Sunday, January 2, 2011

Diagnosis anyone?

A podiatrist couldn’t diagnose my foot pain last year…maybe experienced runners can. 

Here is the background:  A year ago, I ran a twenty mile run (training for Surf City).  Later that day, I felt a sudden, excruciating pain on the top of my foot between my ankle and my toes.  It came on like a cramp.  I iced it and the pain eased but I felt the pain in my foot for a few days.  I took the next six days off, icing and wrapping my foot regularly.  It felt better by the end of the week and I ran my planned half marathon on Saturday with no pain (I even PR’d!)

The pain seemed to magically disappear.  My foot would mildly ache every now and then and I would ice it and that was the end of it.  It doesn’t hurt when I push my toes, but when I push where it hurts, I often get a shooting pain/tingle, like hitting your funny bone. I ran Surf City in February with no problems.  In fact, it was my best race ever.

I went to the podiatrist shortly after that.  I think subconsciously I waited until after the marathon, which wasn’t exactly a responsible thing to do.  I was afraid that he would tell me not to run.  He took x-rays of my foot and showed no stress fracture, which was my biggest fear.  He prescribed some custom orthotics and told me to get a bone density scan* since my x-rays showed some spots that looked somewhat weaker.  He never told me what was causing my pain.  Orthotics and calcium were the only take-away from the appointment.  I received my orthotics in March and have been running with them ever since.

A couple of weeks ago, the pain returned.  It was subtle at first.  I thought it might have been from running a couple of runs in my trail shoes without switching the orthotics into them.  But on Christmas Eve, we ran a long run and I could vaguely feel it when we started.  Around mile 7-8, it started to hurt.  It actually hurt worse if I stopped to walk. I focused on keeping my steps light and finished 12.5 miles with moderate pain.

The next morning I could barely walk.  My foot hurt worse than ever.  I was so scared that I had a stress fracture that somehow hid the x-ray last year.   I immediately iced and wrapped it and took Ibuprofen.  It hurt for a while and then as suddenly as it started hurting, it stopped.  The intense pain when I walked was gone, leaving only my normal ache.  I consoled myself saying that a fracture wouldn’t stop hurting so suddenly.  But what could it be??

My Google search came up with limited answers.  The scary thing that comes up is metatarsal stress fracture.  My pain does not seem to be emanating from the metatarsal bones, it is closer to the ankle. 
The arrow points to the approximate area where I am feeling pain.

The other (and more likely) possibility is midtarsal fault and nerve entrapment, where “there ends up being a jamming of the bones on top of your foot that will lead to pain, with or without shoes.”  The nerve entrapment However, this is caused by over-pronation and/or flattening of the feet.  My orthotics should help prevent that, right?

The only suggestion for treatment was rest [check] and tying shoes looser [check].  I am going to try new shoes, but I have been going back and forth between two pairs of shoes that aren’t all that old.  Could my orthotics be worn out after nine months??  I hope not!

My friend Stacey suggested the pain was related to my Achilles.  She was looking through information on trigger and pressure points in the foot and found an area of the Achilles that causes pain in the top of the foot.  I suppose this could be it.  I tried to roll out some knots in my Achilles.  I am pretty sure I need a good massage, but not sure yet if the pain is related.

I would love to see a specialist who is an expert in running injuries.  Unfortunately, I am limited to doctors within the Kaiser network.  I can’t afford to go out of my network right now.

Any suggestions??  I hope that it just goes away like it did last year.  I need my running now more than ever.  As I say goodbye to one of the worst years in my history, I can safely say that my running was a huge positive in 2010.  I am hopeful that 2011 brings about positive changes in all aspects of my life, including my running.  An injury would really put a damper on my optimism.

Best wishes to all of you in the new year.   Oh…. and happy running.

*the results of my scan showed that my density is at the low end of normal.  A calcium supplement was indicated.  I was surprised that my density was so low, considering all the weight bearing exercise I do.  However, my mother has osteoporosis, as did my grandmother.  It is not something to be taken lightly.


Laura said...

I have no idea what it could be, but I'm not very good with medical stuff. Hopefully another reader can help!

Southbaygirl said...

Sounds similar to a pain I had for YEARS!!!!! First of all, did you get a weight bearing xray???? that is KEY! I saw EVERYONE had xrays done for years, had a bone scan- everyone said nothing was wrong with my foot, yet I would get this pain in my foot and it got worse and worse and worse-finally to the point where I would be in tears running. I ran in pain for about 7 years until I finally saw my rockstar podiatrist who was the only one to give me a weight bearing xray! And there it was right in front of me!!!

My problem was every time I planted my left foot, my big toe was rolling away from the rest of my foot. The tendons and ligaments (i did gymnastics and have run for years) were so slack, loose, crappy whatever you want to call them that they couldnt support my big toe. So every step i took I'd have localized pain just up from my toes, right where the tendons and ligaments should have beem working to hold my big toe close to my foot. The pain eventually moved up my foot and I was feeling it in my ankle. Basically I ran with this issue for so long the pain was felt all over.

He said he sees this alot in gymnasts... lucky me I guess. He gave me three options:1) I could wrap my foot with vet wrap(that stuff that sticks to itself) for the rest of my life-well, ok but that wont look cute with heels on 2) i could have surgery on my foot but would be out for at least 5-6 months-um HELL to the NO or 3) i could try an alternative medicine called prolotheraphy which is used to strengthen tendons and ligaments (the US Ski team does this treatment on their knees) I opted for prolotheraphy.

Now I'm not pushing prolotheraphy but it was a miracle for me! I had about 8 treatments on my foot and now-no pain at all!!!!! if I feel a little niggle I might go in for a shot but WOW, after 7 years of pain it took about 8 treatments, so about 8 months to have zero pain.

Now I'm not saying this is what you have, I actually thought I had compartment syndrome as well.....until i saw the weight bearing xray!

I would recommend, if you havent already, finding a podiatrist who gives you a weight bearing xray-you'll get a much better idea of what is going on with your foot in the position you feel the pain!!!~

Call me if you need the name of my podiatrist-he's in Santa Monica and is a ROCKSTAR!!!!! or my prolotheraphy doctor (who is an MD as well, he's in Santa Monica)...

Aka Alice said...

I don't have a diagnosis for you, but when I had a stress fracture last year, it hurt in pretty much the same place. It was very, very, very small fracture. In fact the doctor missed it all together when he first looked at the x-ray, and only after I practically smacked him upside the head when he pressed on the sore area did he go back a look a second time and noticed the small "chip" he called it.

The potentially good news for you is that it did NOT ever stop hurting and my toes were pretty swollen, so what you have may not be a stress fracture.

I'd have someone look at again....just in case. I'm not that familiar with Kaiser, but can you request that someone who is more familiar with sports injuries look at it?

Good luck!

Irene said...

My only advice is to be a "squeaky wheel" with Kaiser so they can do CT scan, MRI or some test that will look at everything. I was misdiagnosed three times at Kaiser and ended up needing surgery because of the misdiagnosis. It ended up costing me and Kaiser more money. Insist on further testing and/or what ever treatment they will offer.

Glenn Jones said...

I've not had this problem, but if you want a good sports medicine doctor (he's the Medical Director for Surf City), let me know - he's a great doctor and won't tell you that you have to stop running unless you *really* have to. He's an MD with specialty in Sports Medicine....

Allie said...

I have no idea, I'm not a doctor (nor do I play one on tv) but I do hope you figure it out and recover quickly.

L.B. said...

I have similar pain. Mine hasn't yet caused me enough discomfort to stop running for a few days or weeks to rest, or even enough to stop running during a run, but at the rate it's been increasing in discomfort level my luck might run out soon.

Alissa said...

I wish I had an answer for you! That sounds soooo frustrating! I agree with Irene - try to get them to prescribe an MRI. Thats going to be your best bet to make sure its not a stress fracture. If you have lower bone density, I would guess you are at a higher risk. Keep us updated!

Lindsay said...

i wish i had a suggestion! i would google the heck out of it. MRI's are expensive, but since you've been dealing with it awhile you could look into that. :-/ i'd like to think since it comes and goes it's not serious.

Unknown said...

it is likely to crack. This normally occurs in healthy and fit individuals who subject their body to excess physical activities. This kind of fracture is normally experienced by sportspersons and military recruits who engage in physical activities for long periods of time. They develop a stress fracture that leads to foot pain. The second situation is where people have extremely weak bones. This commonly affects women with osteoporosis.


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