PT Question -- I'm a little scared about this

[VeloVT]

This afternoon I went for a run, for the first time in about a month. I'm generally out of shape right now, I had a stressful summer with some unfinished school work.

I ran 5 miles, didn't ever feel like I was pushing too hard, legs weren't too fatigued by the end (and not too sore now, three hours later) but at the end, my boyfriend and I always try to pick up the pace significantly for about the last 400 meters. When we are in shape, this becomes an all-out sprint to the death; when we (or one of us, ahem) are not in shape or are not feeling good, it's a good little pick up. Well, I was totally feeling up for it today and we started picking up, and got up to a near-sprint, and all of the sudden, I lost leverage in my right foot/ankle. It didn't go numb, it didn't hurt, I didn't feel or hear anything snap, and oddly, it didn't buckle, although it sort of felt like it should have. I just suddenly couldn't push off with that foot -- the foot was just kind of hanging there and hitting the ground each stride. I was able to keep running until the "stopping mark" probably 100 meters later. During our cool down walk, again, I could walk, and my foot had normal sensation -- heat, texture, weight, etc, wasn't numb, didn't feel like it had fallen asleep, but wasn't "right" either.

Now, several hours later, still able to walk, still normal sensations in the foot, but I can't flex it fully. I can point fully, but compared to my other foot, the most I can flex is probably 80% of normal. If I try to do the exercise where you start with your foot pointed, then pull your foot back as far as you can with the toes still pointed, unpointing the toes last of all, the whole thing totally falls apart, toes completely unable to do anything, just shy of vertical (I can normally get well past vertical, and can now with the other foot). I can do many things more or less normally, I have feeling in the foot, but some parts of it almost seem partly paralyzed.

I don't know if this is related, but I also noticed that, in addition to overally calf tightness, I have a big knot in that calf, slightly less than halfway up, in the back, but definitely to the outside of the centerline. I can feel this when my leg is relaxed, and I can feel it with my hands if I palpate it somewhat deeply (with thumbs). Also a prounounced tightness at the top of that hamstring (and not on the other leg).

During the run, nothing strange happened -- no bad footfall, no twisted ankles, etc...

It's strange that my foot isn't really working, but it's not painful at all, nor is it numb or lacking sensation.

Any idea what this could be? Anything I can do to help it along? Stretching, RICE, etc? Does it sound serious? Should I see a doctor? It's strange and unlike anything that's ever happened to me before.

Thanks!!!

[esther231]

I'd go to the doctor. It could be just you jarred it or twisted it slightly but if it's not getting better, I wouldn't play around and I would go. You need to know how to take care of it so you heal properly.

[VeloVT]

No change this morning, stilll doesn't hurt, but still can't bend it back anywhere near normally.

I guess I'm partly hesitant to go to the doctor because it doesn't actually hurt at all. But I also don't want to do permanent damage...

[tulip]

I second going to the doctor. It doesn't have to hurt to need professional attention.

[GraysonKelly]

I third you going to the doctor. I understand not wanting to go, but even if you don't have pain your foot is not "acting" right. That could lead to a very big problem.

[TahoeDirtGirl]

Sounds like you have tight calf muscles and you possibly did something to either your posterior or anterior tibalias muscle(s). The posterior tib is the one that flexes your foot. It could have been that your arch supports were not good or just that you haven't used it in a while and your legs weren't strong enough. If you go to the doc they will probably shuffle you off to PT which is a good thing. DON'T let it go like I did. I injured mine in Oct and it never hurt until I tried to run. Now it's been my third month in rehab with it and I see light at the end of the tunnel. Mine didn't hurt either but after a while, it just felt like my feet were broken. Weird.

[Wahine]

This definitely sounds neurological. Go get it checked out. You could have inadvertently damaged the common peroneal nerve where it curves around the outside of the leg. near the knee. That would account for the lack of strength without pain. If only part of the nerve is damaged you may not have any numbness except direct between the big toe and second toe. Get some one to touch that for you and then you can tell if it's numb. It doesn't work well if you do it yourself.

Regardless, it sounds like nerve involvement and should definitely be checked by an MD.

[AnnieBikes]

I think that you could have ruptured part of the Achilles tendon. If there is a "knot" in the calf, it could be one head of the Achilles with a problem. I would highly suggest that you see an orthopedist. Good luck and let us know what happens.

[VeloVT]

thanks everybody (and thanks Wahine),

I have an appointment Weds morning. The way my university health insurance works I'm going to have to have a visit that's probably not very helpful at the regular health clinic, and they will refer me to Athletic Medicine... so it probably won't be until the end of the week that I'll know anything.

I feel like I probably shouldn't run until I know what's going on -- is that reasonable? Could running make it worse? I am quite aware of the symptoms when I run... I rode my bike a few miles to classes today and I was slightly aware of the problem, but it was ok, I was even able to ride out of the saddle (less power than normal probably, but I was stable). Ability to flex foot is about the same (well below normal).

[TahoeDirtGirl]

Running can def. make it worse. You are weight bearing and there are muscles that are working against gravity which you might not be using when you ride and thus, they don't hurt when we ride!

I was under the impression that my cycling was making my legs strong. I dropped weight training last September due to lack of time...

Last October I crammed my foot between two rocks while cutting my teeth on my new found New England trails. It didn't really 'hurt' but sometimes it felt like my foot was broken. I put it off thinking if it was a stress fracture it would heal on it's own like they have before. Well in April I decided I wanted to start to run. HAHAHHAHA...NOOOOO...so I went to my doctor, who sent me to PT.

Guess what? If I had kept up with my weight training, chances are it would of resolved itself. Now I have posterior tibialis tendonitis that I can't shake.

And worst of all...they told me yesterday I can't ride for a week. And if that doesn't reduce the inflammation, I may have to get a cast and keep off of it for a few months. NOOOO...

Moral of the story: If you get injured, get it checked out if it's bothering you. And second, don't stop strength training because you think you are getting enough weight training from riding. Especially 'balance' activities. You would be really surprised at how untrained you are from just working in the sagittal plane most of the time (ie flex/extension from riding). I think if I had to choose weight training vs balance- I would pick the balance part. This is where I really learned how messed up I was!

Good luck with your appointment. You will heal much faster addressing it now than later!

[Wahine]

thanks everybody (and thanks Wahine),


I feel like I probably shouldn't run until I know what's going on -- is that reasonable? Could running make it worse? I am quite aware of the symptoms when I run... I rode my bike a few miles to classes today and I was slightly aware of the problem, but it was ok, I was even able to ride out of the saddle (less power than normal probably, but I was stable). Ability to flex foot is about the same (well below normal).

You should probably just take it easy until the appointment.

When you say you can't flex your toes, I am taking this to mean that you can't bring them up towards your shin. Is that right???

[VeloVT]

When you say you can't flex your toes, I am taking this to mean that you can't bring them up towards your shin. Is that right???

Yes. If I'm standing, and I try to flex my foot up so heel is on the ground and toes are in the air, right toes/forefoot can only attain maybe 20% of the height left toes/forefoot can attain. Right foot barely gets off the ground, really. When I'm sitting with my legs outstretched, the difference is not as stark, but it's still quite noticeable.

First hypothesis from doctor at student health clinic is that I have a hairline stress fracture. She did motor strength, range of motion, balance and reflex tests as well as making me touch my nose and then her finger repeatedly as she moved her finger around in a circle, and similar things... apparently I aced all of those tests. She also felt down each bone in my foot starting at the ankle and moving down to the toes. This was fairly gently, not serious mashing (when I had peroneal tendonitis and some serious pain in the bottom/outer edge of my foot and I initially thought maybe I'd fractured it, they really pushed it around -- this was just a little heavier than lightly touching). When she pressed lightly on the second bone, near the toes, I had a very strange sensation -- hard to describe. Not pain, not numbness or tingling, but very similar to the sensation I get when I try to flex that foot as far as possible -- at a certain point, it just feels weak -- it's not that dissimilar to how it feels when you are lifting weights and you try to do one rep past failure, and your muscles just say no, and there's sort of an icky feeling that is different than pain. Anyway, that was the only symptom she was able to produce in the exam, and it was very, very localized.

She sent me for a foot x-ray, but told me that if it WAS a hairline fracture, it was highly likely that it wouldn't show up on the x-ray. Um, what? You're prescribing a test for a condition that probably won't show up on that test? Generally speaking, I think people who try to argue that the rising cost of healthcare is primarily driven by unnecessary tests and if people had to pay for more, it would keep costs down, are full of bunk -- but this seemed a little like healthcare bloat to me. Anyway, I got the x-rays and am awaiting the results...

I also have a referral to the PT department and will make an appointment with them as soon as they call me back or start answering their phone. DR says I'm not to run or bike, and must wear supportive shoes, until I get the OK from PT. Apparently she will stay in contact with them, which is good...



Again, thanks everybody!

***Why should running 5 miles for the first time in a month cause a stress fracture though? I thought stress fractures were usually a result of repetitive trauma?

[Wahine]

OK, now I have to say that this really doesn't sound like a stress fracture or a tendonitis. Both conditions are quite painful. I'm sticking with my first thought and that is nerve damage. Ask your PT if that's a possibility when you go. If it is nerve damage you should be getting nerve conduction studies done to see how much damage there is and where.

Please let us know how it goes.

[VeloVT]

So I had my PT appt today. My university athletic medicine dept is severely understaffed right now (one person left right before the school year started and another is on maternity leave, so there's only one physical therapist on duty), so they couldn't get me in for like three weeks, so I was referred to a private practice... Which ordinarily would be fine but my university health insurance benefit for non-university physical therapy totally sucks -- 80/20 to $500. Arrgh.

Anyway, the PT thinks it's a muscle strain and has prescribed rest, icing, stretching, with a few ultrasound sessions and some massage, and some strengthening as function returns.

It actually has improved a little bit in the past week since it happened, but it's still significantly not normal.

He looked over the notes from my dr appt, then observed me walking for quite a while, on the floor and on the treadmill, barefoot and with shoes. Then he measured range of motion and strength for dorsiflexion, plantar flexion, inversion and eversion on both sides with me sitting on the table, and pushed around on my feet and ankles (I think to get a feel for how the joints workd) then massaged around in my right calf, which is actually pretty tight. My peroneal tendons/muscles and anterior tibialis are especially icky tight on my right leg (not so bad on the non-injured side).

Apparently I have very unusual feet (symmetrically unusual). The university PTs noticed this two years ago when I had peroneal tendonitis on the other leg... I guess my rearfoot is valgus/wants to turn in, but my forefoot tends to supinate, and I have high and somewhat rigid arches. I guess if you look just at my forefoot motion my foot looks very neutral, but from the rear I have a pronounced heel whip and overall there's a lot of compensation going on that leads to a lot of muscular tension in my lower leg, which in turn predisposes me to lateral injuries.

So he basically thinks I overdid it and in the context of already tight muscles caused a sudden strain.

I have some lingering doubts about this diagnosis, but if he's right, it seems like that's a much better and less serious scenario than I was expecting...

I asked if he felt like a strain was consistent with both the suddenness of the injury and the lack of pain, and he didn't seem to think that it wasn't... To those who know about these things, does that sound plausible or not?

Thanks!

[TahoeDirtGirl]

I know what you mean about that doubt. I've been sitting on my butt for over a week now, and I don't feel that much better.

What has helped me the past couple of days has been icing it and of all things, taping it. I lucked into finding someone that knows how to tape arches and he taped my foot and ankle. You would not believe how great it feels. The stupid arch supports in shoes have nothing on taping. But it's a pain but I will take what I can get.

If it's feeling better with rest, it could be tendonitis. But see, mine just feels the same or worse, so what's up with that?!

I'm going to a couple of more PT appointments (I hear you on 80/20 that's what I'm paying bc I have out of state insurance) and then I'm going to find a podiatrist. Or maybe I should just find a podiatrist anyway...