I Am a Medical Miracle
I know, you’ve all been wondering. Where have you been? What have you been doing?? Are you dead???
I’m happy to report I’m not dead. It’s almost worse than that. I’m injured.
Such an interesting word, “Injured.” So innocuous sounding. If you try to sift its meaning from its components – “in-“ , meaning “not”, and “-juris”, presumably meaning something pertaining to a jury or judgment – you might almost think it means “not judged”. Innocent. Virtuous.
Okay, so I’m no Latin scholar, but that’s not important. What’s important is that there’s nothing virtuous about injury. Being injured sucks!
For a runner, it takes away your daily routine, your source of stress relief, your social circle, and your immediate goals, all in one fell swoop! You’re left literally on the sidelines, watching your former training partners shave seconds off their paces and minutes off their PRs, feeling like they’re actually running away from you. Oh, and on top of all that, you start to get fat. And then you have to eat less. And that REALLY sucks.
At its lowest point, injury might even find you telling your email to “eff off!” every time it suggests that “time is running out for early bird registration” on this race or that. Not that this happened to me. At work.
At the outset, my particular injury seemed fairly straightforward. Tendinitis, on the inside of my left leg, around the big knobby ankle bone. It hit me out of nowhere on my first run back after Chicago, and didn’t go away the next day.
No big deal, I thought, I’ll just take a few days off.There are always weird lingering pains after a marathon, even one you run “easy”.
When those few days off didn’t work, I went to plan B, an appointment with my local Airrosti provider. This scream-inducing form of “myofascial release” had helped me through hamstring issues, heel pain, an IT band flare-up, and even Achilles tendinitis. It really is amazingly effective for soft tissue injury.
Until this one. The next Saturday, I had to quit a long run early for the first time ever. I don’t mean that I’d never crapped out on a run before, but this was the first time I’ve HAD to stop. The pain was so bad I barely managed to limp back to Rogue.
Okay, so this thing was going to stick around for awhile. No biggie. It was the week before our wedding, and family and friends were descending from near and far. What better excuse could there be for taking some true, solid rest? With the exception of a 4-mile “Run Off the Nerves with the Bride” event that I’d planned weeks in advance for the morning of the wedding, I didn’t run a step for two weeks. (As a result of running off those nerves, I winced my way through our first dance as husband and wife…and all the other steps before and after.)
After 4 weeks without any real running, I decided that it was time to pull out the big guns. At the suggestion of Coach Chris, I headed off to the big-name orthopedic surgeon in town. He checked me out and told me a bunch of things I already knew: My feet are beyond flat, I need to strengthen every muscle in my body, I really should consider orthotics, etc.
He also noted something I hadn’t really noticed – I couldn’t get my left ankle to flex beyond 90 degrees. In fact, I couldn’t even get it TO 90 degrees.
Then, holding my foot in a neutral position, he grabbed my heel with one hand and my calf with the other and yanked. On the right side, not much effect. On the left side, I could feel my entire foot moving a solid centimeter forward and back. Accompanied by some fun crunching noises of course. NOT NORMAL.
“Have you ever had a severe injury on this side? Like a really bad sprain?”
Well, I did step in that pothole last year, but I was back running in a couple days.
“Huh, are you sure?” Oh well. He warned me that it would probably take a good 6-12 months to get a normal person’s strength and mobility in both ankles, but dedication and some good physical therapy should do it. I started weekly meetings with my PT that day.
I was a pretty good student. Not the best, but I did my exercises most days, and we started to see progress. After a month of work, I was able to get my right ankle 10 degrees past perpendicular. (15-20 is “normal”.)
The left improved too, though not as much. Only to about a 6. And any time we tried to introduce any sort of running, the pain came back immediately. Needless to say, when I had my follow-up with the doc on January 2nd, everyone was aware of my frustration.
He performed the same tests he had the first time, noting many of the same problems.
He also noted certain points that were no longer painful and counted that as progress.
Then he went straight to the heart of the matter, pressing hard into all the places he expected to hurt. I could sense his confusion when only one actually did. He tried the right foot for comparison, then returned to the left. “You’re sure you don’t feel anything here?”
Nope, feels fine.
He compared the two again, then sat back. Then leaned forward again. Then poked some more. “What the…” He flexed both my feet. “Where is…”
Then he literally ranout of the room to grab my PT and his assistant. “Look at this! Look at this! Do you see this?”
He dug into my foot again. “Where is your ATL?”
Uhhh, my what now?
He asked me once again about any severe sprains, but I had nothing. Then he noticed this:
|You try getting a good picture of your own leg with an iPhone.
“What’s this scar from?”
“Oh, a car accident when I was 16. There’s glass in there.”
He grabbed both my feet and flexed them. “Do you see that right there?”
|Right foot flexed. Note giant ligament just left of center.
Of course I saw it. It was a giant ligament.
|Left foot flexed. Well, shit.
“I think you severed your ATL in that car accident and have been compensating this entire time.” That’s when he started to get excited. “How much have you run since then?”
“Seven?!? Walk on your heels for me.”
How did he know I’ve never been able to walk on my heels?
At this point, he actually started admiring the other ligaments in my foot, particularly the one that runs from the ankle joint to the big toe. “Look how developed that is! It is a miracle that you have been able to compensate in this way!”
I felt like I was watching one of those medical mystery shows.
…tonight, on DiscoveryHealth. An active patient with no acute injury mysteriously develops pain after years without issue. No one thinks of a possible tear because a) no one misses a torn ligament – there’s a loud pop and a LOT of pain when it goes, and b) hardly anybody ever tears this ligament.
(Seriously, I Googled “ATFL tear”. Turns out it’s there to stabilize the ankle joint and prevent excessive lateral movement. It’s usually injured when you twist your ankle, but almost never tears. The only sport that is remotely common in is squash. And when’s the last time you thought about squash??)
Doc looked as excited as a kid on Christmas.
I could almost see the gears turning as he dragged the back story out of me. Car accident at 16. I’d thought my ankle was broken, but X-rays showed nothing at the time. I also wasn’t a runner then. Stitches and swelling hid any noticeable knot from the tear. The swelling never went away because a horse ran that same leg into a metal post about a year later. (See, there’s even confounding data – sounds important, but turns out not to pertain to the actual injury.)
By the time I really started running, I’d adapted to the lack of an ATFL and never noticed a problem.
So why the sudden issue now?
Well, there’s more to the back story. Last spring, I tried to move away from the custom orthotics I’d worn for years to help with chronic IT band issues. The idea there was that orthotics are like a crutch. They support a joint without actually requiring any of the muscles that are supposed to support it to get stronger.
Little did I know that those orthotics were pretty much holding my ankle joint in place. My left foot was a ticking time bomb from the moment I pulled them out of my shoes.
So what now?
Well, last week the doc asked me to come in for a mini-seminar for his staff. He wanted to see if they could put together the mystery themselves, and then talk them through what they might do if presented with this scenario. For 30 minutes, I was something between a human PowerPoint and a frog on dissection day.
I know what you’re thinking, because believe me, I’ve thought it too. “How the eff did nobody ever notice this?!?”
I can’t fault the doc. He was so open about having missed it the first time and so excited to troubleshoot the problem. He even offered me my next pair of orthotics for free in exchange for 30 minutes as a guinea pig!
I’m also not at all angry with any of the running experts who encouraged me to move away from orthotics. I know their intentions were good, and even the surgeon agreed that most people, with enough strength work, can learn to run without them.
Just not people missing basic anatomical structures.
Unfortunately–or fortunately, depending on how you look at it–the initial injury occurred so long ago that I’m not a good candidate for surgery. Chances are there’s nothing left to reattach, and you can’t do a graft on such a small and mobile ligament with any degree of certainty that it won’t just tear again. So that leaves me with lots of PT ahead. And a life with orthotics in both my running and street shoes. (Well, except for a few party shoe nights, of course.)
I’ll probably never run a 60-mile week, but as the doc himself said, with the only evidence being what I’ve been able to do so far, there’s no reason to think I can’t do that all again.
Face it. I am a medical miracle.
And the next time a well-meaning running shoe salesperson tries to suggest a minimal shoe? Well, I’ll just show them this: