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The Princess Toe

5/11/2017

1 Comment

 
It's been four weeks since Boston and I still cannot run. 
 
A week after the race, I attempted three miles on the treadmill. I got through two and the "balling-up" sensation returned.  I hit the stop button immediately. At the track that Wednesday, three easy miles felt great. The softness of the track made for an ideal running surface. But as I walked to my car, that awful feeling returned: a hot poker stabbing into the back of my calf muscle.

This is not normal. This is not healthy. Time to call in the experts.
 
A week later, I found myself perched on the exam table of one of the most respected sports med doctors in town, wearing the ugliest pair of blue shorts I'd ever seen. I had a sundress on, but they insisted I wear these shorts "for everyone's comfort."

Sure, whatever. Just fix my leg.
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The doctor was awesome and extremely thorough. He and the PA listened patiently as I regurgitated the whole story, yet again.

"...and then, on mile 9 of my last long run..."

No MRI needed since the injury was already four weeks old. Instead, he bent my leg into as many awkward positions as he could, asking over and over again, "Does this hurt? What about now?...and now?" He measured both calves; the right had already atrophied a half inch. He rubbed his hands over the back of both calves and then had the PA do it as well. They murmured in agreement.  "Gritty," he muttered. She nodded, taking notes.
 
Gritty?

Once the ugly shorts were off, they came back with the official diagnosis: Grade 1 strain of the gastrocnemius muscle, the fleshiest part of the calf. The grittiness he noted was scar tissue. It was in exactly the area I had felt the pop.

I was so relieved. I finally knew what was wrong (no ruptured plantaris, it definitely wasn't a "cramp"), and Grade 1 is the best kind of strain to have; it's the most minor. Only about 25% of the muscle fibers tore. It usually takes three weeks or less to yield a full recovery. But as we all know, that little thing called the Boston Marathon loomed only 16 days away from date of injury.  It was the timing of that pop on April 1st that made this so problematic. This was no April Fool's joke, sadly.
 
But now? There are no races, nothing on the horizon. So I gratefully accepted this information, as well as the doctor's Rx for four weeks of physical therapy.
 
I was pretty excited at the idea of physical therapy. When I had gone back in 2013, it ended up being a wonderful experience. I took all of their suggestions to help my back pain and it did wonders for my running. Back then, I couldn't get past mile 7 without significant lower back pain. With the prescribed exercises, all tiny little movements, I learned how to strengthen that area of my back to take the pressure off the degenerative disk. Even now, when I feel a twinge back there, I jump right into the workouts they taught me.

I felt a bit like Judy Hopps walking into my first appointment. I was going to be the BEST PT patient they had ever seen! Write 100 traffic tickets? I'll write 200...before noon! Aside from the strain, I knew there was something seriously off with my right leg - I had felt it since the middle of March. But I had no idea what the heck was going on. The idea of working with professionals for four solid weeks felt a bit like spring cleaning for the leg. Sweep out the dirt, usher in  new solutions...let's' run stronger, better miles.

Because man, do I miss running.

::sigh::

During my first appointment, the therapist asked questions. So many questions. She asked me if I had experienced additional issues with my right leg. Well that was perceptive. You mean ole rightie, my problem child? I mentioned the sore Achillles that required icing several times a week and that bizarre issue with my adductor. I chalked the soreness up to high mileage and bad timing.

She felt my leg and then asked me to walk across the room. I hadn't gone more than three steps when she "tsk'd" loudly. I turned my head to look at her but she was staring at my right foot. I had barely sat down when she opened her mouth and launched into the issue.

She didn't mince words. A "significant weakness in my right posterior tibial tendon" ruined the month of April for me, as well as my marathon.  The tendon runs from the mid-foot up the back of the leg, and apparently, it's kind of a big deal. Any weakness in this area will shoot problems straight up the leg. Just like a house of cards, if the foundation isn't solid, the structure won't be either. Complications from the foot to ankle to hip result.
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Why is my post tib so weak? Apparently, I "sickle" my foot, putting weight on the outer edge while curving the foot inward. This motion prevents the tendon from engaging. This was her "tsk" during the evaluation. Based on what she said,  my post-tib has been laying pretty low for quite some time. I've been walking on the side of my right foot for as long as I can remember.  It's an unconscious thing I've been doing for well...years.

When you don't walk correctly, running is even more challenging. "Not a big deal if you weren't a runner," she told me kindly. "But because you are, the more "load" you put on your leg, the harder your other leg muscles must work." Kind of like the co-worker that never pulls their own weight at the office; everyone else has to do their share PLUS his. Not surprisingly, the other muscles get burnt out, pissed off, and quit. It was all starting to make sense:the Achilles pain was actually post-tib soreness and the adductor discomfort resulted from my knee dropping inward. My gastroc got so mad at being overworked, he put in his notice on Mile 9 of that last long run.

When she asked me to raise up on my toes using just my right foot, I couldn't. If I transferred my weight to the outer edge of the foot, sure, no problem. But raise up with my big toe on the ground? Wasn't happening. The way my foot curved in, the ball/big toe area never touches the ground, making it impossible to get any height. Unless using deliberate effort, my right toe does not touch the ground. I have to push it down  consciously, and even then, I can only pull my heel off the ground less than an inch.

During that first session, I stared at my right foot like I had just seen it for the first time. How had I missed this...for years?!  My big toe did not want to touch the ground. At all. Like a defiant toddler, like a little princess. Too pretty to get dirty, too good to touch the ground. Always with the toenail in the air, like she's at High Tea. What the hell?

I've now spent over a week working on the various exercises and cannot stop laughing. The weakness is so obvious, so pronounced. How did I not see this before? Princess Toe literally never touches the ground, whether I'm at rest or walking. Even when I'm sitting on the couch at night, totally relaxed with my feet up on the ottoman, my left foot points forward and the right one sickles in, like a backwards "C."  Well, too bad. This toe is no Kate Middleton. This pampered life is officially over. Princess Toe is getting smushed into everything now: exercise balls, balance boards, the yucky, yucky ground. Time to get with the program to allow the post tib to actually do its job.
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In many ways, understanding "the why" has given me something more valuable than any race medal: peace of mind. I spent a great deal of time mentally beating myself up, getting hurt so close to the race. We all know the cardinal rule of marathon running: Get to the Starting Line Uninjured. I felt like Icarus; I flew too close to the sun and got burned. I just *had* to do that 5K before my 20-miler. I *had* to ramp up my mileage. I just *had* to push it.

Typical Kim, always pushing, pushing, pushing.

But now, this experience is a bit of a blessing.  Instead simply treating the injury, I have a chance to tackle the underlying disorder. Princess Toe, no more!

Plus, this could have happened at any time, at any speed or mileage. My leg could only handle so much. It was a ticking time bomb. I'm lucky it was *just* a strain. I'm glad I went in to get answers, since as my PT pointed out, the next body part to go would be the knee - an area that usually requires far more aggressive treatment and rehab. I'll take a soft tissue tear any day of the week.

All of the new exercises must be working because my leg is so sore. Like, burning-sore during PT, and achy-sore the rest of the day. This tendon is probably thinking, "What the heck? Years of inactivity and now she wants me to work?"

Yup. Suck it up, Buttercup.

Not running is awful, I'll be honest. I'm tempted to start a group counseling program for injured runners; we could to commiserate with each other because this sucks and no one else quite gets it. I am a runner at heart. I want to run. Anyone who runs understands this feeling. So mentally, I'm trying to stay strong, but...yeah. No bueno.

Plus, fitness-wise, simply put, pound for pound, there is no better exercise than running.  While cycling and swimming are great for endurance, I am terrified of my eventual return will be like an astronaut returning to Earth. With all of these no and low-impact exercises, running is going to be painful. Very painful. It's already painful enough; why must I continue to get hit by the pain train?

I'm trying to come to grips with this. In my low moments, I get really pissed off. After all, I worked so hard this year. Big miles. A 5K PR. And yet...and still...pain. Loss.  Frustration.

But isn't that kind of life in a nutshell? There are no guarantees. We can work as hard as we can, yet the outcome hinges on stuff far out of our control. Like, the fact I've had an undiagnosed Princess Toe my whole life. Who knew?

The only difference: running lets me control that pain, loss, and frustration on my time. So, I'm going to continue, because that's what you do.

No looking back, right? That's not the direction we are headed.

So, let's fix this and move on.

*Hopefully I'll be cleared to run on May 31, my next appointment. In the meantime, I *may or may not* cheat occasionally by running up and down the street, five to seven minutes at a time. Just don't tell my doctor.

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