Of course! It would be a disappointment for me to do anything less than being complicated.
The doctor spent a long time with me today marvelling at the results of the MRI and looking at the pictures. I think I actually heard him giggle with excitement. LOL!
Here's the technological low down on the ankle:
1. Findings compatible with partial split tear of the peroneus brevis tendon distal to peroneal tubercle of the calcaneus with associated tendonosis distally and tenosynovitis.
2. Tenosynovitis of peroneus longus tendon with segmental tendinosis at level of cuboid bone.
3. Segmental tendinosis of flexor hallucis longus tendon at level of sustentaculum talus with grade 1 strain of the muscle at musulotendinous junction.
4. Tenosynovitis of flexor digitorium longus distally.
5. Tenosynovitis and focal tendinosis of posterior tibialis tendon distally.
6. Mild marrow edema in distal fibula and in medial malleolus compatible with stress response phenomenon.
Here's the findings on the foot:
1. Findings compatible with tendinosis and tenosynovitis of the peroneus longus tendon including at site of insertion at base of first metatarsal bone with focal mild marrow edema representing stress phenomenon.
2. Fluid in tendon sheath of flexor hallucis longus.
Some things to remember. The peroneal tendon is basically what caused the major damage here. The peroneal tendon runs from the base of your big toe (on the bottom of your foot) diagonally across the bottom on your foot to the outside of your foot. Connects to the cuboid area there and then runs back to your heel and up behind the ankle knob and then along the tibia to the mid calf area. The tibia is the big outside shin bone and the fibula is the smaller inside bone. They both end in the ankle joint. Distal means lower third of the bone. Tenosynovitis means tendonitis which is chronic. The cuboid does not have an avulsion fracture like we thought based on the xray 10 days ago. This "event" didn't happen because of the 15K race I ran. The 15K was just the final stressor on the tendon. The entire "cascade of events" can be blamed on my bad mechanics. As a matter of fact the right foot is starting to show signs of stress as well.
So, now the translation as best as I can do...
There is chronic swelling in the peroneal longus tendon which caused the tendon to swell and become painful. During the race it split ruptured at the site of the cuboid bone (this tear was so white on the xray that it appeared as an avulsion fracture but in the MRI it is a split tear at the smaller brevis tendon that attaches to the cuboid and peroneal). There is also a small early fracture where the peroneal attaches to the bottom of the big toe. Then another early, but larger stress fracture of lower fibula and medial malleous. More chronic swelling and tendinitis appears at the tendons along the top of my foot which control flexation with the ankle. And, even more along the inside of the foot to the top of the ankle.
Even more basically...every tendon that there is all the way around my foot and ankle is swollen and painful. There are 3 total stress fractures but they are all early catches and didn't go all the way across the bone. There is one tendon rupture.
I am cleared to return to the boot without crutches starting today. BUT, I had to promise not to over do anything and to continue elevation and ice as much as possible. I must go slow. He still has a referral for the foot and ankle surgeon for me if I misbehave. I also start PT again tomorrow, but this time instead of them throwing every modality possible at me we have a clear plan and we now know it's much more than just a peroneal tendon strain. If pain escalates again during PT then I am back in the soft cast and on crutches and I go back in. But, if everything starts healing and getting better then I don't go back for another follow up until January 13th.
The doctor spent a long time with me today marvelling at the results of the MRI and looking at the pictures. I think I actually heard him giggle with excitement. LOL!
Here's the technological low down on the ankle:
1. Findings compatible with partial split tear of the peroneus brevis tendon distal to peroneal tubercle of the calcaneus with associated tendonosis distally and tenosynovitis.
2. Tenosynovitis of peroneus longus tendon with segmental tendinosis at level of cuboid bone.
3. Segmental tendinosis of flexor hallucis longus tendon at level of sustentaculum talus with grade 1 strain of the muscle at musulotendinous junction.
4. Tenosynovitis of flexor digitorium longus distally.
5. Tenosynovitis and focal tendinosis of posterior tibialis tendon distally.
6. Mild marrow edema in distal fibula and in medial malleolus compatible with stress response phenomenon.
Here's the findings on the foot:
1. Findings compatible with tendinosis and tenosynovitis of the peroneus longus tendon including at site of insertion at base of first metatarsal bone with focal mild marrow edema representing stress phenomenon.
2. Fluid in tendon sheath of flexor hallucis longus.
Some things to remember. The peroneal tendon is basically what caused the major damage here. The peroneal tendon runs from the base of your big toe (on the bottom of your foot) diagonally across the bottom on your foot to the outside of your foot. Connects to the cuboid area there and then runs back to your heel and up behind the ankle knob and then along the tibia to the mid calf area. The tibia is the big outside shin bone and the fibula is the smaller inside bone. They both end in the ankle joint. Distal means lower third of the bone. Tenosynovitis means tendonitis which is chronic. The cuboid does not have an avulsion fracture like we thought based on the xray 10 days ago. This "event" didn't happen because of the 15K race I ran. The 15K was just the final stressor on the tendon. The entire "cascade of events" can be blamed on my bad mechanics. As a matter of fact the right foot is starting to show signs of stress as well.
So, now the translation as best as I can do...
There is chronic swelling in the peroneal longus tendon which caused the tendon to swell and become painful. During the race it split ruptured at the site of the cuboid bone (this tear was so white on the xray that it appeared as an avulsion fracture but in the MRI it is a split tear at the smaller brevis tendon that attaches to the cuboid and peroneal). There is also a small early fracture where the peroneal attaches to the bottom of the big toe. Then another early, but larger stress fracture of lower fibula and medial malleous. More chronic swelling and tendinitis appears at the tendons along the top of my foot which control flexation with the ankle. And, even more along the inside of the foot to the top of the ankle.
Even more basically...every tendon that there is all the way around my foot and ankle is swollen and painful. There are 3 total stress fractures but they are all early catches and didn't go all the way across the bone. There is one tendon rupture.
I am cleared to return to the boot without crutches starting today. BUT, I had to promise not to over do anything and to continue elevation and ice as much as possible. I must go slow. He still has a referral for the foot and ankle surgeon for me if I misbehave. I also start PT again tomorrow, but this time instead of them throwing every modality possible at me we have a clear plan and we now know it's much more than just a peroneal tendon strain. If pain escalates again during PT then I am back in the soft cast and on crutches and I go back in. But, if everything starts healing and getting better then I don't go back for another follow up until January 13th.
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