ThyPeace

Hi Folks -- Got a second opinion from another orthopedist with a similar result. The only way to repair the tendon is to replace it; it's shot. However, as I read more and ask more questions about the condition I apparently have, which is called alternately "adult acquired flat foot" or "posterior tibialis tendon dysfunction," the more I realize that I have probably been seeing the wrong kind of doctor. Besides which, the doc I have been seeing has never even mentioned those terms, and now that I know how badly my tendon is messed up, I think he could have figured it out at least a month before he did. So... I think it's likely that what I need right now is a podiatrist to help with orthotic support to the foot, rather than a surgeon. When I have a brace or orthotic on, I am basically never in pain. It's not clear, from what I've read, whether orthotics are enough to arrest the progression of the condition or not. But it's worth trying. I've decided to give myself a year of really hardcore work at that before I consider surgery. Today I'm wearing my sneakers at work, and under one of those sneakers is an AirCast. It's not a great thing to stand on, so I'll have to think that through. I will say that it essentially eliminates any pain I was feeling while walking. The bad news is that most people with this kind of injury never run again. There are only a very few instances where people do, and I have a feeling their tendons are in better shape than mine. But I'm starting to see that it's not the end of the world and that I can still lead an active if I'm careful and really cautious about dealing with the injury from here on out. ThyPeace, really need some aerobic exercise, though. May have to invest in an exercise bike or rowing machine or something.

Well... crap. After a lot of slow progress and continuing pain, the doc finally did an MRI. I have something called a full-length split tear of the tendon. Basically, that means that my sense that the tendon had been shredded was entirely accurate -- think of a string that has split lengthwise. There are apparently very few options other than a major surgery where they take the tendon out and replace it with one that currently controls the scrunch motion of the foot. Crap. ThyPeace, adjusting to a new reality ... badly.

So the next week, I did what the PT said. Did my exercises, including the new ones he gave me. And I did my 1.5 mile walks. The first day I did some very ginger running. I learned that my ankle can't take a corner well, but straight and flat I can do 30 seconds at a time. So I did four of those. I kept that up until my next PT session. The physical therapist was, I think, trying not to laugh at me as he suggested that I could increase it to a minute per run and didn't need to be so cautious. He was again pleased with my progress. I guess all that strength work with the first PT did me some good. Anyway, so that day I'd planned to go running, but also had a dentist appointment to get a cracked tooth repaired. After an hour of that, some of it before I was numb (OW!) and some of it when my face was so numb that I couldn't quite feel my nose, I was not up to going out to run. So it ended up being two days later, and I got a lot of rest in between. It was GREAT! I felt so freaking fantastic -- I went for a minute and felt okay. I walked for a while. I went for another minute. I did it again. EIGHT TIMES. And extended the distance to 1.75 miles, though I briefly considered that maybe I'd done enough before I did that. Turns out I should have considered that more carefully. By that afternoon, I was aching like crazy. Took a day off from the PT exercises, slept a lot, iced, and went back to just easy walking. The next PT session was not so good, as the PT spent a lot of time wondering why my ankle had reacted like that. I had no answers for him (and did not say "I told you so" because after all, it's my body, not his). It took four days until I felt better, which is when I saw him. He wanted me to try running again the next day, so I did. I could go for a minute without much in the way of pain, and did four sessions of it. I was feeling pretty good when we were almost home, and decided on the spur of the moment to try some side stepping that the PT had had me try on a treadmill. Guess what? ThyPeace the genius has learned that bounding side steps are -really- not a good idea for an ankle sprain! Yeah, I know. I'm a genius. Sigh. So I suffered with soreness the rest of that day and the next. I did everything I could to stay off of it and rest, and by Sunday, I felt a lot better. And I had plenty of free time. And have I mentioned that DH has been trying to get ready for the half marathon that I had planned to run, though his own sea of pain associated with his Achilles? No? Sorry about that. The poor guy has really been suffering. He'd much rather just ride his bike, and I keep telling him he can have a pass and it's fine, but he's stubborn. He's decided he wants to do it and he's going to. He did finally get an appointment with a PT last Friday and she gave him a ton of useful advice. I think he's going to be better, but still in a lot of pain after the half, which is only ten days away now. Anyway, Sunday he needed to get in a long run, which he's been doing at the local track because it's easier on his Achilles. So we biked to the track together and I walked while he did his run. I tried a few steps of running and decided my ankle wasn't quite ready for it, so it was 50 minutes of steady walking for me -- way more than I have done in the last three months. I eventually had to stop because my calf was starting to complain, but still, it felt fantastic. The bike ride home was a lot slower, but we were both functional the rest of the day. That's progress; the previous weekend, DH was a wreck afterward. I think the longer walk breaks, more water, cooler temperatures, and advice from the PT all helped. And the peanut butter sandwich I made him try. He hadn't been fueling at all, and with a half, he really needs to have something along the way. Next week I think we may try half-strength Gatorade. He's not doing a Whole30 at the moment, and it's pretty tried and true. This week I've been pretty cautious about running, and only doing what I think I can do without hurting myself. I'm getting better at gauging it. This morning was fine -- five runs of a little over a minute each -- and I think I'll be able to go out again by the end of the week. My next focus is finding better dress shoes. I've been wearing my brace with my dress shoes, and though it allows me to function, it's uncomfortable and I think my gait is messed up from the way it has limited me the last few months. I hope the low boots that I ordered will work. They have a removable sole that I can put some Super Feet into, I hope. That ought to work out okay. ThyPeace, slooooow progress.

Okay, so I think 18 days later is long enough to leave everyone in suspense. Let's see. I went for a walk. The first walk was an evening one, and it took me 30 minutes to cover 1.5 miles. Golly, I was ginger and feeling weird! It didn't exactly hurt, but I noticed my ankle with every step. And golly, I wanted to run so badly I could taste it!! I contained myself, though. Since that had gone well, I did it again a couple of days later, this time a little faster but still carefully. That got me to my next PT appointment, where he was pleased with all my progress and encouraged trying out some very short intervals of running mixed in with the walks. ThyPeace, and now another pause; I'm a bit short on time right now. More to come!

I'm not exactly an old hand, but I did find this: - Make sure to eat more carbs ahead of a long run. Doesn't really matter what, so pick what you like. Starchy seems to be the recommendation of choice here over fruit; I'm not sure I agree. But try that first and see what happens. - During a run, try dates rolled in salt and potassium chloride. I've also read about people using boiled eggs on their long runs. Also, try coconut water - Afterward, it's all about rehydrating, rebuilding your electrolytes, and rebuilding depleted carbs. For me, that meant a mix of water, a fruit juice, salt, and potassium chloride. For you it might look different. ThyPeace, I will also note that walking in the house from a long run is NOT the time you want your kid saying, "Hey Mama, do you want a Rice Krispies treat?" But you know, it tasted really, really good.

Not that you need my vote, but 2000 meters of swimming counts as high intensity in my book, too. I used to swim 3600 yards a day 5 days a week, and I definitely needed food afterward. For me it was a roast beef sandwich on white bread, but I was 19 years old and all food was good at the time! You will probably want something a little healthier. ThyPeace, the good old days...

So the weekend actually held two bike rides. One was a flying craziness with my husband, trying to do seven miles before it got dark. (I'm slow. He's not. I was in front and still struggling to keep up. He even coasts faster than me!) Probably pushed it too hard because my knees were sore afterward. Sunday we did a calmer ride up to the track so DH could run. I stopped at Starbucks and got coffee on the way, so you know it wasn't hardcore! Once I got to the track, I decided to walk a little and found that it didn't hurt nearly as much as I expected it to. So I walked a half mile, then sat and drank some coffee, then walked another half mile. While carrying coffee to force myself to go as easy as possible. I had physical therapy on Monday. The physical therapist was all "You're awesome!" and "There's nothing wrong with you anymore!" and "You're 100%!" And I was all like, "I can't do a single step of running yet, what planet are you on?" Now, I will admit that I can do squats on a Bosu ball, planks with my feet on the Bosu ball and tapping down on each side, single leg squats with a slider thingy, and more weight on the leg press machine than any other current patient can do. Great. I'm strong. But I fall over when I try to do the single leg touches. I shake and get exhausted standing on one leg on squishy foam. I take an eternity to walk a squish balance beam. I am not 100%. And I can't run. Tuesday, I told the doctor all of this as he was testing me and said, "Yeah, still some weakness there" while I tried to hold my ankle inward against his push and couldn't. He suggested that I seek another physical therapist, even though the one I've been seeing is with his practice. I decided to take him up on it and called the physical therapy practice that advertises at the races I've been to, and where I went to the stride clinic back in February. They had had a cancellation and fit me in the next morning. So I got a fresh new evaluation from a new physical therapist yesterday morning. He seemed pleased with my overall strength, and instantly identified weakness in my left outer glutes. He said that is tied to the arch and we need to activate it to get the arch muscles activated. he also noted the different in the arch in my two feet (yes I know...) and asked about a dozen times "So... no one did an MRI?" It was pretty clear that he would not have done things the same way as they went in the last three months. But oh well, we all knew THAT by now, eh? He said that there's pretty clear evidence of a stretch injury, which is likely not the original injury but from one of the major tweaks I had after that. And the day when I felt my whole foot shift, he said was probably the tendon popping part-way out of the groove it's supposed to live in. When I later felt my foot shift back into place, that was probably when it had calmed down enough to go back into the groove. Interesting interpretation and different than the one I'd previously, which was that it was the ligaments being damaged. I have no way to judge which one's right, of course. The assessment involved checking the strength of various muscles in various directions. The key was using the glutes to hold the leg up (rather than the hip muscles) when I'm on my side but my leg is slightly behind me, where the larger muscles can't work. Turns out I can't do that on one side. He also had me do a mini squat on each leg to see if my arch engaged when I was doing it. Yes on the right, no (and falling over because of lack of balance) on the left. Ah ha! I think we have a new view of the problem. So after the assessment, he took an ultrasound machine to my ankle (after again appearing surprised that no one had tried it before). He said it was to improve blood flow in the tendon by warming it up, which seems to have been generally true; an hour later, the area was warm and a little puffy, and then it receded later in the day. Interesting effect, that. Then we looked at my shoes (Mizuno Wave Inspire) and inserts (SuperFeet Green) and he pronounced them an excellent choice for my current status. He also looked at my brace and said it's a good one. And he said we'd try some tape. I looked perplexed, so he got the tape and proceeded to tape my foot in a way that supports the arch. He asked me to leave it on until I had a chance to go back to the track and walk, to see if the tape would allow me to go a little further without pain. I said sure, I'll give it a go. He also recommended finding a combination of walking, stationary bike, and elliptical to get me back into cardiovascular movement "so I won't feel so much like a slug." Hey! He must be a runner -- he knows how I feel. Then it was on to the exercises. He gave me deceptively simple ones that are designed to engage the glutes and the arch at the same time. Stand on one leg, bend it slightly, engage the glutes and the abdominal muscles. From there, just pull a very light stretch band that's around the ankle (of the foot that's not on the floor) in and out. Easy! Except for the mental connection that I'm required to make between the glutes and the arch -- they have to engage at the same time. And that part? Hard. I'll keep working at it, but I will definitely need his advice on when I'm doing it right and when not. That exercise is to be done 2x20 times on both legs and in two directions, twice a day. And I'm to continue doing any of the other exercises that I found helpful. So, that's the doctor and physical therapy report. Next time, I'll report on .... (dramatic music here!) Going For A Walk. ThyPeace, how's that for a cliffhanger?

Another week, another week of the same workouts. Nothing too interesting and definitely no running. I am noticing that I am craving carbs quite a bit at the moment, which is not helping me with my continued quest for a healthier lifestyle. I keep thinking about what I'm going to do to improve my diet and life overall, and keep coming back to "Meh. Things are fine. I'll improve later." This is probably not a good answer. I note two things about my body composition. When I look at myself from the front, I see a belly that is rounder than it was two months ago. I attribute that to not running, though my weight has not changed much in that time. And when I turn around and look at myself (thank you, mirrors) from the back, I see that my back seems much more muscular than the last time I looked at my back closely, probably six or eight months ago. I'm noticing that my upper arms and shoulders are more muscular, too. Can't quite figure that out, since I'm not actually working those parts of my body (unless you count two sets of planks twice a week, which I don't). ThyPeace, looking forward to a bike ride this weekend. I need the peace and quiet.

Still doing the same workouts as described above. The physical therapy assistants who follow me around while I'm doing it tend to get really big eyes somewhere along the way in the workout. Apparently they are more accustomed to the older people who are recovering from hip replacements and things like that, rather than someone who wants to go back to being really active afterward. Speaking of afterward, I'm in far less pain than I was two weeks ago. I still can't imagine running or jumping. Instead, I -can- imagine walking without a brace. That's a good step. I skipped the brace yesterday to allow my foot to recover from the injuries it does (bruises and pressure spots, mostly), and today I'm not too sore. I had to go back to wearing it, though, so you know I'm still not healed. This week I have a regular PT appointment, a PT evaluation, and an orthotics fitting. I have a feeling I'm going to be really tired after all three -- and two of them are on the same day. I'm wearing my new shoes today to get them broken in a little bit before the orthotics appointment -- the pedorthist asked me to buy a larger and wider shoe size so that the orthotics would fit well. And he told me I really would be better off in the larger size anyway. I haven't don't any real exercise other than the PT in weeks. I did go for bike rides both days this weekend. It felt good to get a little exercise in -- just light 40-45 minute rides both days, tooling along at maybe 7-8 miles per hour, so nothing intense. Once I'm finally cleared to get a little more exercise, I'm going to have a lot of catching up to do in terms of cardiovascular fitness. I'm building muscle nicely at the moment, though. Even my biceps, though the only things I'm doing to strengthen them is planks and holding the stretch bands when I do my ankle exercises. ThyPeace, likes having muscle, but not as much as I like running. I think.

I'm glad you figured it out, Meiyonce! And yes -- I think your body will tell you what it needs, if you listen. I am not so good at listening all the time, but luckily it pretty much keeps telling me until I get it. ThyPeace, sometimes it takes a smack over the head...

So... no one answered, which I'm sorry about, @Meiyonce. Hope you're doing well. I thought about making some specific suggestions, but at this point you're far enough along that you've probably tried everything I would have thought of. So instead I'll just ask -- how's it going? ThyPeace, has been away a lot lately.

Just a brief stop-in. My vacation was nice but frustrating. Going to a water park when you can't run around is hard. I did play mini golf once and spent time in the lazy river. I had bourbon with my brothers and stopped at a biergarten one of them started a few weeks ago. And the one slide I went down was because my 2 year old nephew wanted to go with me for his very first water slide ride. Hard to turn that down! And I tripped while walking (apparently that wasn't a place someone with a bum ankle should walk) on the second night there. It hurt badly enough that I ended up crying on my husband's shoulder after we went to bed. The next day, I realized that the pain of that encounter was not all that much worse than PT had been. It really made me think hard about PT. I rested as much as I possibly could after that. Spending a lot of time in the water, where I was putting no pressure on my ankle and foot at all was really nice the last part of the trip. I came back with the swelling and pain significantly reduced. This week has been a slow increase in aches and pains as I have gone through physical therapy and just getting back into my routine. I backed off on the thing that was really hurting my ankle the first time back to PT, and the next day, amazingly, wasn't crying in the shower. I think the several days off from PT was also helpful. And so today, of course, I got a whole new set of exercises. Here are a couple of pictures -- note the emphasis on balance -- that demonstrate one of my new exercises: https://www.meyerpt.com/airex-balance-beam Fiendishly hard. I didn't start with that, I started just standing on one foot on the stuff. Ugh. Then there was this exercise, the sliding side (and also back) lunges: See how he keeps his foot in the same position the whole time? I can't do that. But I did 20 of the best I could. And last but not least, we now have planks with my feet tapping down from a bosu ball. That was hard. I did two sets of ten of these (one rep requires tapping down with both feet). With the leg press, calf raises, one-legged leg press, and Bosu ball squats, I'm getting a pretty good lower body and core workout twice a week. No cardio or much upper body, though. Sigh. ThyPeace, who really just wants to go out for a nice long run-walk.

Okay, so on to the orthotics fitting. That was Tuesday. It was a really interesting process. The pedorthist ("a professional who has specialized training to modify footwear and employ supportive devices to address conditions which affect the feet and lower limbs," thank you Wikipedia) had me describe what had happened and what shoes I was wearing in more detail in far more detail than anyone so far. Of interest was that he said that he was seeing quite a few people come in with injuries after wearing the Brooks Adrenaline shoe. He attributed the problem to walking in them, rather than running in them. The design that prevents over pronating in a runner seems to roll the ankle outward too much when walking. That then leads to the muscles tightening up to try to compensate, which then leads to everything on the inside of the ankle also tightening up. Over time, that leads to the type of injury I have. It got exacerbated when I tried to run on it, not realizing the problem. The lack of stability, combined with the force, damaged the ligaments between the ankle bones as well as the tendon. And because I continued to wear those shoes after I was injured (thinking hey, new shoes, probably better for my feet, and they're larger so the brace fits better!) means it just continued getting worse. Maybe that's why the first PT session, when I was still wearing those shoes, was such a horrible experience. Sigh. Live and learn. So anyway, he went on to check my feet and ankles carefully. Apparently my feet are slightly inverted, meaning they point inward somewhat when in a neutral position. In addition, I am asymmetric. On the left side, my big toe doesn't fully hit the ground. On my right side, it's my little toe that doesn't quite get there. Which is why the left ankle got hurt more. And my toes are straight. This is apparently a good thing. After he looked at my feet, it was time to do the imaging of my feet. They do a 3D image instead of a plaster cast, and the way they do it meant that I had to stand on one foot with my other knee on a chair for a couple of minutes each side. I really, really should have asked to put my brace for that part. Standing in that awkward way put a huge amount of pressure on my ankle, and I was really tired and sore by the end. We also talked about my PT. His assessment was that I have been given an extremely aggressive PT regimen. He wasn't convinced it was a good idea (he is also a physical therapist in addition to being a pedorthist), but said only that he'd talk to my PT about it. And then .... I wait five weeks (!!!) for the orthotics to come in and "then you can start healing!" or so the pedorthist said. I wanted to hit him over the head for that. I darn well better be a lot more healed 5 weeks from now than I am today. That said, knowing that orthotics are helpful for this is a good thing. I may go find a running store while I'm on vacation next week and buy some more supportive shoe inserts than the ones I have now. And since I'll be on vacation, I can spend all my time in my supportive sneakers rather than in my somewhat less supportive dress shoes. The next day I had physical therapy again. I was tired and sore from Monday's PT and Tuesday's excitement with standing up barefoot for a long time. The PT itself went about like Monday -- elliptical (yay!), exercises (boo!), and Game Day were all the same. This therapist spent a long time doing a very gentle massage of the posterior tibialis tendon itself. It was knotted at one point, and her goal was to unknot it. Now, I know she was using the level of pressure that you might use when rubbing a baby's back to get her to fall asleep. I -know- that. However, it hurt like she was sticking a needle into me. Sheesh. Talk about a tough session. The Game Ready only helped some afterward, and I was icing my ankle all through supper time. The next morning (yesterday), I was in so much pain that I didn't do my exercises and could barely walk. Things steadily improved as the day went on, thank goodness, and this morning I was back to where I was on Tuesday morning. I don't quite understand everything that contributes to high pain levels, but I can tell you for sure that PT brings it on! I do think that if I could just get in more healing time between PT appointments, I might heal faster. However, the constant reminders that this is a long process are... good. I guess. Sigh. Tomorrow, we go on vacation for a week. It was supposed to be a fun active vacation with beach time, water park time, running, and other good stuff. As it is, well, I'll play mini golf and spend time in the lazy river. At least I get to see fireworks, my nephew, and drink bourbon with my brothers! ThyPeace, looking on the bright side as much as possible.

Physical therapy is still progressing slowly. Last Friday I got to work almost the whole time with my physical therapist instead of starting with the assistant. That was really helpful because she actually corrects me and modified the exercises that I just can't do yet, rather than just watching me fall over the way the PTAs do. I kept telling her how much how much it my ankle still hurts, but she didn't start to believe me until I yelped when she happened to squeeze my ankle in just the right spot. Her whole demeanor changed at that point -- apparently I should NOT have that much swelling this far into the game. Her comment was, "Wow, you must really have done some ligament damage, too." I was in too much pain to say anything snarky. So I got to meet my new best friend, the Game Ready machine. It gets cold and compresses. And then relaxes, and compresses again, the goal being to reduce inflammation. And she told me to go get an ankle sleeve to reduce the swelling even more, and to ice every day (already am), continue with the ibuprofen (I was), and just keep trying (yeah, I know). I decided that over the weekend I was going to do Absolutely Nothing, and see how that felt and whether it helped. I slept 9 hours one night, 10 hours the next, and then took a 2 hour nap. Poor DH had to do far more work than usual to let me do it, but sure enough, by Monday morning, I was in a lot less pain and there was a lot less swelling. I was still a little tender, but not as bad. At PT that afternoon, I got to go on the elliptical for 10 whole minutes!! That's the most aerobic work I've done in weeks, and it felt fantastic. I was really careful with my ankle and was able to use the time to warm up the area really well, which led to less pain rather than more. That's a good thing. PT itself was just about as miserable as always, but I can still tell that there is some progress. I can do the Bosu ball squats without it hurting, for example. And I'm up to 200 pounds on the leg press (they started me at 120 pounds, but that's just silly; I weight 170, after all!). 120 pounds on the single leg press was hard. I could only do 17 reps instead of the 20 they asked for. Ah, well. I'll work at that no problem. The single leg touches (below) are particularly hard. I did ONE on the bad side. Nine on the good side. Sigh. The other exercises are all either easy (stand on something and rock my leg back and forth) or hard-but-not-painful (planks). More to come on the orthotics fitting, but for now must go back to other things. Have a good day and don't get hurt, y'all! ThyPeace, "be careful out there" is one of my favorite lines from Hill Street Blues.

Not feeling like you want to throw up is a great start to any day. I was thinking about the difference between an RXBar and a LaraBar. Seems like the main difference is egg white. Have you tried cutting the RXBar in half and adding two egg whites, just to see what that mix does? ThyPeace, just guessing here.