Ankle pain (OMG not again)

[ny biker]

I am somewhat freaking out. Back in the early 1990s (when I lived in cities and walked a lot) I had a problem with the posterior tibial tendon in my right ankle. Basically pain on the inside of the ankle, for years, and eventually having surgery in 1993. There was no acute injury; the problem with many microtears caused by repetitive strain from overpronating. The surgery and rehab experience was not fun and it took years for the pain and stiffness to go away. But for quite a while now, I don't know how many years, there have been no problems with it.

Until Saturday night. I was walking from one room to the other when all of a sudden there was a sharp pain in the same inside part of my right ankle. I have no idea why. It didn't seem like I stepped wrong or twisted anything. It hurt for a while every time I took a step. I iced it, it felt better. The next day it was mostly okay. It felt a bit inflamed but only hurt a small amount once or twice. I iced it again that night. When I got up on Monday it seemed fine for several hours, then started to hurt again with every step, for about a half hour, then was okay, later that day more pain for a while and then okay again, iced it at night. Same thing again today with some periods of sharp pain with every step and other times it's okay.

I am thinking that compression might help. Any thoughts on that, or other ideas on how to deal with this? I simply cannot have this develop into the long-term problem that I had before.

I went out and bought a compression thing for ankles at lunch today, but will have to return it. Following the directions on the box, I measured around my heel and instep. The box said size small would fit 10-12.5" and size medium would fit 12.5-15". Of course I measured 12.5, on the cusp. I bought the small but within 30 seconds it was digging into my foot so I took it off. Being on the low end of the range for medium, I wonder if there would be enough compression to matter with that size. Maybe I should just get an Ace bandage and wrap it tightly?

BTW from the wear patterns on the heels of all of my shoes, I know that I am now an over-supinator, not an over-pronator. For years during and after the injury I only wore shoes with really good arch supports, and I guess that helped. These days I don't really worry about arch support one way or the other, except for my sneakers and bike shoes. Thinking as I type this, I should go out and get some Superfeet insoles. Will do that tonight.

I really don't want this to become a big problem. Really.

[Pax]

That sucks, NY, not much to offer but sympathy... but I agree on the Superfeet. I stopped wearing mine after my knee replacement, for some reason my plantar fasciitis stopped after the surgery, but every once in a while it still flairs up and it's Superfeet to the rescue.

[north woods gal]

Sorry to hear about the ankle issues, NY. Old injuries like that seem like they come back to haunt us, now and then.

One suggestion for when you get back to biking is to try flat pedals instead of clipless on your road bike. I know ditching clipless is almost heresy for the road bike crowd, but I switched to flats, this year, precisely because I was plagued by foot cramps on long road rides when using clipless. Would have to stop and massage the foot and sometimes it was a long and painful process. Going to flats allows me to move my feet around more on the pedals rather than having them locked in permanently in one position. Has greatly reduced the foot cramps and, maybe it's just a coincidence, but haven't had as much back pain or pinched nerves in my legs that also plagued my in the past from too many miles on the bike. I'm no doctor, but I do think locking your feet into clipless pedals might further aggravate the repetitive stress injuries to your ankle.

Remarkably, have kept track of my average speed over the same routes with clipless versus flats and have not found a significant difference. Anyway, just a thought to keep in mind as an option.

[ny biker]

Thanks ladies. I went out and bought some insoles last night and I think they started to help immediately.

I actually was looking into flat pedals with pins yesterday. My bike is in the shop right now for the annual clean-and-tune, but this weekend looks like we'll have good riding weather and I'd like to take advantage of it. I suspect I will be able to pedal without problem, but turning my foot to clip out could be an issue. But, if I get flat pedals I will need shoes too, because I think the soles of my sneakers are not stiff enough. So this could get expensive quickly. Another option would be to put flat pedals on my mountain bike and ride that for a while -- I think I could use my mtb shoes without cleats. My main concern there was Catrin's comments in another thread about the pins scraping up your legs if the pedals hit them, since I do recall cuts on my legs back when I had flat pedals with toe cages on my mountain bike.

But, one thing at a time. I'm wearing compression socks today with Superfeet insoles in my sneakers. Tonight I will look for a better-fitting compression sleeve.

I know you can relate to how hard it so to suddenly not be active. It's bad enough not being able to go out and walk with the nice weather we're having. But around here we have several large outdoor shopping centers -- mega strip malls and "town center" clusters of stores. I always park my car and then walk from store to store when I'm running errands, but now I need to think about driving from one to the other if they're not close together. :(

[Pax]

One thing that might help is your superfeet in your sneakers, they will stiffen them up a little. At least enough so you could ride some now and figure what you want longer term.

[Catrin]

NY Biker - While I DID get a few scars from pedal slap from my SunRingle ZuZus - that passed pretty quickly as I learned how to both start and stop and avoiding pedal slapping at the same time. I can't even see those scars any longer, so they weren't very deep. Tall socks would help as well - and guards for mountain biking.

[Crankin]

I hope you figure this out, NY.

[north woods gal]

NY, you really DON'T need special shoes for flats. You don't want too floppy, of course, but going too stiff may aggravate your ankle injury. A good walking shoe or light hiking boot is fine. I use my light New Balance hikers most of the time for backcountry work. Heck, in the summer, I've even used my Birks for quick rides, but my lug sole Columbia hiking sandals also work. In the winter, some folks up here even use Sorel pack boots.

There are special shoes for flat pedals if you want to spend the money, of course, but one of the big advantages of going with flats is that it gets you away from needing bicycle specific shoes. The only real advantage of flat specific shoes is the sole material that allows good grip with pins, but all kinds of regular shoes can do the same. Even my lugged hiking boots and lugged sandals have plenty of grab. Just a matter of trial and error with a given flat pedal to see what works.

[ny biker]

So, an update. I bought two different ankle-compression things and lost count of how many others I tried on, and I hated them all. They either are too tight on my foot, or have a heel opening surrounded by too-tight stitching, or bunch up in front of my ankle when I try to walk. I already returned one of the ones I bought and will be returning the other one tomorrow.

Ultimately the best thing has been an old-fashioned Ace bandage, because I can decide how tight to make it. And they cost less than all the other things I've looked at. I've bought two of them so I can wash one and still have one to wear. With the Ace bandage and the Superfeet, I have been mostly pain-free for several days now. After a week off from all exercise, I'm going to the gym tonight for weight training.

While I was at the bike shop the other day I mentioned that I might need to put flat pedals on my road bike for a while while the ankle recovers. I stressed "might" since I hadn't tried to ride or clip in and out yet. But they insisted on lending me a pair of inexpensive plastic pedals and showed me how to take off the Speedplays and put on the flat ones if needed. I had to buy a pedal wrench but can return it along with the pedals if I don't need it. As it turned out, the nice weather we were expecting for the weekend didn't happen and I ended up spending a lot of time working on the furniture painting project, and the place in my living room where I normally set up the indoor trainer is currently full of newly-painted dresser drawers. So I still haven't tried to ride the bike yet.

[north woods gal]

That's a good bike shop to let you try a set of flats like that. As long as those pedals have at least some teeth for the sake of grip, they'll give you a good test. Best of luck. Ride when you can.

[emily_in_nc]

Yes NY, I hope the pedals will enable you to ride. Sorry the ankle braces didn't work out, but sounds like wrapping in an Ace bandage is the best solution -- and nice when it is also the least expensive, no?

[ny biker]

It's 71 and sunny right now but I can't go outside to ride or even take a walk. GRRRRRRRRRRR.

It's been two weeks. The ankle is much improved but not totally healed. It is so hard to resist thinking that I can take a chance and go out and do something. But I so do not want to make things worse.

I rode my bike on the trainer for 25 minutes last night. The ankle felt fine. I could clip in and out without pain. But then I realized -- I always clip out first with the right foot and put that foot down when I stop. If I'm on a downhill or have to stop suddenly, the foot hits the ground with a fair amount of force. It could injure the tendon more. So I think I need to stay off the road bike for another week or two. This is so hard! We will have great weather for an evening ride later this week, too.

I think there is less risk riding the mountain bike if I take it out on flat trails. Not today, because it still needs some repairs to the left shifter. And with this weather the trails will be mobbed anyway. So I will put the flat pedals on it and take it to the shop for repairs. Maybe next weekend (after another week of rest) the weather will be decent and I can go for an easy trail ride. My thinking is that I go slower on the mountain bike and with the wider tires, I am better able to balance so it would be less urgent to put a foot down if I have to stop suddenly.

Ok, typing all this out and just having a plan makes me feel better.

[emily_in_nc]

So sorry, NY. I can only imagine how frustrating that would be with the early nice weather.

I hope your ankle will be 100% soon. And just remember, spring is coming. It's only February, despite all appearances to the contrary in so many parts of the country!

[north woods gal]

I'm one to talk with all the crazy riding I do in extreme weather, but, really, I'm with Emily. Take your time. Maybe a short ride to see how things pan out. Best of luck.

[ny biker]

Thanks ladies. I got lucky with the mtb when I took it to the LBS to get the shifter repaired -- it just needed a few drops of lubricant, no need to replace any parts. Also I was not able to get the old pedals off that bike, couldn't loosen the bolts at all, so I had them put the flat pedals on for me. As an added bonus they put on new grips and moved the shifters in a bit so my wrists don't hurt anymore.

Since I was able to get everything done while I waited, I had a chance to go for a short test ride on Monday. Overall it went well and the ankle felt good. The only problem was that I have forgotten how to ride with flat pedals!! I just couldn't get started, especially on an incline. This caused some problems at intersections with stop signs where drivers were waiting for me to get going and clear the intersection. We've had plenty of people over the years who posted a thread looking for advice on how to clip in, but I may be the first who had trouble transitioning from clipless to flat pedals. :eek:

[Crankin]

Ha, ha, I had the same issue a few years ago when I was commuting to the train station in street clothes, to go to class. And, it wasn't even an uphill start (which cause me issues even with my Speedplays). My foot just flew off of the pedals when taking off at a crowded intersection, on my old Jamis with campus pedals. There were cars everywhere around me and I got really freaked, in a way I never do with my road bike. However, there have been a few times since then we have rented bikes for city tours while on vacation, and I just have to make myself think and focus while riding with flat pedals and it's fine.
I empathize with you. I had to force myself to cool it while my probable stress fracture healed last fall. Riding did not bother it, while riding, but afterwards, it ached. Since I had to stop hiking and walking and modify my tabata class, I did not want to give up riding. I should have.

[emily_in_nc]

You are not alone, NY! I had to relearn how to ride with flat pedals when we were riding cruiser bikes in Belize and again in Mexico. It is a transition like any other change. And hills definitely make it harder. We were lucky to be riding in flat places; I'm not really sure how to manage an uphill start without clipless. I am sure my 10-year old self knew how! :D

Anyway, glad you were able to get the changes made and get out for a short ride. I know it must have been good to be on a bike again, even if the situation was not ideal. I am sure the pedals will become easier in time, just like all other things bike-related seem to be.

[ny biker]

Another update. A week ago things felt really good, then it started to hurt again. Oddly, it hurt when I woke up, as if I'd done something to it in my sleep. Maybe I was turning my foot the the wrong way in my sleep or something. After a couple of days of that, it's been better again. But it seemed like it was time to check in with a doctor, so I went to see an orthopedic surgeon today.

Finding a doctor took a while. I asked around for recommendations and then looked to see who accepts my insurance. Called one place for an appointment but they only do knees and shoulders. They referred me to a foot and ankle practice, and I got an appointment with one of the two doctors there, the junior one in the practice. Then I found out that one of my co-workers was a patient of the other doctor there, and she hated him and everyone else who worked there, the PA, front-desk people, etc. Great. Asked around some more, found that a neighbor went to the guy that my co-worker hated but she described him as "a genius." What? Poked around online and read some reviews, and found that every doctor who is highly recommended has some haters, too. So I decided to keep the appointment I had but had names of other doctors to see if I didn't like the first one.

One thing that I thought was potentially good about the doctor I had the appointment with -- according to his bio on their website, he played rugby until an injury ended his career. My hope was that someone with a serious athletic background would be a good fit.

So, this morning I had the appointment. Overall things were fine. An assistant took x-rays and I gave her copies of the operative report from the original surgery. The doctor read the report, recognized the name of my old surgeon, who publishes a lot of research. I thought this was a good sign.

He said everything looked good on the x-rays -- the arch of the foot has held up well, he could see where things were done during the surgery and those areas looked okay. Then he examined the foot and ankle. Based on the the site of the pain, he thinks I just strained the tendon. He recommended that I rest it by wearing a boot for 4 weeks. I asked if I could do other activities, e.g., upper body weight training, stretching upper legs and hips, and he said that would be okay. But no cycling, and wear the boot all the time except when I'm in bed or driving.

So I'm not loving the boot. My toes are cold despite wearing two wool socks on my foot. It will be a huge pain trying to run errands, like getting the maintenance done on my car which I've been putting off for several weeks already. I expect my other leg or my back will start to complain from the weird way I have to walk in the boot. But all in all this could be much worse!

After the four weeks, he recommends custom orthotics to wear going forward. If it continues to hurt, he'll probably order an MRI. Needless to say I'm hoping that won't be necessary.

p.s. re: the cold toes. I do have neoprene toe covers for my bike shoes. I wonder if I could wear one on my foot with this boot... will have to try that out when I get home...

[Crankin]

I bet the toe cover would work.
Re: the foot hurting when you woke up today. I found that this was occurring when my stress fracture/toe was healing and near the completion of the process. Not sure why this happens, though. My foot (the one I hurt) was aching when I got out of bed today, too and the only reason I can think of is I have new shoes for the gym and I did a lot of jumping in tabata yesterday. I had the shoes last week, too, but there was a sub and the class was different.
Good luck with the boot. It would drive me nuts.

[emily_in_nc]

Ugh, NY, that does not sound fun or comfortable.

I'm glad to hear that the doc sounds like he's suggesting lots of conservative treatment. Many Ortho surgeons jump to recommending surgery pretty fast since that's what they do, and it's obviously their bread and butter.

[Pax]

Ugh, NY, that does not sound fun or comfortable.

I'm glad to hear that the doc sounds like he's suggesting lots of conservative treatment. Many Ortho surgeons jump to recommending surgery pretty fast since that's what they do, and it's obviously their bread and butter.

Definitely, I was never so happy as when I reached the age and maturity where I understood I controlled the treatment. I've had orthopedic surgeons want to cut on my foot, both shoulders, hip and my good knee. I declined and sought out more conservative treatment and I'm FINE.

[ny biker]

If this turns into a more prolonged problem, whether surgery is recommended or not, I already have a plan to get multiple opinions from different doctors. There are one or two in this area that were recommended and participate in my insurance plus a third practice that several people recommended but doesn't accept my insurance. And there is the option of going back for a consult with the doctor in NY who did the original surgery back in the day. And my cousin is a nurse at in an orthopedic surgery practice so she might be able to recommend someone, either in NY or a couple of hours away in Virginia where her in-laws live. So I really hope that it never becomes an issue, but if surgery is recommended I will make sure as much as I can that it is really the best course of action.

One thing that I am thinking about now is that, back when this problem first started around 1990 or '91, no one prescribed the kind of rest that has been prescribed for me now. A doctor in Chicago gave me a cortisone shot, the one in NY had me wear orthotics and I don't remember what else we may have tried before finally going ahead with surgery. But I did so much walking back then and no one ever told me to wear a boot or use crutches or do anything to rest the tendon and let it heal. I suppose I cut back somewhat, I remember wearing sneakers all the time (with business suits), but I was still walking to and from the subway to get to work and walking to the grocery store and the bank and the drug store and the dry cleaners and all my other errands. It seems kind of obvious now, but apparently I wasn't smart of enough to do it on my own and no doctor recommended it.

[ny biker]

Two subplots running concurrently in my life...

1. When you put the ankle boot on, you inflate a couple of small bladders in the back so the boot won't be too loose. After a while these bladders dig into the sides of my ankle and it hurts. I've tried wrapping a soft microfiber cloth around the ankle inside the boot, but it still hurts. If only I could find a thicker soft cloth...

2. I'm working on learning to crochet. So far my initial row of chain stitches is a mess but once I get going the rows of single crochet, double crochet and half double crochet stitches look pretty good. For practice, I crochet a section about 6 inches high and 8-10 inches wide. I've got several of these practice crochet pieces now, what am I going to do with them?

1+ 2
I put two pieces of practice crochet into the boot behind my ankle. It feels much more comfortable now. :D

[emily_in_nc]

LOL, NY, your post made me laugh, and that's a good thing. :D

Good luck with the crocheting. It is really not that hard to learn (easier than knitting) and immensely satisfying! I used to knit and crochet quite a bit though haven't done either for years. I didn't have the stick-to-it-iveness for really large projects, but a couple of of my favorites were crocheted white snowflakes (made with white twine and stiffened up in a cornstarch/water bath) for Christmas tree ornaments, and a lovely cotton cardigan I crocheted for one of my nieces. Oh, and a few cute dog sweaters!

[ny biker]

I'm thinking of crocheting something like a footless sock to wear over my heel and ankle inside the boot. Right now I'm wrapping pieces of crocheted fabric around it, but it's hard to hold it in place while putting my foot inside the boot. But first, since it's about to get very cold here, I'm going to see if I can wear one of my winter cycling booties inside the boot. The thicker Gore booty may not work because there's a zipper down the back, but the Louis Garneau neoprene booty might be okay. I've also got wool Kneekers (knee warmers from DeFeet) that might do the job. Or maybe I'll try a fleecy arm warmer, folded to double thickness.

Oh, I just remembered the fleecy Terry ear band that I bought about a year ago. It has a velcro closure. Maybe I could wrap that around the crochet pieces to hold them in place. Hmmmmm. I'll have to go through the Big Orange Tote Bag of Winter Cycling Gear tonight and do some experimenting...

BTW, it is SUCH a pain in the a$$ having to take the boot off every time I get in the car and put it back on when I get out. It's very hard to do it in the car with the steering wheel in the way, so I have to open the door and swing my legs out. Today when I got to work it was windy and the car parked next to me was too close to get the door open all the way so I could barely reach down to my foot. I was swearing like the father in A Christmas Story when the furnace breaks down. Then I realized I had forgotten to pick up lunch on the way in, so I had to take the boot off again and put my sneaker back on to drive to the deli. &^%$#&&*@!#! When I got back to the office I parked in one of the visitor spaces right near the door, where there was plenty of room to maneuver with the boot.

For short walks into sandwich places to pick up lunch or to put gas in the car I make an exception and don't put the boot on, but for everything else I remind myself what the doctor said: it won't work if you don't wear it. Last night after work I had three errands to run in stores that were next to each other. One store was Whole Foods, so I made that my last stop, bought a salad at the salad bar for dinner and ate it there. It generally is less annoying if I can park the car once, put the boot on, then run multiple errands.

The other night I managed to go to the gym for weight training. I had to skip a few exercises but was able to do most of them. No cardio, of course -- walking around the office or in grocery stores is the closest I get to that. At least I'm weight bearing and not forced to use crutches. And I have a few pairs of shoes that are close enough to the boot in terms of heel height, so I'm not having problems with hip or back pain.

p.s. I do like the crocheting. So far my single crochet, half-double crochet and double crochet stitches are pretty good. My first row of chain stitches is still a mess, very uneven in size. But I think I am ready to move on from practice swatches to an actual pattern. I'm thinking of starting with one of the pink hat patterns from the pussyhatproject.com. I'm also starting to think about possible Christmas gifts that I might be able to make for people next year -- I like the snowflake decoration idea.

[ny biker]

I remain in forced sedentary status due to the ankle tendon issue. Two weeks down, two more to go wearing the boot. Will be a total of 8 weeks of almost complete inactivity by the time I take it off and hope the pain is gone for good. My mood is now a constant state of blah and I've gained two pounds.

I'm working on crocheting a scarf for myself using a mushroom-brown worsted wool. The pattern I started with (alternating two types of stitches) didn't seem to look right so I'm improvising one of my own, mostly single crochet stitches with some double crochet rows every four inches or so.

The boot is causing some discomfort (sometimes outright pain) in other parts of my ankle and leg. I've tried to add padding inside it but that seems to alleviate discomfort in one spot while causing pain in another. Frustrating. Had to put a plastic bag on it a few days ago so I could go outside and clear the snow/sleet/ice from my car and shovel the area around it. My foot was very cold.

I can't stand being stuck in my house all weekend with the stomping neighbors upstairs so I've been looking for excuses to get out. So far I've seen Logan and La La Land. Trying to decide what movie to see this weekend and which theater to go to. Also I'd like to finish up the bedroom furniture painting, which will necessitate wrapping the boot in plastic again to keep from getting paint on it.

I so hope the tendon is healing!!

[Pax]

There are many downsides to living in FL, but one big upside is the kayaking. I get so tired of being held hostage by my bum leg "is it okay enough to ride or walk today... how about tomorrow". My upper body still works fairly well, so I can almost always paddle!

[emily_in_nc]

Sorry NY and Pax! Having a bum leg, ankle, knee, whatever, is really a pain in the ...! :(

[Crankin]

I empathize with both of you. Since I am hopeless at any handwork, finding that kind of replacement for sports would not work for me! Having a stress fracture (twice) and flantar fascitis pushed me to the limit, because usually if I am tired or hurt, walking is my go to thing. I couldn't do that with foot problems. The first stress fracture and plantar fasciitis, I had a pool, so I swam. Since I can barely swim, it was a good thing the pool was in my backyard. It was 5 AM and I was blasting aerobics music. Thankfully, it was still September in Phoenix, so the AC units were droning away, drowning out the music.

[ny biker]

I am definitely lucky that cycling is generally considered an okay activity when you have ankle problems. I will try to ramp things up slowly once I can stop wearing the boot, because I don't want to end up hurting something else due to trying to do too much too soon. So I'll probably start with easy rail-trail rides on the mountain bike with flat pedals, then if all goes well will progress to relatively short flat road rides.

If I couldn't ride my bike, I think I might look into swimming, even though I suck at it and look hideous in a swim suit. And I actually do want to try flat water kayaking one of these days. I'm glad it's something you're able to do, Pax. I know some people who have had leg injuries that prevented them from kayaking because they were not able to get in or out of the boat. Also I've thought about your reluctance to get a handicapped placard for your car -- more than once I have wished I could park in a handicapped spot over the past few weeks. Most of the time I'm fine when I'm out shopping, but sometimes I am just tired and the boot is just not comfortable. And we don't have reserved parking spaces at my condo, but if you have a handicapped placard the management office will designate a space near your door for you to use. Since I typically get home late, I usually have to park several doors down from my building and I'm always carrying stuff and there's just enough of an incline in the parking lot to make it hard to walk with the boot. So I completely understand reasons for not wanting to get that handicapped tag, but at the same time if this was not a short-term thing I would already have asked the doctor to fill out the form for me.

Meanwhile, one thing I am still able to do is upper body weight training at the gym. I'm going tonight. Still have to do a modified version of the workout I was doing before, but that's certainly better than nothing. Another thing that I've thought about recently -- I never went to the gym before I had the ankle surgery back in the day. But I struggled so much with the crutches after surgery, once the physical therapy was over I decided to join a gym. At the time I just wanted to make sure to have enough upper body strength if I ever needed crutches again. But it turned out that I liked weight training enough to stick with it for all these years. And the personal trainer that I met when I first moved to DC and joined a gym here was very helpful and supportive when I bought a bike and then bought another one and started to do longer rides. And he's been helpful and supportive in other ways, up to and including this here current ankle problem. The ankle surgery was painful and disruptive, but it did start me on a path with all sorts of unexpected consequences -- friendships and empowering accomplishments.

[north woods gal]

Plus one on the kayaking suggestion for anyone with leg or foot issues, but, yes, getting in and out is the challenge. My hubby can't walk or stand for long periods of time and struggles, at times, to get in and out of his kayak, but once in, he loves it. Kayaking is a great sport in its own right. My preferred watercraft is a solo canoe. Pretty much grew up in a canoe. One advantage for a canoe is that getting in and out of a canoe is a much easier thing to do. Does require more expertise as far as knowledge of paddling and paddling strokes, but you can use an extra long double bladed kayak style paddle designed for solo canoeing and do quite well. Not as traditional, but using a double-bladed canoe paddle is easier than using a single blade canoe paddle. I carry both in my canoe.

http://i66.tinypic.com/23t5yqu.jpg

[Pax]

Only way I can get in or out of a kayak is at wading depth, docks don't work, thankfully not an issue where we are in FL.

For all you gals that say you can't swim or don't swim well, I dearly wish I could get an hour of pool time with each of you! Swimming is a complicated mix of movements, and one piece of the movement being out of sync is usually what causes the issue... a short time with someone who knows what they're looking for, a bit of coaching, and it almost always fixes the issue.

[Crankin]

I find that I can't lift my left arm up and back enough to do the front stroke. I can't float on my back, either. Just sink... Plus, I just hate putting my face in the water. Wearing contacts makes it worse. I can't get them wet, but even after finding jr. sized goggles for my pinhead, I struggle. Covering up any one of my 5 senses makes me feel claustrophobic and sends me into a state of near panic. Swimming without my contacts just renders me blind and gives me the same claustrophobic feeling. Then, I worry about drowning. I mean, I can swim enough to tread water, etc, but I feel like I need to be able to stand up if I am tired. So, during those times I have had to swim for exercise, I do the breast stroke, pretty much without putting my face in the water. I spent the first 15 years of my life at the Cape every summer, in the ocean, but I didn't really swim, like for exercise. And was always wearing a pfd when sailing, which was a big thing for me (I did Sunfish racing as a young teen). So, this is why I always laughed about 10 years ago, when people tried to get me to do a triathlon.

[Pax]

I find that I can't lift my left arm up and back enough to do the front stroke. I can't float on my back, either. Just sink... Plus, I just hate putting my face in the water. Wearing contacts makes it worse. I can't get them wet, but even after finding jr. sized goggles for my pinhead, I struggle. Covering up any one of my 5 senses makes me feel claustrophobic and sends me into a state of near panic. Swimming without my contacts just renders me blind and gives me the same claustrophobic feeling. Then, I worry about drowning. I mean, I can swim enough to tread water, etc, but I feel like I need to be able to stand up if I am tired. So, during those times I have had to swim for exercise, I do the breast stroke, pretty much without putting my face in the water. I spent the first 15 years of my life at the Cape every summer, in the ocean, but I didn't really swim, like for exercise. And was always wearing a pfd when sailing, which was a big thing for me (I did Sunfish racing as a young teen). So, this is why I always laughed about 10 years ago, when people tried to get me to do a triathlon.
I could so help you! I'd modify your stroke or teach you a better form for backstroke until you got comfortable. I taught adult TOW (terrified of water) classes for years and never failed to get someone comfortable in the water, basic desensitization techniques... although a therapist who recognizes what I'm doing would be more challenging. :p

My wife also has a tiny head and awful vision, I got her some of these and they helped a bunch: http://www.speedousa.com/jr-vanquisher-optical-goggle/style-7500602

[Crankin]

Ha, I know I could conquer it if I wanted to, I just don't. I don't even have a swim membership at my gym, too much $ for something I will never use.
Those are the goggles I bought at one time, thanks to everyone here at TE.
We do have a very nice kevlar canoe, that we haven't used in 3-4 years. DH did some repair on it last summer, when he wasn't working, so we will try to use it a bit this year. We only do flat water ponds, though. I always feel that canoeing for an afternoon is taking away from my riding time, though, at the peak of summer weather. Will force myself this year, after my cycling vacation.

[Pax]

You sound so much like my wife, she just sees "water things" as not very interesting. Although she's coming on board with the kayaking.

[lph]

I used to be a bad swimmer, in the sense that i could swim fine, but I was tense and anxious, used a lot of energy, didn't want my face in the water, and was mildly afraid of deep water. I even took a scuba diving class to get to grips with some of it. That helped some, but what really made a huge difference was trying snorkelling. Being able to just hang around in the water, completely relaxed, face down, getting lots of air, and seeing lots of interesting stuff was amazing! And it was so much easier to gear up and go than for scuba diving, which always felt like I was buckling up for war. I'm a much better swimmer for it, and a happy kayaker now that I have a certain feel for the water and what's below the surface.

[north woods gal]

Really an apples and oranges thing to compare my canoeing to my bicycling. Love them both for what they are. Will admit that I do far more bicycling, though, and it's not a matter of access, either, because I can walk down to our dock and canoe anytime I want, just as I can get on the bike and ride right out my back door into the trails in our woods. The bicycling, in particular the mountain biking, is certainly more aerobically physical and that's a big part of the attraction for me. Two hours of paddling leaves me a bit sore in the arms and very stiff in the legs when I get out of the canoe, but two hours on the mountain bike or fat bike, riding the trails, or a long run on the road bike leaves me winded and tired all over, but in that good kind of tired that brings a big smile to my face and, now and then, an outright cheer for having completed a great ride.

That was the point, though, about using kayaking as physical therapy due to its lower impact on the legs and feet and so on.

[Crankin]

I actually like canoeing and my upper body always feels it!
You'd have to kidnap me and tie me up to snorkel. That hits me exactly where I cannot tolerate. To cover my nose, and ask me to breathe through a tube by mouth would immediately put me into suffocation mode. I can't cover any sensory organ, or I am done.

[ny biker]

Last summer when we were in Massachusetts we rented a house next to a pond near Plymouth. They had a 2-person kayak which looked more like a canoe to me. It was great going out on the pond. My brother went out with my 80-year- old father, who insisted on sitting in back and reportedly did his fair share of the paddling. Back in the day they went on many Boy Scout canoe trips together. I got a great photo of them while they were out on the water, which I printed and framed for Christmas gifts.

I always enjoyed canoeing when I was younger. I have minimal interest in snow cycling, North Woods, but your dock and canoe look might inviting.

I certainly am hoping to get back on my bike soon, but if things don't go well with the ankle I will have to find a place to rent a kayak and give it a go.

[ny biker]

Okay, four weeks have passed.

For the first couple of weeks, I had various aches and pains when I wore the boot, but felt okay when I took it off. For the last couple of weeks, reverse that. Pain all around the area of the posterior tibial tendon, up the side of my shin, sometimes the achilles tendon felt stiff, if I wasn't wearing the boot. No pain with it on. So my foot and leg adjusted to the motion of walking in the boot.

I typically put an ice gel pack on it when I go to bed, held in place with an Ace bandage. I just go to sleep with it on, then remove it when I wake up a few hours later. The other night (after removing the gel pack) I turned my foot inward in my sleep and something hurt enough to wake me up. Not sure exactly what was hurting, though. Since then I've left the gel pack and bandage on all night since it acts like a soft brace to keep me from turning my foot while I'm sleeping.

So, today. Day one without the boot! My plan was to just do minimal walking around the office. I had hoped to ride the bike on the indoor trainer tonight, just slow easy pedaling for a half hour. I'm wearing sneakers with Superfeet insoles. Things were fine until late afternoon when my leg started to hurt above the spot where I had the surgery and up the side of my shin. I put an ice pack on it for a while and that helped. Meanwhile I have a terrible cold. So I've decided no bike tonight, my trip to the gym to do upper body weights (I considered putting the boot back on so I could get in a short workout). Just sitting, driving home, sitting again, going to bed. Icing it again and leaving the gel pack on.

Tomorrow I'm supposed to meet up with cousins who are in town for the weekend with some friends. Word is that one of the friends broke her foot and is in a boot. I'm sorry she's hurt but am thinking it will make it easier for me to say that I want to sit and rest for a while, since she'll probably not want to do lots of walking.

One day at a time. Hoping for the best but who knows what will happen...

[Crankin]

I hope you feel better, NY. It must be frustrating.

[Catrin]

Feel better soon NY Biker!

[ny biker]

Two weeks without wearing the boot after four weeks with it. In general, the ankle is worse now than it was before I wore the boot. Before, after the first few days where it hurt a lot, the pain subsided and it mostly did not hurt, except for one night in my sleep I turned my foot wrong and the pain woke me up, so I went to the doctor. Now, it hurts on and off when I walk or drive. Some days are very good, some are very bad, some are on-and-off pain. On the very bad days I wore a certain pair of suede "comfort mocs" from LL Bean with Superfeet insoles in them. On the other days I have worn sneakers with Superfeet insoles. At this point I plan to wear sneakers every day indefinitely. I have two old pairs of the same New Balance running shoe, one white and one gray; I just ordered a new pair of the same model in dark blue and plan to order new pairs of the white and gray soon. So I'll have three pairs of brand new sneakers that should be as comfortable as I can get.

I am very angry and frustrated and worried that it is worse after wearing the boot.

I have an appointment to see the doctor early next week. I am already planning to seek a second opinion. Today I went to the website for the surgeon in NY who performed the original surgery and sent a message via the "contact us" form, asking if they could recommend a doctor with expertise in posterior tibial tendon dysfunction in DC/VA/MD. I included a brief summary of my history (surgery in 1993, excellent results, no pain until recently.)

Whatever happens next, I expect that this is going to cost $$$. In addition to the copays to see the doctor (and possible second or third opinions from out-of-network doctors) I may be facing an MRI, custom orthotics and physical therapy. My health insurance includes a series of $1000 deductibles on durable medical equipment and PT as well as limits on the number of covered PT appointments. And a $200 copay for an MRI.

Last week I rode 40 miles on the indoor trainer and on Sunday I did a flat 30-mile bike ride; both times my my ankle felt fine. Tonight I'm going to try a short ride with hills. Even if it doesn't hurt at all, I am very worried that the doctor will say that I can't ride my bike anymore. Also worried that he will say I can't drive -- if I have to be trapped in my apartment with the stomping elephants upstairs and no ability to exercise I will go completely insane. For the first time ever I am using cruise control in the car. It seems to help, though often there is too much traffic to use it. (Also it feels weird and I can't figure out where to keep my foot while it's on.)

I know more than one of you knows what this is like. Maybe it will improve over time, I hope so. But then again I went through all this before and ended up on the operating table with a long recovery period.

Sigh.

[Pax]

I hope you get an easier fix than PT and MRI's and all the expensive stuff.

Mine seems to be improving by leaps and bounds with my new tennies (Brooks Addiction) and superfeet, and wearing my Olukai's around the house. The Brooks are hideous, but I'll deal rather than have that pain.

[ny biker]

Pax, I'm glad your tendon problems are improving. Thanks for mentioning Olukai. I've seen some styles of their thongs at a few stores; I can't wear thongs without getting blisters on top of my feet but I may order one or two of their other styles. Some other sandals I've found with arch support are Vionic and Sole. Rockport has some but they all seem to have high heels. Also there's a store near me called Abeo that sells sandals and other shoes with three different insole/arch shapes. You walk and stand on a special mat in their store and from that they determine if your arch is high, neutral or low. I bought some sandals from them, haven't worn them yet.

So. I went back to Dr #1 about 3 weeks ago. He said that the inflammation he had felt in the tendon prior to my wearing the boot was no longer there, and that I needed a few more weeks to adjust to walking without the boot. Gave me a handout with stretches and exercises to. I bought a Theraband for the exercises.

He also recommended custom orthotics. Long story short*, I didn't get them and I'm not going back to Dr #1.

A couple of weeks have passed since then, I've been using the Theraband, things are better. But there's still some pain in the same tendon, especially after I tried a 20-minute walk last week. I have researched different doctors, was about to make an appointment with one in Baltimore, but then I did a bike ride with someone who recommended a surgeon in DC who treated her broken foot a few years ago. I went to see him yesterday. I was told he tends to keep his appointments very short but if you tell him you have questions he will stay and answer them. I found this to be true. Overall it went well. He said that my foot looks good on the x-ray, did not think there is anything seriously wrong, and recommended PT and 30 days of Celebrex to get the inflamed tendon to calm down. I have a follow-up scheduled in 5 weeks and he gave me a script for an MRI if it's not better in 3-4 weeks. He works with a medical assistant who gave me her card so I can contact her if I have any questions.

First PT appointment is scheduled for late next week. Just took the first Celebrex with my lunch. Am cautiously optimistic.

Oh and Dr #2 said "cycling is good." He is the foot and ankle specialist at an "orthopedic surgery and sports medicine" practice. They don't participate in any insurance plans so they're not the least expensive option, but so far I like them better than the first place I went.


*Custom orthotics, long story long: Dr #1 is at an all-in-one foot and ankle practice. Surgeons, podiatrist, PT, custom orthotics, small shoe store in the waiting room. On the surface this seems convenient, but..... For orthotics, they don't give you a prescription, they give you a form with specific insurance questions that must be filled out before you can see the orthotics person. Does your insurance cover them, if so what percent, is there a deductible, etc. Because they expect you pay up front before you get the orthotics. Combine this with the shoe store in the waiting area, and you feel more like a credit card than a patient. But wait, there's more. If you go through insurance they charge $1500 for the orthotics. Under my plan my out of pocket would be almost $1000. If you don't go through insurance they charge $530. And they repeatedly encourage you to go through your insurance. Holy crap. So I said, I really need to talk to the orthotics person, I am not even sure I want to get them. Amazingly, they did not make me pay to talk to her. She was very helpful and nice. I was very upset. I told her that I tried custom orthotics years ago and still ended up on the operating table. So for the time being she recommended OTC orthotics from Sole, for $50. They can be heat-molded using your oven or worn as-is. And Sole has a 90-day return policy if you wear them but don't like them. They felt like better support than the SuperFeet so I bought them. So far I like them. And BTW they are available from various stores including REI. And Sole also has various styles of shoes and sandals on their website.

[Catrin]

Yikes NY Biker, do keep us posted, not fun at all!

Sent from my SAMSUNG-SM-G891A using Tapatalk

[Pax]

I wonder when orthotics became such a racket? They have tried several times to get me to go that route, but I watched my sister in law sink a couple of thousand into "custom" orthotics that were so custom they had athletic tape attaching new pieces as needed. She went through the mill with that office, so I decided unless I got completely desperate I'd stick with superfeet and good shoes.

[Catrin]

My first attempt at orthotics over 10 years ago felt the same way. My new ones from last year has been little less than a miracle...and after insurance I only paid 80. (They were 500 before - for the pair, not for each). So they are not all a racket and mine have prevented foot surgery 😎

Sent from my SAMSUNG-SM-G891A using Tapatalk

[Crankin]

i remember when my insurance (from where I taught in AZ) paid for my custom orthotics in full, in 1987. Although they cured the plantar fasciitis, little did I know I was setting the stage for my back being a wreck now, from teaching high impact aerobics on concrete floors, covered by thin carpet.
I have used Superfeet in my cycling shoes since 2011. I could not tolerate the fancy custom molded things that came with my shoes. Too thick.

[Sky King]

I have a custom orthotic somewhere... The inserts I stumbled upon and really like are actually birkenstock insoles! As my knee gets worse though I can see my left hip dropping so should probably find the orthotic to before my back starts to get wonkie

[ny biker]

So, Celebrex is helping though I did have a few days last week where my ankle hurt. Side effects are pretty much minor.

First PT appointment was yesterday. It went well. The PT seemed impressed that I had my own Theraband -- I brought it to show her what I had and find out if I should get a different color (different resistance). She also seemed to like that I knew the names of the various tendons and muscles and that I'd noticed a difference in muscle mass and shape between my left and right lower legs after the surgery. There are a few exercises I need to do every day, some twice a day and one thing (ankle circles) five times a day. I'm able to do them all at work as well as at the gym, which is good.

One weird thing -- in most of the tests she did, my right (injured) foot and leg were stronger than my left (healthy) foot and leg.

One very interesting thing that she said, and that I wanted to mention to Pax and anyone else with ankle problems -- apparently strong hip abductor muscles are important for keeping your ankles healthy. I don't remember all the details of what she told me but I think it has to do with ankle stability. If your hip abductors are weak, your knees end up working more, which is not ideal. The abductors are the muscles on the outside of your hips (I always get adductors confused with abductors so I had her clarify for me). One of the exercises I'm doing specifically works the abductors, and I can really feel them working so I guess they do need to be strengthened.

[Catrin]

Glad to hear the Celebrex is helping! It sounds like you're working with a good'un, keep her. May things continue to go well!

[ny biker]

A plot twist.

I went to PT for 4 weeks, have been doing the exercises, the therapist noted improvements in various measures of strength and range of motion. But my ankle is not better. I am still very limited in the amount of walking I can do, and some of the exercises I was doing for PT made it hurt. The doctor had said that if it didn't improve I should go for an MRI and come back to see him. So I had the MRI last week and saw the doctor today. He looked at the MRI and said, it looks like a different tendon is damaged. Um what?

In my crude understanding of the anatomy -- there are three tendons close together in a normal foot and ankle -- the posterior tibial tendon, the flexor digitorum longus, and the flexor hallucis longus. Back in the day I had a torn PTT. The surgery I had was a "tendon transfer," in which part of the PTT was removed and the FDL took its place. The location of the pain I've been having since January indicated that the current problem was where the FDL and PTT were attached. But on the MRI, that area looks okay -- and the FHL looks damaged.

As a next step, I will go next week to have a long-acting anesthetic injected into the FHL. If this relieves the pain, it confirms the new diagnosis. Based on what I've read about the function of the FHL, and one particular PT exercise that caused pain, I suspect this will be the case.

One good thing is that I'm still able to ride my bike. I have noticed some minor pain when I ride up steep hills. Based on today's developments, I think I need to be more conscious of my foot position when I pedal, to make sure I don't point my toes at all.

[Crankin]

Sorry to hear this, but glad you most likely have pinpointed the cause.

[Catrin]

NY Biker, how is this going? All better now, I hope?