Wednesday, December 22, 2010

Well, THAT was a surprise...

I had my 7 week follow-up visit with the podiatrist this morning. Visits to the doctor when you're injured are a bit like visits to the Oracle.  You traverse a perilous and stressful journey (through DC traffic), make an offering (Visa copay of $30), present your question, and then wait for the Oracle's pronouncement, which is grounded in the interpretation of things beyond your ken (x-rays).

In my case, the good doctor first palpated my foot and wiggled my toes (no pain anywhere, at all) and asked me how it felt when I walked or ellipticalled (no pain at all, just a lot of stiffness, especially during the toe-off phase of walking).   So, very good.  He sent me to the next room to get the foot x-rayed for the third time in this saga.

Then I waited, and waited.  And stared at a shiny poster depicting all the things that could go wrong with my feet.  And played with my phone, stunned at the lack of reception despite being in a fifth floor room with a window on K street in downtown DC.

I was debating whether to break down and actually read a pamphlet about bunions when he strode back in (I don't think I waited much at all after the x-ray, it just seemed like an eternity).

"This looks really good."

Huh?  I had braced for the opposite.

He pulled up the x-ray on his laptop, and the improvement was clear, even to me.  The fracture was completely gone; in its place was a perfectly formed bone with a fuzzy halo around the site of the fracture.  He explained to me that what he saw was a repaired bone, with a fully formed "boney callus" around it.

To explain further, my (non-medically trained) understanding is that bone healing has several stages:
  1. the reactive stage: the initial inflammation and clotting;
  2. the reparative stage: formation of a soft "callus" made of cartilage around the injury site that brings the bone together; followed by conversion of the soft callus into bone -- the "boney callus".  
  3. the remodeling stage:  the bone's all there, the body just needs to fine tune it and carry away the excess (at this point, stress to the bone is helpful, as it provides guidance to the body as to how to remodel the bone).
According to the x-ray, I am in the remodeling stage, which can last for up to a year.

After giving me a brief tour of my own metatarsal, he looked at me.

"If we really wanted to play it super-safe, we'd wait until the beginning of the year to start running on it.  But this looks really solid.  I think if you want, you can start running on it now.  Just be very careful - I only want you running every other day for the first few weeks, and I don't want your running to total more than a mile a day for the first week; 2 miles a day for the second week.

"It's going to be a bit stiff and achy, and that's normal -- you've got all sorts of soft-tissue adhesions that are going to break apart as part of the process.  Just keep an eye on it.  If you feel any real pain, back off for 2-3 days.  If it starts hurting, and doesn't feel better after 3-4 days of no running, give me a call and we'll discuss whether you need to come back in.  But right now I don't think I need to see you again unless something changes."

I was shocked.  I had hoped as a best case scenario that he'd tell me to come back in 3-4 weeks for another set of x-rays, and an evaluation of whether I could start running again.  As funny as it sounds, I'm not sure I'm ready to run just yet.

Truth be told, I may have a bit of injury/poolrunning Stockholm syndrome.  I've come to see myself as an injured princess runner in my deep water fortress, safe from worrying about time splits or the reality of crappy running days.  I've grown spoiled.  I'm now used to the constant affirmations of how wonderful it is that I'm trying to stay active while injured, the constant compliments on my avid poolrunning, and the people who open doors or carry bags for me.  The pool is windfree and warm, while ice and chill lurk outside.  And now I have no excuse not to shovel snow.

Additionally, aside from any mental issues, while the bone may be ready for running, I'm not sure the leg is.  Six weeks of immobilization have left the foot and lower leg very weak, and my range of motion in the left ankle is much less than the right.  It improves every day as I walk -- I hobbled the first day or two, but now walk almost normally.  But I fear that if I begin to run right now, while this bone will hold, something else somewhere will give.

So I asked the doctor if I could delay running another week or two.  This isn't as odd a question as it first sounds.  During our last visit, he had been very clear that it wasn't that I could take the aircast off and start the elliptical at the 6 week mark, but that I needed to, and that he wanted to see me after I had been walking and ellipticalling and stressing it.

In this case, though, he told me I was fine and even smart to take it slower.  I told him that I wanted to spend more time walking and using the elliptical, and just bringing that leg up to the same range of motion and strength as the right, before I began to run, and he agreed with the idea.

So, that's my plan for right now (unless coach objects).  The next week or two will be dedicated to ever increasing elliptical and walking (I'd like to get up to "power walking" for at least an hour), plus foot strengthening and range of motion exercises, before gently starting to run (starting by going to the track and jogging the straightaways and walking the turns).

I'm registered for the National Half Marathon in late March (I registered this past July, to take advantage of the discounted fee) and the Cherry Blossom 10 Miler in early April, but I am operating under the assumption that I won't be running either.  Maybe I can race the 5K associated with Cherry Blossom, and maybe I'll be able to head up to Philly take a crack at the Broad Street 10 Miler in early May.  But it's still way too early to hope, and the priority remains on getting totally healthy.

As for how I managed to cut 12 weeks healing time down to 7?   Doctor pointed out that I was a) very compliant and b) very aggressive in treating this. A few examples:
  • During the initial injury, within about 30 seconds of the foot going "pop", I called it a day, and began icing.  The foot didn't hurt at all, and I felt silly at the time, like I was overreacting.  But apparently that willingness to shut stuff down ASAP saved this from being much worse than it could have been.
  • Once I had the aircast, I stayed in the aircast.  I've heard stories of a lot of people "cheating" on it, or trying to cycle or elliptical with it.  Nope.  It was hard, but I stuck to the pool.
  • I'm well aware of my tendencies towards lousy circulation, as well as my Raynauds (fun picture of an attack here).  Both indicated a problem with healing, which is so dependent on blood flow.  So I addressed these by constantly keeping a heating pad on the foot and hopping in a hot shower anytime the Raynauds hit.  I think my heavy regimen of poolrunning also helped a lot here in keeping the blood moving.
  • I also made the affirmative decision to accept weightgain during my down time.  I calculated early on that I could either a) try to diet to keep from gaining weight during this period of decreased activity, or b) focus on sufficient protein and calcium and calories, and if that meant a few pounds, oh well.  I chose B.  7 weeks later, the jeans are tight, the rear jiggles, and the scale is a few pounds up.  But I'm cleared to run, and I'm more than happy with that trade-off.
  • Finally, the magic machine: the Exogen 4000 Bone Stim.  It pulses ultrasound to the bone, promoting healing.  My podiatrist wanted me to get one from day 1, due to my circulation problems and Raynauds. 

    I spent the first week coordinating with the Smith and Nephew rep who was trying to get my insurance (BCBS) to cover it.  During this time, I did some research online, and it became pretty clear from BCBS's published coverage memos that they were NOT going to cover it until I had gone 3 months no healing.  This was unacceptable.  So I went to the medical provider of last resort -- Ebay -- and purchased a slightly used device for ~$350 (about the same as my copay would have been, had BCBS covered it).  

    The research was based on using it once a day, but my doctor told me to be more aggressive, and so I zapped my foot every 8 hours (5 am, 1 pm, 9 pm) with religious zeal.  Did it work?  Honestly, no way to tell from this sample size of one.  But research (published on S&N's website, and I've also verified independently) indicates a reduction of healing time of up to 38% from consistent use of the bone stim.  38% of the original projection of 12 weeks is ~ 4 and a half weeks less -- which is about where I'm at right now.  Hmmmm. 
The Oracle has spoken.  Now for the elliptical.


  1. Yay! Model Feet! ;) Great post and great news! I think the coach will agree with that plan and I have to say you really handled this injury amazingly, very focused.

    One of the ladies at my gym who runs had a stress fracture, she bought a similar stim device and swore it worked, so I think there's something to it!

    Congrats, a step forward!

  2. Wow. Great news! But I understand the mixed feelings about running again. Boy, do I understand.

    I love my Exogen 4000.

  3. Wooot! That's awesome news! I've been dealing with my own injury issues (and stress fracture paranoia) and I can just imagine the mental relief. I also know what you mean about feeling weird emotions about getting back to actual running. Hope the next phase of the recovery process goes as smoothly as it has been :)

  4. Thanks y'all. I am thrilled to be where I am, and just hoping I don't screw it up!

  5. Hey there,
    Not sure if you'll get this....but.... Flo Karp told me about your blog when I got my stress fracture. Great blog! I actually did take your advice and got an Exogen on Ebay. Question: How do I know this thing is working? I don't feel a thing. It's a used machine so just wondering if this is normal or if I got a broken machine.


  6. Hi Carrie -- I never felt a thing while using it. My only real evidence that it worked was my second set of x-rays, showing healing 5 weeks ahead of schedule.

    I've never heard of anyone feeling it while using it. One way to check whether it's working might be to hit the button while it's NOT attached to your foot. It should detect the lack of contact and show an error message and shut off. Other than that, I think you just have to go on faith.

    Good luck!

  7. Thank you! Flo sent me your message. I appreciate the feedback and love your blog. It's been a leap of faith with this used machine, but glad to know it seems to be working.

    -Carrie (week 5.5 of fibular sfx) Also known as Janie on RWOL.

    Haven't tried pool running yet, but swimming is keeping me sane. Never would I have imagined.