frank - could susan's condition possibly be related to an arthritic condition? might this have developed while she was running on the ankle while it was still inflamed? i have heard that many athletes with lingering ankle pain compound and aggravate their situation as they cannot take adequate time off from running - thus leading to a slow decrease in the cartilage in the ankle area - coupled with endema, it makes for one painful and chronic result?

[reply]frank - could susan's condition possibly be related to an arthritic condition? might this have developed while she was running on the ankle while it was still inflamed? i have heard that many athletes with lingering ankle pain compound and aggravate their situation as they cannot take adequate time off from running - thus leading to a slow decrease in the cartilage in the ankle area - coupled with endema, it makes for one painful and chronic result?[/reply]

Unlikely, arthritic changes should be easily distinguishable by either MRI or CT. She had both with no discernable abnormality save the edema.

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Frank,
An original Ironman and the Inventor of PowerCranks

My orthopedist suggested it might be arthritis, but the context in which he put this theory wasn't consistent with my experience of what happened. He made it out to be something that would have developed over a long time. But that's not it. Your explanation sounds more plausible. Here's what happened, as best I can reconstruct it:

I sprained my ankle in December. It wasn't getting better, so I went to my physiatrist in February, who sent me to PT, and it started to get better, and with direction from my very conservative coach, I started walk/running in April (I think) and then gradually increased the run time and decreased the walk time. After a coupla months, I wasn't walking at all and was building my total time by about 10% a week and everything was going fine.

And then suddenly, during the first part of June I think, it just all started to unravel. Little things like wearing Birkenstocks all day on a Saturday would trigger pain for 3 days. One night I did *one minute* on my balance board--and couldn't even ride my bike for a week. I was all to pieces, because up to that point, there had NEVER been a time that it hurt to ride my bike.

And the character of the pain has changed. I used to be able to feel with my finger the one tiny place deep inside my ankle where it hurt. And it didn't hurt unless I did something to make it hurt. Now, it's this diffuse pain that reaches several inches up my leg sometimes. And it hurts all the time, even just sitting at my desk.

Is this arthritis?

Susan

[reply]My orthopedist suggested it might be arthritis, but the context in which he put this theory wasn't consistent with my experience of what happened. He made it out to be something that would have developed over a long time. But that's not it. Your explanation sounds more plausible. Here's what happened, as best I can reconstruct it:

I sprained my ankle in December. It wasn't getting better, so I went to my physiatrist in February, who sent me to PT, and it started to get better, and with direction from my very conservative coach, I started walk/running in April (I think) and then gradually increased the run time and decreased the walk time. After a coupla months, I wasn't walking at all and was building my total time by about 10% a week and everything was going fine.

And then suddenly, during the first part of June I think, it just all started to unravel. Little things like wearing Birkenstocks all day on a Saturday would trigger pain for 3 days. One night I did *one minute* on my balance board--and couldn't even ride my bike for a week. I was all to pieces, because up to that point, there had NEVER been a time that it hurt to ride my bike.

And the character of the pain has changed. I used to be able to feel with my finger the one tiny place deep inside my ankle where it hurt. And it didn't hurt unless I did something to make it hurt. Now, it's this diffuse pain that reaches several inches up my leg sometimes. And it hurts all the time, even just sitting at my desk.

Is this arthritis?

Susan[/reply]

RSD

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Frank,
An original Ironman and the Inventor of PowerCranks

I might add. Get thee to a good anesthesiologist who can do a good sympathetic block ASAP. PM me once you have an appointment and I will tell you how to tell if you got an adequate block when it is performed. You and your doctors need to get serious about treating this now.

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Frank,
An original Ironman and the Inventor of PowerCranks

Deke, rroof, Frank, and cerveloguy--

I am away from my computer for the day, and I finally log on and am astonished and overjoyed to see your well-reasoned posts. Thank you, and it will take me time to digest it all. Here's what I think right now (which is not to say I won't think something else by tomorrow):

(1) I am going to buy the PowerCranks, and if the learning curve means I can't do the century ride in 2 months, so be it. My LBS guy is working on figuring out whether I need to do something to one bike or the other to make the PCs fit both. I suggested that he call you, Frank, but I think there may be an ego issue involved. It will be next week before I have myself together enough to think about placing the order, but it will happen.

(2) I am not going to get a sypathetic block or a steroid injection right now. I would rather see if the pain goes away on its own or with a less invasive approach, because shots hurt. When my rheumatologist friend injected my finger, it hurt *a lot*, and I don't want to do that again unless I've already tried everything else.

(3) My PT suggested that my orthopedist write me a prescription for a home IFS (interferential-something) to reduce inflammation after I ride my bike. It's on order now.

(4) I didn't pursue getting a boot to walk around in, because I cannot bear the thought of wearing another piece of orthopedic equipment. I already wear an S3 scapular stabilization brace. (Black lycra, with wide black elastic straps that anchor over each breast with velcro, wrap around my body, cross in the back, and attach with more velcro at the hips. A friend suggested I accessorize it with stiletto heels, black fishnet hose, and a whip.)

(5) There's a pain clinic with anesthesiologists at the local teaching hospital, and the acupuncturist (who is an MD) practices in that group. If my ankle doesn't improve in a coupla months, I will want to talk with you, Frank, about whether I should go to that clinic or to somebody else. But I don't want to go anywhere right now, because I have missed so much work already, and every time I have an appointment with somebody, I lose half a day.

(6) No chiropractor, even though if you were available, cerveloguy, I might be persuaded. I had a really bad experience with a chiropractor in December, when on the recommendation of a friend, I went to one to see if he could help the pain in my shoulder while I figured out the least disruptive time to have surgery on it. The short story is that he did something to destabilize my spine, according to my PT, who has spent months working toward making it right again. The facets are still irritated, but I can now at least swim without having to stop every few laps and curl up in a ball to interrupt the pain.

I didn't mention this back issue earlier because it wasn't relevant to my ankle and because I am embarrassed that there is so much going on with my body right now--my historically sturdy, resilient, and capable body, which has done everything I have ever asked of it without complaint and which I believe can function like that again. I just need to figure out what kind of support to give it so it can heal.

Susan

[reply]Deke, rroof, Frank, and cerveloguy--

I am away from my computer for the day, and I finally log on and am astonished and overjoyed to see your well-reasoned posts. Thank you, and it will take me time to digest it all. Here's what I think right now (which is not to say I won't think something else by tomorrow):

(1) I am going to buy the PowerCranks, and if the learning curve means I can't do the century ride in 2 months, so be it. My LBS guy is working on figuring out whether I need to do something to one bike or the other to make the PCs fit both. I suggested that he call you, Frank, but I think there may be an ego issue involved. It will be next week before I have myself together enough to think about placing the order, but it will happen.

(2) I am not going to get a sypathetic block or a steroid injection right now. I would rather see if the pain goes away on its own or with a less invasive approach, because shots hurt. When my rheumatologist friend injected my finger, it hurt *a lot*, and I don't want to do that again unless I've already tried everything else.

(3) My PT suggested that my orthopedist write me a prescription for a home IFS (interferential-something) to reduce inflammation after I ride my bike. It's on order now.

(4) I didn't pursue getting a boot to walk around in, because I cannot bear the thought of wearing another piece of orthopedic equipment. I already wear an S3 scapular stabilization brace. (Black lycra, with wide black elastic straps that anchor over each breast with velcro, wrap around my body, cross in the back, and attach with more velcro at the hips. A friend suggested I accessorize it with stiletto heels, black fishnet hose, and a whip.)

(5) There's a pain clinic with anesthesiologists at the local teaching hospital, and the acupuncturist (who is an MD) practices in that group. If my ankle doesn't improve in a coupla months, I will want to talk with you, Frank, about whether I should go to that clinic or to somebody else. But I don't want to go anywhere right now, because I have missed so much work already, and every time I have an appointment with somebody, I lose half a day.

(6) No chiropractor, even though if you were available, cerveloguy, I might be persuaded. I had a really bad experience with a chiropractor in December, when on the recommendation of a friend, I went to one to see if he could help the pain in my shoulder while I figured out the least disruptive time to have surgery on it. The short story is that he did something to destabilize my spine, according to my PT, who has spent months working toward making it right again. The facets are still irritated, but I can now at least swim without having to stop every few laps and curl up in a ball to interrupt the pain.

I didn't mention this back issue earlier because it wasn't relevant to my ankle and because I am embarrassed that there is so much going on with my body right now--my historically sturdy, resilient, and capable body, which has done everything I have ever asked of it without complaint and which I believe can function like that again. I just need to figure out what kind of support to give it so it can heal.

Susan[/reply]

That is fine Susan but if your foot gets any worse get there sooner than later. RSD can spread and it is the general concensus that the earlier it is treated the easier it is to treat, although I am not sure I agree with that view entirely.

If you are that sensitive you may not be able to ride the pc's also but you won't know until you try.

If you ever need a block PM me and I will do my best to help you out.

Frank

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Frank,
An original Ironman and the Inventor of PowerCranks