Monday, December 11, 2017

My lateral what? Timeline of an injury

Google tells me:

"Cuneiform fractures are quite rare"

"Nondisplaced fractures with a stable tarsometarsal joint can be treated closed with a short leg walking cast for 6 weeks."

"This bone works to support the body while also playing an important role in movement."

"Cuneiform stress fractures - These injuries seem to occur from a similar manner as do those at the base of the metatarsals. Vertical forces are a potential contributor to this injury and may be caused by too much speedwork, hill running (not as often as the speed work), or running on the ball of your foot."

"The 2 forces responsible for cuneiform stress fractures are bending and compression. Bending forces are applied across the cuneiforms due to their location in the midfoot. The medial cuneiform lies in the axis of the first metatarsal and is susceptible to compression-type stress fractures. Body weight passes through this axis, and muscular insertions on each side of the first cuneiform exert strong opposing forces across a small area. The lateral cuneiform is the keystone of the arch with 6 articulations leading to several force vectors across this bone."

x-ray that shows nothing (of course, the
bone I brokeisn't in focus)
On November 14th after months of no diagnosis, pain and no running I finally learned what was broke. I had to have the nurse reread the report because in my extensive pre-diagnosis googling I never suspected a fractured cuneiform. I fell to the ground and started to cry. My biggest fear was that the MRI would show nothing wrong. I finally had a diagnosis!!! After weeks, months of waiting my doctor wanted me to be seen by the orthopedist ASAP. 

Nondisplaced fracture of the lateral cuneiform tarsal bone with mild patchy bone marrow edema at the second and third tarsometatarsal joints. 

Translating my report, it means I have a fracture-fracture (not a stress fracture) and I have a stress reaction at the metatarsal joints that articulate with the lateral cuneiform. 
Knee scooter is a game-changer

Timeline of an Injury

August 9th--during my weekly tempo run, my foot started to hurt. By the time I finished I couldn't walk without limping. (10 miles total)
August 10--urgent care visit. x-rays show nothing.
September 15--urgent care visit. Repeat x-rays show nothing.
October 2nd--primary care doctor, referral to orthopedics and MRI
November 7--MRI
November 14--MRI results indicate fracture
November 15--ortho appt short leg cast for one month
December 14--ortho appointment (hopefully cast will come off! fingers crossed)

I've spent a lot of time thinking about how my injury occurred; if I could have prevented it. I strength trained, I yoga'd,rolled and stretched. I spent time before every run activating my glutes, core, calves. I warmed up. I took my recovery days like a champ. I had regular massages and still went to physical therapy. I had regular appointments with my sports chiropractor for ART. I felt like I did everything right. I didn't have niggles that I ran through and my right foot didn't start to hurt until that fateful run on August 9th.

I don't think it was the amount of miles or my goal. I think, and this is just a guess, it has to do with using a local high school's hard dirt track for all my tempo runs. Regularly running on that hard track for 10+mile runs was not smart. I also think nutrition issues played a role. I was slightly amenorrheic for the past few years and its only recently that everything has gotten back on track. Last month I had a blood test which showed that I'm deficient in Vitamin D and at-risk for injury. I'm also low in Vitamin B12, DHEAS, ferritin, and iron (though, those levels are only "needs work"; some do play a role in bone health). 

I've made changes to my diet and I have started to take Vitamin D supplements. I'm hoping I get good news on Thursday and my cast comes off. I hope I'm cleared to start physical therapy and cross-training. I hope to be able to start running again in January. I love running and I love running lots of miles. 

I have big goals for 2018 and will work closely with my running coach, my strength coach, my physical therapist, my nutritionist and my doctors to have a healthy year. :)

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