[foot] 6th time’s a charm
I’ve been toying with the idea of writing about this for a long time—years!—but something kept me from it. I suppose it’s the idea that once something is written, forged in “online stone” so to speak, it becomes permanent. I wasn’t ready to deal with that for a long time but as this week begins, and I face my 6th time undergoing the orthopedic surgical knife on my left foot, it seems like I need to resign myself that my new normal, is well, happening.
This is a long story that’s manifested over 31 years but it’s accelerated in the past 14 months. I suppose it’s like growing old in some ways, where there seems to be so much time ahead of us when we’re young that suddenly starts to speed up. The good things seems to rush by in mere milliseconds while the unpleasantries slow to a crawl and when life is great, we wonder where all the time went, and why, in those low periods, time refuses to go any faster. So I’m going to do what I should’ve done years ago and document this journey. I’ll start with now and then give the full backstory along the way, if for nothing else, than to share with someone who may be going through the same thing. There’s also some catharsis in recalling the entirety of the journey and heaven knows, I could use some of that right now.
I’d be remiss if I didn’t give credit to an old work colleague who’s now becoming my confidante and has been offering me an alternative path to explore. I’ll share more about his story in the coming weeks, but for now, let’s crack open the novel and get vulnerable.
May 17, 2023: 5th metatarsal surgical repair for avulsion fracture and non-union with bone graft. Check-in at 10am, surgery scheduled for noon.
I suffered what felt like a stress fracture on Dec 31, 2022 on my morning “walk-run” and after hobbling home, I propped up the foot, applied ice and let it rest, knowing that we weren’t doing much except sitting at our favorite restaurant for dinner, then coming home. Thankfully, the ample NYE adult beverages numbed the pain until the following morning, when the foot was swollen up like a heavy grapefruit and I was relegated to the couch, not for a hangover, but for a respite from the throbbing intense pain manifesting along the outer edge, the 5th metatarsal and the boney protrusion about halfway up. My husband has a long background in EMT medicine and he was able to diagnose it as “not a break but something that necessitated a visit” to the ortho. So we went the following week.
Doctor: Stress reaction
My husband: Stress fracture
We could see the faint line on the x-ray and after my husband pointed this out to my ortho, he demurred saying “it doesn’t really matter, they’re both healed the same way.” After arriving and leaving on crutches, we joked on the drive home that my husband was better at reading x-rays than my doctor. I was instructed to stay non-weight bearing until such time as I felt ready to go into one of the many orthopedic boots I have lying around my house, the result of having had so many foot issues. I let 2 weeks go by and started using one of the aircasts in hopes of alleviating the pressure that my lower back and hips were feeling from too much time hunched over crutches.
MRI: avulsion fracture, minimal signs of healing
I waited about 5 more weeks, hoping for the best but the pain was still intense. So in mid-February, I preemptively reached out to my ortho’s PA over email and asked for a) an MRI and an appointment to come in and read the MRI, and b) some pain meds. When there is a bone break/fracture, NSAIDS such as ibuprofen are generally not OK to take as they slow bone growth. Little do these professionals know I have built up a pretty solid tolerance to both pain and Advil so I rely on this symbiotic relationship to keep me going as an ultramarathon runner (side note: yes, I know all about the dangers of mixing Advil and ultras.) Anyway, I got an MRI and a prescription for Meloxicam, an Advil alternative, which is an NSAID but is somehow OK..? I’m not a doctor so who knows.
Anyway, the MRI came back with a laundry list of a lot of problems but the one we’re focusing on right now is the avulsion fracture of the 5th metatarsal. Somehow, I managed to break it (spoiler alert: I have my theories I’ll expand upon in another post.) When I went in to review the situation with my ortho February 16th, I erroneously went alone, which proved to be a mistake. My ortho likes my husband. He does not like me. He said once again, as he has several times “what do you expect, Emily?? You’ve had multiple failed surgeries.” He then argued with me that my bones were likely weak and that was probably why it wasn’t healing as much as it should have at this point. He refused to discuss it much further, instead insisting I come back once I’ve had a “DEXA” (aka, a bone scan.)
DEXA: very healthy, no known issues
I had the DEXA the following week. My bones are strong AF. I know this because:
a. I have been weight-training for 20+ years
b. There is no history of soft / weak bones in my family
c. I have an insanely healthy diet and am 5'3', 112 pounds which is mainly muscle
d. I have never had anything beyond a stress fracture years ago in the same foot (diff metatarsal) due to over-training that healed in about 6 weeks
But I was determined to wait this out and see if these strong bones would go on and heal themselves. So I did. I waited until I was 18 weeks post-break just so I could say I “gave it enough time” before returning to the ortho office. During that time, I tried to stay active but with each short walk, each outing, each small bit of exercise, the pain remained. As I mentioned earlier, I also have prior surgeries I’m dealing with and having spent most of last year going in for PT 1-2x a week, and religiously doing all my exercises daily at home, following a March 2022 ankle-foot reconstruction (more on that later!), I was watching what progress I had made, slip away.
Door #1: EXOGEN Bone STIM 2x a day
Door #2: Surgical repair
We met with the ortho May 4. He took x-rays. The “stress reaction aka hairline fracture” we saw in January was now a full on break with a 2mm gap in-between the bones. It looks like this (note: not my x-ray, but mine looks identical) So in 4.5 months, it worsened. No wonder it hurts like hell. Side-note: I told you I have a high pain tolerance. Side-side note: I feel somewhat vindicated that I’m at least not dreaming up non-existent pain. Emphasis on “somewhat.”
We talked for a while with the ortho and he suggested putting in for an EXOGEN bone stimulator device that gets worn 2x a day for 20 mins, and is supposed to help heal “hard-to-heal” bones. He said he’d write the order so that it would get approved bc these devices are hella pricey and insurance usually will cover if it’s been more than 12 weeks with no improvement. SPOILER ALERT: BC/BS said it wasn’t “medically necessary” and denied coverage. DOUBLE SPOILER ALERT: It’s cheaper to outright buy the machine than it is to pay the out-of-pocket expense if it were to have been approved. US health insurance never fails to amaze me in its sheer stupidity.
Covered rental price out-of-pocket costs: $732.60.
Outright purchase for lifetime ownership: $420.19.
But he also said there’s a catch. The break is such that at this point, the device probably won’t heal it on its own. It would have, maybe, had I used it way back in January but now, not so much. The best outcome would be surgery where he’d go in and shave the bone a bit, put in some hardware and graft a small fragment from a nearby bone to help promote blood flow and regrowth. The outcome has a “90–95% success rate.” We didn’t discuss the other 5–10%. And we didn’t talk about how this happened in the first place and what’s to keep it from happening again post-surgery. I’ve tried to bring such questions up in the past and I am generally unable to get a real answer. Because no doctor, especially not an orthopedic one, is willing to tell you what you should be told should things not go as planned. This I’m learning over and over again.
So here we are. Surgery in 2 days. Once again, I’m back on crutches. And back to square one.
Next: Thwack-Thwack
