Scott Douglas’ Terse Bloviation

Peroneal Surgery #6: Keep Hope Alive

It’s now been a bit more than 10 months since I had surgery to repair my two right peroneal tendons. For those contemplating or recovering from the procedure, I hope that this update will give you some hope.

Overall, things are going well with the foot. I’m back to daily running, and starting to do what almost feels like training. The foot is still very much in my thoughts daily, but I’m largely able to live how I want, with a few exceptions noted below.

During the fall I stayed conservative in returning to running. I didn’t have a seven-day stretch of running every day until October, six months after the surgery. By mid October I had built up my long run so that I was able to complete the Runner’s World Half Marathon in Bethlehem, PA. This was one of the most gratifying experiences I’ve had at a race, even though I wasn’t racing and I ran almost half an hour slower than my half marathon PR.

I’d done a 12-miler, really gently paced, a few weeks before the half. The next two weekends, when I was trying to keep upping my long run, my mechanics got sloppy early on, and I cut the runs short, to something like 10 miles. (Then, and even now, my thinking was/is, my foot can’t afford to bear the brunt of my running poorly. As I was still getting used to running regularly, this happened more often then than now.) So in the half, I just wanted to run comfortably and have it be a positive experience. I started with the 1:45 pace group (8:00/mile), moved up as I felt like doing so, and finished in 1:37:57. It was the most I’d felt like a runner in a year.

My point in droning on about an unremarkable run that’s now four months ago is that it was useful to have that modest-but-slightly-demanding goal (”feel good comfortably finishing the RW Half on October 20″) as I got back into running. Although I wasn’t training, just getting used to running, it helped to have a first benchmark to work toward.

Things kept going well after the half. I was on vacation the second week of the month and felt I could push things a little more than during normal life. I wound up with 65 miles that week, which is still the highest week I’ve had since surgery. At the end of the month, I ran the 4-mile Thanksgiving race in Portland with the goal of breaking 28:00 without too much duress. I wound up running 26:43, and it felt good to do something sustained harder than I’d been running, and for my foot to not bother me doing so.

December was a setback. I discovered after it was too late that snow and ice and the uneven footing they cause are a challenge. I had too many days of taking too many bad steps, and around Christmas time my foot felt as bad as it had a year earlier, pre-surgery. I was really despondent for a few days. I missed a bunch of days of running. But it turned out to be a flare-up, not serious re-injury. I was able to resume progressing in January, and averaged 51 miles a week for the month, a little more than I had in November. After December’s setback, I felt like I was starting from scratch in terms of building my long run. As of last Sunday, the longest I’ve been is 17. My plan is to keep building on that leading up to the Boston Marathon on April 21, where my goal is what it was for the half in October–to be fit enough to enjoy myself running comfortably for the entire distance.

The only other race I’ve been at was a local 10-miler at the beginning of February. I kept with a modest goal–to break 70:00 with as little duress as possible–and was happy to run 69:27 without having to work all that hard. Sustaining faster running is still more of a challenge mechanically than cardiovascularly. I’ve started to do one hard workout a week, such as this morning’s session of 5 x 5:00, but probably won’t do any real racing until after Boston, because I don’t want to introduce another variable that could interfere with that goal.

Again, I hope that someone reading this can see that you should be able to gradually work your way back to close to pre-surgery normality. I still ice my foot after every run. I still do my PT exercises almost daily. And I still limit where I run and walk to minimize the chance of bad steps. (For example, as I write this we’re getting tons of snow, so I assume I’ll be on the treadmill tomorrow). But running feels so much better than it did at this time last year, we’re at mid-February and I’ve missed only one day of running so far this year, and I can reliably plan on running with friends, which is great.

Sorry this is long, and sorry that I’m feeling too lazy to proof it before publishing.

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18 Comments so far

  1. walt February 16th, 2014 7:19 am

    Sorry to read of your surgery and the long trip back. Very best for excellent health and many enjoyable miles.

  2. Alexander b. May 17th, 2014 7:55 am

    Hello Scott. I seem to be having similar pain around my ankle as to what you are describing. While reading all of your posts I am becoming incredibly inspired by your recovery. I am worried about my symptoms as I have sprained my ankle about a month ago and then sprained it again while not properly resting it. I’m worried that my peroneal tendons are damaged. I have only pain on the outside of my ankle now and it’s really causing me worry. I feel as if you are a great role model through these messages and I am trying to be patient but I haven’t gotten an MRI and I have been told I have tendinitis. I am seeking some advice as a 24 year old young man that absolutely loves to hike and run I would like some help. Even to hear some advice over the phone if possible? Your story truly is inspirational. I hope we can get a chance to talk.

  3. Erin November 6th, 2014 2:40 pm

    Scott, thanks for posting this. There isn’t a whole lot of info about there about what recovery is like for this surgery and I’m considering having it.

    Like you there wasn’t one single thing that caused my problem, it was cumulative from old injuries, bad biomechanics, etc. and one day a year ago I got out of bed and things were really not right with the ankle. I got a steroid shot 11 months ago, it helped for several months but after a yoga session a couple of weeks ago it started getting worse again. I still can’t run, do cardio classes, yoga, bike, or swim without aggravating it. The pain isn’t that bad if I don’t do anything besides walk, but I’m only 43 and can’t see going through the rest of my life like this!

    My orthopedist says the shot helped the symptoms but not the root cause, I’m having an MRI next week but she’s positive there’s a tear. She said some of her patients can’t get back to running after this surgery, which alarmed me, but she seemed to think I could do most other things eventually and I’m encouraged that you are able to run.

    Thanks for the info!

  4. Judi Milin May 18th, 2015 10:36 pm

    After reading about your success being able to continue running my spirits are lifted. I’ve been “grounded” now for over a year with ankle swelling from even a short walk. The avulsion is noticeable. My MRI will be in a few days. Thanks for your courage, tenacity and willingness to share!

  5. Katie January 24th, 2016 12:50 pm

    Thanks for this post. I had surgery 01/18 to address 2 tears to my peroneus brevis. One tear was quiet large at 7 cm so my time on crutches has been extended from 2 weeks to 4-6 weeks. I also had my tubercle removed, which was believed to have contributed to the tear. I’ve already been casted for new orthodics to help address the root cause, with PT beginning as soon as I am in a boot. I did a TON of research and see published studies of good outcomes, but appreciate you sharing your experience. I am a 3:05 marathoner, but at this point just want to be able to enjoy my sport again on a daily basis. I’d love to hear how you are doing these days!

  6. Scott January 25th, 2016 7:34 am

    Katie:

    Good luck with your recovery. Be as dedicated to the PT as you are when marathon training, and be as disciplined about returning to running slowly as you are about piling on mileage when marathon training, and you should come out okay.

    My situation these days is excellent. For 2014 (surgery was April 2013) I had a bit more than 2,800 miles. Most of that was just running. In 2015 I had just over 3,000 miles, and that was what most people would consider training–regular workouts of short turnover sessions, tempo runs, 5K pace intervals, long runs, short recovery days, etc. I have no pain in the area operated on, and I feel like my mechanics are similar to what they were pre-injury. I seem to get slower by the week, but that feels related to age and too much sitting rather than specifically because of the peroneal situation.

    I remain diligent about non-running exercises–stretching, drills, core, hip and butt strengthening, etc. On some short running days I spend more time doing “extra” stuff than I do running. I’m happy to make this investment in staying healthy.

  7. Zaida March 17th, 2016 8:33 am

    Hi Scott,
    Thanks for posting this! I just had peroneal tendon repair and navicular bone removal, and I’m going nuts!!! In my case, it’s started with a sprained ankle last June. PT for a while…that didn’t help. I was determined to run Chicago ‘15, with a goal time of 3:30. The marathon didn’t go as expected- finished in 3:58 and couldn’t walk after. A couple days later, i decided to ‘jog’ on a walking trail and the pain creeped in. Went to see an Ortho/Sport Med Dr, he put me on a boot because he was sure there was a stress fracture (no MRI no X-rays). 3 month go by, I’m out of the boot and returning to run but there was something there. No pain during the run but unbearable pain after. Went to see my Dr again, he said that I was fine. At this point, I decided to get a second opinion. The new Dr did decided to X-ray the foot, and right away he found the navicular bone (which was broken in half). First treatment- cortisone shot, thinking that the tendon was just inflamed. Couldn’t run more than 6 miles with out pain. Another month goes by, this time he told me to get a MRI. The extra bone was tearing into the tendon. Last week I had my surgery, they remove the bone and suture the tendon.

    No weight bearing for 3 weeks, no idea how long with the boot (bearing weight). No idea when I can return to running…although, I’m already a registration for late summer (beach to beacon). One thing the Dr told me was it could take years to get a PR or even go back to my normal ‘race’ pace. I was wondering how long after the surgery did you start running again?

    Thanks!!!

  8. Scott March 17th, 2016 9:04 am

    Zaida: Sorry to hear about your drawn-out experience.

    Medical people might dislike my saying this, but I feel like many times they feel like they’re expected to make more definitive statements than are warranted. Maybe they think patients won’t be satisfied with something vague like, “Well, who knows how things will turn out? We’ll have to see how things go for you.”

    For example, almost immediately after my surgery the surgeon told me I’d never run more than 25 miles a week. Set aside the not-great bedside manner/bad timing of this pronouncement. I remember thinking, “On what basis is he saying this? Does he have access to tons of data on long-term follow-up studies of dedicated runners who’ve had this surgery?” Of course he doesn’t.

    That’s a long way of saying it’s possible you can get back to where you were before. As I think I’ve opined elsewhere in this thread, you’ll probably get there sooner by being more conservative early on. Apply the discipline you use in marathon training to the goal of returning to running more slowly than might seem warranted. I would guess that, a year from now, that approach will have you closer to where you want to be than pushing your return.

    Specifics of my return to running:

    Surgery was mid April 2013. I did my first “run” on July 3. It was 10 x (1-minute jog/1-minute walk). I started with two of these jog/walks per week, then went to three. I gradually increased the duration of the jogs while maintaining the walk breaks. I was still in PT at least once a week at this point, and consulted with my PT–a runner who I really trust and respect–on whether what he saw supported upping the running amounts.

    By mid August I was up to 20 minutes jogging, a few minutes walking, 20 minutes jogging. At that point the PT okayed cutting out the walking. So it was late August–more than four months after the surgery–before I ran 5 miles straight.

    At that point I still wasn’t running every day. And I was doing nothing but easy running. I cycled most days, either indoor or outdoor, and did regular hard workouts on the bike indoors for quality work and blowing off steam purposes. I gradually upped my longest run of the week so that by mid September I was at 10 miles. In mid October I ran a half marathon at the easy pace I’d been doing all my runs at.

    It wasn’t until the middle of that November (7 months after surgery) that I ran every day of the week. And that was because I was on vacation near Acadia National Park and felt like with the soft carriage roads and not having the stress of working I could afford to push things a little bit.

    I had a scare late that December, when my foot felt almost as bad as it had before surgery. It got better after a few days of not running. I think that was from the new stress of running on snow. That problem hasn’t returned.

    One big difference between your situation and mine is that the surgery coincided with my getting slower all the time anyway. (I was 48 when I had it.) PR days for me have been long gone for a long time. But I feel like now I can train as hard as I’m willing to for other reasons (energy level, justifying the time to be such a mediocre racer). I had a bit more than 3,000 miles in 2015, and despite how bad I am now at racing, I overall enjoy my running as much as I ever have.

    Good luck and don’t be shy about asking questions.

  9. John Anderson April 11th, 2016 1:53 am

    Thank you! I REALLY appreciate the fact that you documented your progress. I’m 2 weeks post surgery, and so far my experience has been identical. The struggles, the angst, all of it was spot on for me. It’s been a huge relief to read your progress. It gave me that sense of hope that I was beginning to lose. Thanks again!

  10. john April 14th, 2016 11:00 pm

    thank you Scott
    I am reading this on my bed 2days after survery.
    I didn’t expect much from this peronial brevis tendon tear surgery caused cumulative sprains without any treatment for decades. but now I am very motivated to take good recovery from this hoping I could run.
    appreciate your sharing
    John

  11. Scott April 15th, 2016 5:12 am

    Two recent Johns: Good luck with your recovery. Overly conservative at first, with the hope it will mean greater functioning later.

    I just realized Wednesday was the three-year anniversary of my surgery. On that day I ran 10 miles in the morning, with the middle six at half marathon pace, and in the afternoon walked in the woods with my wife and dog. I hope this view from the other end is helpful.

  12. Zaida April 27th, 2016 9:24 am

    Just an update 8 weeks post-surgery. First week off the boot, and I’m allowed to do low resistant cycling (90-100rpm) to start working on my endurance. Felt good to sweat!!!! Haven’t had issues with swelling, but tends to be a bit achy at times. Starting PT this week and hopefully the recovery will continue to go as well as it’s going. This post and your responses have been really helpful. :)

  13. Bonnie June 11th, 2016 12:21 pm

    Just found your blog and it’s been helpful (and hopeful for a return to running). I sprained my left ankle running the Zion Half Marathon on 3/12/16 (happy 50th bday present to me). My first DNF in 37 years of running after tripping into a rumble strip at 2.5 miles into race. Xrays that day showed no break. Given crutches and ASO brace. Almost 3 weeks later went into Orthopedic Dr at home as ankle was still bruised, swollen and painful. He told me (without new xrays or MRI) to stop using crutches and get weight bearing. Like many good training schedules I’ve created, I started with 8 steps on 4/5 and got up to walking 5 somewhat painful miles before a 5/6 trip to Italy with cobblestones and steep hiking (continuation of the milestone bday celebration). Yesterday, I received the torn peroneus brevis diagnoses (and other minor things) from Dr #3 after he suggested an MRI. He is suggesting surgery will get my 50 year old tendon back to the way I was before my ankle sprain. Sure hope he’s right! There are a lot more miles to run in my lifetime! Thanks for the info! Glad to hear your running well again.

  14. Scott June 11th, 2016 12:36 pm

    Bonnie: Good luck. I was a couple months from turning 49 when I had my surgery, so while your healing might take longer than others’, you will get back. In a way, it might be better to have to be more cautious in the immediate aftermath–could increase the chance of being symptom-free and doing what you want when you’re 52.

    You mentioned “other minor things.” I had some of that, too, no doubt compensatory issues from the tears. (Example: I could barely raise my right big toe independently of the others.) With the enforced rest post-surgery, those went away and haven’t bothered me since.

  15. Bonnie June 14th, 2016 7:46 pm

    Thanks for the words. I’m tentatively scheduled for surgery on 7/24 (unless I decide to chicken out and see if it heals on its own). An acupuncturist I’ve seen says a 1.5″ longitudinal p. brevis tendon tear can heal without surgery. Not sure who to believe. I just want it to withstand a few more decades of running and hiking…

  16. Zaida Ramirez August 8th, 2016 7:46 am

    Hello Scott,
    I was wondering at what point did you started upping up the pace of the runs? I had my first post-surgery race (10k) this last weekend…I’ve been running relatively easy with maybe some pick ups, and Ive been cycling. I started the race conservatively, and pretty much kept the same pace- but I know i can run faster than that…it was a bittersweet moment at the finish line. Right now I’m running 5 days a week, with about 30-35mpw and the longest run so far is 12.5; hence, ~2min slower than before the surgery. Thanks,
    Zaida

  17. Scott August 8th, 2016 12:52 pm

    Zaida: I did normal easy to moderate pace for several months. I wanted to get my running-specific endurance and mechanics back toward normal before adding in planned faster running. Like I always have, I ran by feel rather than trying to hit a certain pace on daily runs, and that effort naturally meant I gradually got faster as the months went along.

    Because I was working toward running the 2014 Boston Marathon, my initial emphasis was long runs, not speed work. I wanted to add as few new variables as possible at one time.

    As it turned out, I didn’t do Boston because of a weird thing happening with my non-surgery foot soon before the marathon.

    Anyway, I didn’t really start regular workouts and tempo runs until the spring of 2014, after not running Boston. Those didn’t introduce problems, so then I added drills and turnover work that fall.

    Bear in mind that I didn’t have any real racing goals during this time. I might have been more aggressive if I had. And you could make an argument that it would have been good to start doing form drills and striders relatively soon once I was back to daily running, because they would better strengthen the foot and reeducate my foot on good mechanics. Perhaps I was overly concerned about doing stuff like that and then having to miss a day or two of running while the foot complained.

  18. Zaida Ramirez August 8th, 2016 1:22 pm

    Scott: Thanks for the info. I’ve been running by feel/slow for the most part. No race goals for this coming year, although im still debating running a 1/2 marathon- maybe the Chilly Half Marathon in Newton, MA. I would like to run a 50k or 50miles by Sept2017, so its just long miles and some trail running. Im just so afraid of getting injured again…

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