healing and anti-inflammatory vibes your way!
Matt, sorry to hear about the foot troubles. Glad to hear your onboard with some hard recovery work though!
I'm with Dr. Mike on the question front: was there an actual diagnosis or just an "it might be a few things" so we'll hit it with prednisone and see what shakes out??
Just so I have the right visual here- we're talking pain is primarily on the top of the foot or is it underneath??? any weird stuff- tingling, clicking, popping, etc??? out of curiosity- what's your current setup shoe wise? did he give you any way to immobilize it?
how's the tenderness now a few days later? can you provoke pain by poking or even just walking on it?
We must be drinking the same water because I also just got the answer this week to all my recent "issues" of which you're familiar with. The fix: 8 weeks of no running, so I know how you feel man! At least we can work on banking the SAUs for later.
After poking and pulling on it for a few minutes, he seemed very convinced it was a combination tendon and nerve issues, so I thought it was a diagnosis. He thought a cortizone injection would take care of it, but was hesitate because he couldn't identify the right spot (or spots). So the idea with the oral verison was that it will either take care of it completely, or at least enough that he can pinpoint exactly were an injection may be needed at my return visit. He did an xray just to make sure after, but he couldn't find anything on it.
The pain is primarily on the top and only a little on the bottom of the foot, all centered around the three middle metatrasals and it is pretty much pain free when I'm not moving. When I walk is when it hurts the most. The pain comes on as my foot rolls from my hell to the toes as I step. There is a shooting pain in the middle of the step from when I am on the ball of my foot to my toes and then it is fine again. I can stand on it and put pressue on it as long as I am still and my foot is flat, but as soon as I go to walk and the foot flexes is when I get the sharp pain. I can push on any part of it with my hand and there is no pain at all, but when he pulled any of my three middle toes forward the pain was triggered.
It's now about two and a half days after I realized it was actually injured and it is pretty much the same. I have never been able to provoke the pain by poking it or touching it, but walking is still very painfull.
He didn't give me anything but asked me to stay off my feet as much as possible and said I should only be up to move around the house and mayb go out to eat, but stay sitting as much as possible. I already have crutches so he said to use them if I want and I have to go somewhere.
Sorry, I'm really bad at explaining medical stuff, but I'm glad to keep trying or do anything that would help you or the others figure this out.
Some thoughts:
I doubt it's "neuropathy"...unless you're diabetic, have an underlying medical disorder, etc.
Based on the mechanism it's more likely tendinitis (inflammation)....I doubt you have stress reaction/fracture based on the fact that it's involving 3 bones (that would be very unusual)
Generally rest, activity modification, avoiding wt bearing ex. until painfree.
My thought: If you don't see improvement on a weekly basis then ask for an MRI...would help with tendinitis, stress reactions, etc. (In my practice for a high level athlete, I have a low threshold for an MRI....In fact if it was me I would have asked for a MRI early...probably overutilization of imaging studies but that's what I would do n=1)
Feel free to PM me if you want.
Mike
Matt, if you're so inclined I'd recommend a session or two with an acupuncturist. I bet s/he could clear up that cold feeling.
Thanks for the advice Mike! I'm trying to stay off of it as much as possible and have crutches for when I do have to leave the house. I'll keep checking in with updates and I'll definitely report back after seeing the doctor again next week. If it is not improving I will ask about the MRI.
@Bill, thanks for the advice, I'm going to tackle one issue at a time right now, but I'll likely ping you to hear more about that once I get through this.
another idea is to find a local Graston Technique certified person in your area (hit the website and you can pull up a list of providers in your area). It's an instrument assisted soft tissue release geared specifically towards tendonitis. Might be good to hit that up sooner versus later- especially while you have the added bonus of the med pack.
First off thank you to everyone for your support and comment on hear, facebook and twitter.
I started taking the cortisone last Thursday and until Sunday the only thing it did was keep me up and make me hungry, like I was warned it might. So besides not being able to exercise (or walk), I couldn't sleep and all I wanted to do was eat. Great combination let me say.
The good news is on Sunday afternoon my foot finally started to relax and the pain started to decrease drastically and by last night I could actually walk around my house without limping.
I had my follow up visit today. The doctor did a similar exam again and confirmed that it is tendonitis in the top of my foot. He tried every way possible bend, poke, push, and twist my foot and there is only one direction that causes any pain at all... when he bends my toes or foot down like kicking while swimming does.
He decided to stop the medication and just let it heal on it's own. He cleared me to return to normal activities and non-impact exercise starting tomorrow. He said if that goes well for a few days and the pain is 100% gone in my foot when I bend it that I can start to ease into running sometime next week. He felt cycling would be fine because I wear cycling shoes with a solid sole.
He also said that he recomends I take some time off from swimming and he doesn't think I should kick with fins ever again...i agree since I have been injured more from them this year than all my running and bike ever.
I celebrated with 83 pushups for the 100 push up challenge and assuming my foot feels ok tomorrow I'm going to do an easy spin on my bike.
Good news for sure, Matt. Must be a huge relief for you.
Dave