Scott Douglas’ Terse Bloviation

Peroneal Surgery #5: How I Got in This Mess

Here’s the back story to why I wound up having peroneal tendon repair surgery.

My right calf, Achilles and ankle have always been more rigid than my left. That became more so after a nasty bout of Achilles tendinitis in 1992. As I’ve noted before, I’ve also long had extra “stuff” below the lateral right ankle. And I sprained the ankle a bunch of times as a kid. So I was a good candidate to overstress the peroneal tendons, in part by placing extra load on them because of rigidity in the foot and ankle leading to not rolling through the running gait as would be ideal.

The first time my foot became troublesome in what would become familiar ways was the summer of 2010. The discomfort and dysfunction was not around the ankle, but along the lateral bottom of the foot, near the cuboid bone. I was worried I had a stress fracture. I think I did a couple bouts of a couple days off, and definitely had reduced mileage. It didn’t go away, but it didn’t continue to deteriorate, and I went about my business. Over the next year and a half I would occasionally have flare-ups, and I’d be concerned I had a stress fracture in my foot. (It’s funny to think now that my reaction was, “Not a stress fracture of the foot! I might have to take off like four weeks!” As I write this, I haven’t run in close to four months.)

During that year and a half, I could generally trace a relationship between more time working (read: sitting with bad posture) and my foot acting up. The more my hips felt out of alignment for days at a time, the more likely it was my foot would start complaining. And during this time the wear on my running shoes, which had always been heavier on my left shoe, became much more that way. (Yes, more wear on the “good” foot, but the one with less wear is the one that was going kaput. There are some recent studies about asymmetrical running gaits and lack of relationship to injury site.)

One morning in February 2012 I stepped out of bed and found I could barely put weight on my right foot. The area around the lateral ankle was acutely tender. I had to walk with my right foot turned way out to get going that morning. I remember being in a good mood while cooking the night before and briefly–very briefly–doing a little dancing to “Gardening at Night” by REM.

Of course I ran that afternoon, but something was different. This wasn’t so much the cuboid-area foot pain of before, although I think that was also present. This was tenderness, tightness and dysfunction in soft tissue around the lateral ankle. Running felt different.

I muleheadedly plugged away for the next few weeks. I remember doing an easy 90 minutes on St. Patrick’s Day and spending the entire run dreading every time my right foot was going to hit the ground. I took some time off, got some massages from my friend Julia Kirtland, and experimented with her Kinesio taping me.

When I resumed running, things waxed and waned. I had at least one more stretch of not running for a few days, which I should note was at the time a big deal.

During this time I began to sleep with my foot on top of a pillow. The ankle was always stiffest in the morning. And I will admit to occasionally hiding from my wife how much limping I often did the first few minutes of the day.

In August 2012, I began to ramp up my mileage for the Philadelphia Marathon on November 18. One of the oddest things of this episode is that those three months were by far the best in terms of the ankle. I was regularly doing 80-mile weeks, with what passes for quality for me these days, and things with the foot and ankle were better, not worse, than before.

At the same time, my lifelong nemesis, my left hamstring attachment, got worse. It was noticeable whenever I did tempo runs or workouts. The shoe wear difference became ridiculously large.

The marathon didn’t go well. I was trying to run 3:05, which was a conservative goal given my fitness. Through 15 I was holding back to stay just over 7:00 pace. In the 16th mile my left hamstring attachment went into vise-grip mode. I immediately had to slow, and knew it would be yet another disappointing end-run at a marathon. I thought about dropping out–at this point I could have turned around and jogged back 3 miles and been at the start/finish area. I envisioned my wife having to explain to people nice enough to care that I’d dropped out. So I talked myself down to 18 miles, by which point turning around and jogging back to the finish would mean 23 miles, which, I told myself, would mean that you should just finish the damn thing.

After a couple more miles my form went to complete crap. I wound up finishing in 3:21, aghastly aware of how horribly I was running in a mechanical sense. I don’t remember my foot and ankle being an issue. It was just an overall biomechanical shutdown stemming from the initial hamstring problem.

After the race I couldn’t walk normally. My quads were tender, and the protective gait I adopted was Frankensteinesque, with really no knee flexion.

So the next day, of course, I tried to run. I Frankensteined my way around the neighborhood for half an hour, which I called 3 miles. I felt a little looser after. The following day I ran thusly for 4 miles, then 5 miles three days after the marathon. After that run, I wrote in my log “foot horrible.”

The foot remained an issue since that run three days after the marathon. My theory is that running with such horrible form for so long in the marathon, then stupidly doing so in the days after, pushed the tendons over the edge. They were obviously severely compromised to begin with, but this was too much for them.

The last good run I had was Sunday, November 25, one week after the marathon. It was one of those runs where you step out the door and are in full relaxed-fast mode within three steps. I got to a spot that usually takes 26 minutes to get to in 24:30. I spent the run thinking how I would quickly recover from the marathon, then build on the fitness I’d built training for it.

The next morning my foot was the worst it’d ever been. I ran 10 minutes. I still ran every day that week, but just a few miles. The following Saturday I ran 9 miles with Julia and some other friends on trails, and was limping and wincing the whole way. I then began a phase of taking off a few days at a time, thinking I could finesse my way through the most acute phases. This continued, with ever-decreasing attempts at running, through the end of January.

I did every foot/ankle exercise I could think of that might improve the area, but was never sure if I was doing more harm than good with these.

On January 29 I was in Emmaus, Pennsylvania for some Runner’s World meetings. I joined a large group for their noontime run. I got dropped immediately, while feeling like I was working as hard as I could mechanically. Nothing against the members of the group, but I told myself, “If you’re getting dropped by them three minutes in, it’s time to admit something is really, really wrong.” I turned around and limped back to the office. That 2-miler is the last time I’ve run.

I then told myself I wouldn’t even try to run until the visible swelling in the ankle and foot went away. The swelling stayed. In late February I had an MRI. The radiologist’s reading said torn peroneus brevis, severe tendonosis in peroneus longus, tenosynivitis in hallor flexus longus, and three areas of increased bone activity indicating precursors to stress fractures.

My friend Brian Fullem, a sport podiatrist who has been amazingly helpful throughout this ordeal, told me he’d be shocked if these problems resolved themselves without surgery. So of course I found an orthopedist who told me otherwise, that immobilization for a few weeks would do the job, and of course I went with his take. But I knew deep down that wasn’t going to work, and I got myself to see another orthopedist, and told myself I would have surgery if he agreed more with Brian than the first orthopedist.

And here we are today, almost six weeks after the second orthopedist operated on me.

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5 Comments so far

  1. Sara September 4th, 2013 7:52 pm

    I’ve done 8 healthy marathons….tons of halves. One unhealthy marathon. Peroneal tendon repair (worse than they even thought 9 weeks ago.)

    I pool ran 4-6x/wk with my cast (6 weeks,) then have switched to the elliptical while in the boot. I just ditched the boot. Running seems so far off. Will the progression now that I’m weight baring come quick? How soon were you able to run?

  2. Scott September 10th, 2013 1:35 pm

    It seems like this is one of those injuries and surgery rehabs that vary greatly by person, so even rough guidelines might not apply.

    I had my post-surgery splint on for 10 days, then a hard cast for another two and a half weeks. After that I was on crutches, with really slow progression to some weight bearing. I was to wear ASO brace when doing any weight bearing.

    My surgery was April 8, and in mid June I was still walking tentatively. I did my first token attempt at jogging on July 5. This was 10 1-minute jogs with a 1-minute walk between. By August 11, the most I’d done was 3 15-minute jogs with a 1-minute walk between. After that I eliminated the walks.

    It’s now been five months since surgery, and I’ve had two weeks where I’ve run five days. My highest week has been 25 miles, and my longest run has been 8 miles.

    Before surgery I thought I’d be a lot closer to back to normal by now. Some days this is really depressing. Other days I remember that two months ago I was running only a minute or two at a time, and I’m not entirely depressed.

    From lack of doing it, running still feels odd. By that I mean I’m still hyper conscious of every foot strike, and I almost never have that feeling of being in a pleasant rhythm and just zoning out. I still feel leaden and plodding. I think that’s accentuated by so far doing nothing but slow running and the fact that it’s now been almost 10 months since I’ve been under 7:00 pace. I’ve just started doing really brief form drill sessions a couple times a week and hope that will help get some pop back. But there’s a trade-off with them in that the extra motion and impact force tend to make my foot ache.

  3. Sara Maida September 10th, 2013 2:17 pm

    Thanks for the follow up. Über helpful! I fully agree that the post surgery route can look very different patient to patient. It is very encouraging to hear that returning to this sport can happen and that slowly might actually be the best route! Thanks again!

  4. Sara Maida September 10th, 2013 2:18 pm

    Sidenote: July 5th was my surgery day! And 8 miles as this fall approaches would be delightful!

  5. Sandra January 25th, 2014 11:31 pm

    I had a left peroneus brevis tendon repair on 31 May 2013. Unlike most of you, I didn’t get mine solely from running. Mine was made worse from horse back riding, and the constant twisting of the ankle in the stirrup. I too was completely non weight bearing for 8 weeks. I was in the hard cast for 8 days then a boot for seven weeks. I used crutches occasionally, but relied heavily on a knee walker for the last 7 weeks. I was only permitted to apply weight while wearing the boot beginning in week 9. I wore the boot for 4 weeks, then was released to real shoes. The first week of September was painful but bearable. I agreed to a 1/2 Marathon in March 2014 so started training the 3rd week of October by walking 1 mile. On Thanksgiving morning my husband and oldest son ran a Turkey Run. I’m up to 8 miles without a lot of discomfort, but really need to find some shoes with a low ankle that is really soft. The rubbing on the scar and tendon is what is most bothersome.

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