Sunday, October 30, 2016

Foot injury: the verdict

One post in September (the US 24-Hour Nationals race report) and one philosophical discussion about the benefits of injuries [sic], I haven't been very prolific lately. It's hard to talk about running when you aren't, well, running... Hard to recognize that some dreams may fade away, like running very long distances for ever. Or even hard to complain when you see much worse situations around you. For instance, this week, top ultra runner Dave Mackey decided to get his leg amputated as it isn't healing after one year of pain and multiple surgeries.

So, what's the verdict about my little foot injury? Well, the jury is still out as we say, and they must be in a hot deliberation and arguing. Let's start with the good news first: according to the doctors, radiologist and podiatrist, it isn't a fracture! This is a big relief as it might have required between several months up to a year of rest otherwise, phew! It is just an inflammation of the sesamoids, a sesamoiditis. See for yourself...



Or, for those of us who can't read an MRI, here is the detailed report:
Technique: Axial T1, axial T2 with fat-saturation, coronal T1, coronal T2 and sagittal STIR images were obtained through the right forefoot.
Findings: Skin marker was placed over the area of symptoms in the plantar aspect of the metatarsophalangeal joint of the big toe.  
The tibial sesamoid is unremarkable.  Bipartite fibular sesamoid is noted with increased T2 signal abnormality in the fibular sesamoid, across the syndesmosis. No fracture line is seen.  No soft tissue edema.  Minimal degenerative changes of the metatarsophalangeal joint of the big toe identified.  The remaining forefoot is unremarkable.
IMPRESSION: Bone marrow edema in the bipartite fibular sesamoid consistent with sesamoiditis. 
Hum, so that's an impression, not even an opinion... But the bad words here are 'bone marrow edema.' Not a good combination of words; that means the bone itself got inflamed, a condition potentially leading to a fracture: I'm so glad I did listen to my body on this one and stopped before it was too late!

Now, the prescription was 4 to 6 weeks of rest. This Saturday marked 6 weeks after the race and looked like the right time to give it a try. I did run 15K just below 8 min/mile and it looked ok yesterday. I'm not sure actually as, after such a long break, I have so many strange sensations throughout the foot, including around the ball of it. This Sunday, I went for 25K, still at a slow pace. No major pain, but still some doubts about the incriminated area. Every time I come back after a break, either forced or planned, I'm surprised how I forget about some of the pain involved in running. Or, not to discourage new comers, let's say discomfort.

To conclude, and for the sake of keeping learning about our body anatomy (see my previous post), here are a few pictures highlighting these infamous sesamoids. Small things, yet essential... And really in a tough place with all the ponding involved in ultra running...




No particular or sharp pain as of Sunday evening, I'm hoping I'm good to go for another round then...

Take care all!

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