2 replies to this topic

[jbrokeri]

Hi everyone,

  I apolgoize for this long saga, but I'm at wit's end and don't know what to do from here:
The short story is:
    9/10/11-Foot stomped on in cuboid area
    11/2/11-Foot still swollen, chiropractic adjustment of foot, first set of X-rays (normal)
   11/8/11- Saw ortho specialist, set of weight-bearing X-rays done, all clear, advised 30 days of strict rest and use of supportive shoes
    1/20/12-Foot still swollen over cuboid, continued periodic pain in lateral arch, requested MRI
    2/1/12-MRI normal, suggested that I build back up to normal activity and was told to listen to my foot and back off if it hurt.

I have continued to have pain in the lateral arch between the base of the 5^th met and my toe, and more so when walking on uneven ground but after a day or two it always resolves and with regular day-to-day activity I went for weeks with zero pain.  I have done some periodic strength training and very minimal jump-roping without difficulty, though I for the most part have been sedentary since November.  Walking last night, strengthening exercises and ride to work this morning felt pretty OK.  No sharp or localized pain.

    I went to the PT two days ago, who did some ultrasound, e-stim and suggested some strengthening exercises as my left (injured) leg is considerably weaker than the other.  The ultrasound pinged a sore spot on the lateral side of the foot closer to the pinky toe, but it could not be reproduced.  Since the treatment the foot was more sore over the cuboid, but in a diffuse, mild way.  I went back for a follow-up today, and the ultrasound pinged a spot over the swelling over the cuboid.  The therapist turned up the intensity to try to confirm the spot and I literally jumped—it was a very painful, electrical shock feeling.  With some poking and prodding, the point tenderness could not be reproduced.

I am very worried about the pain during the ultrasound.  The PT (and my massage therapist and chiropractor) informed me that such pain occurs at the site of a fracture sometimes, and she couldn’t offer any other explanation.  She agreed the lack of point tenderness in that area was odd, in addition to having 3 imaging tests done over a period of 3 months that were all normal, but was also curious about the lingering swelling.  Has anyone else experienced this?  I asked for the MRI because I had the impression it was a gold-standard diagnostic test, and if that didn’t pick up a break after 3 months since the start of the issue I don’t know what would.  I have been doing Pilates once a week, but no other consistent activity (hiked and snowshoed a few times during all of this but nothing more).  The PT advised continued avoidance of running and hiking, and suggested some pool work and trainer riding while seeing if these exercises are going to help, with a possible stint in a boot if things don’t progress considerably in the next few weeks.  I have had some other tension and trigger point issues in the IT band/hip/glutes, and I plan to see my massage therapist in the next week, though I’m now thinking it would be best if the foot was avoided.

I’m in a rural area, and don’t have a lot of options for second opinions.  Does anyone here have any similar experiences or possible suggestions (in addition to what was suggested by PT)?  I'm terrified of causing some permanent injury due to misdiagnosis and I'm really antsy to get back to training.

[FitToRunPhysio]

You need to find a good sports doctor and sports physiotherapist.  A bone scan would be the another option for imaging that would show up a hot spot for perhaps a stress fracture/reaction.  Keep up the pilates.  You need to maintain the strength and flexibility for your whole body and try to keep your body as equal as possible.
Good Luck
F2R Physio

[sportsphysio]

Hmmm, a concerning story all up.

The most likely explanation for the ultrasound causing a sharp pain is: ultrasound generates localised heat, the layer of tissue on the surface of the bone (periosteum) is unable to dissapate this heat quickly and, if the ultrasound head is kept still for too long, it causes a periosteal burn. The closer the bone is to the surface, the quicker the heat build up. The association with fractures is a theoretical link due to the increased sensitivity of irritated peristeum around a fracture site.

As for MRI not showing a fracture, it is possible as the accuracy of MRI is not 100% (typically 92-96%, depending on the imaged area of the body). However, a few months after the injury, the MRI would have detected signs of bone healing, even if it didn't spot the fracture line.

Overall, I agree with F2RP on getting an opinion from a sports-qualified running-specific professional; I'm just not sure who this would be in the US, possibly a university clinic rather than a private practitioner.

Interesting that you've come to the Aus coolrunning site rather than the US site. This is obviously a vote for the new forum layout; hopefully it's worth the extra travel time