Foot Injury Not Getting Better After 4 Months - Permanent Damage?

Triathlon Forum
1

Hi,

I hate to dive into Slowtwitch with such a lengthy missive, but I’m at my wits end with a nagging foot injury that has been going on for four months with little improvement. I’m starting to wonder if I’ve permanently crippled myself and am wondering if anyone’s had a similar experience and can provide me with a glimmer of hope for recovery.

Here’s what’s been going on:

Back in October 2012, I hurt my foot during a marathon and it hasn’t improved much since then (nor have I run since then other than a couple of ill-fated attempts of a mile or two). During the marathon a I stepped in hole and twisted my ankle (inversion ? foot rolled inward, ankle outward). I remember thinking at the time that I really dodged a bullet because it seemed like a pretty severe twist, but there was no significant pain and I continued running without issue. That is until several miles later when the bottom of my foot started aching a bit. Naturally, I kept going. As soon as I started walking after crossing the finish line I got a sharp pain on the top lateral part of my foot that reduced me to limping. When I took my shoe off there was a bit of bruising on the top of my foot. It was quite painful (limping) for several days, but then started feeling better (no limping) but still painful to walk on at times.

The pain seems to be mainly on the top of the foot in the area of the cuboid, with it being sharpest on toe-off where the cuboid meets the metatarsals on the top/side of the foot, although at times I feel pain on the bottom of the foot below the cuboid and sometimes along the 5th metatarsal. Eversion of my foot can elicit the pain. There is also some tenderness in the hollow area below the anterior talofibular ligament.

After a few weeks I saw a podiatrist who suggested extensor tendinitis and ‘prescribed’ RICE. A couple weeks later with still no improvement (or running)he suggested an ankle brace that helped minimally but overcompensated (my term) and caused pain along my 2nd metatarsal so I abandoned it.

At 2+ months out from the injury, I consulted an orthopedic doc and had an MRI that showed nothing out of the ordinary. The doc said “no signs of stress fracture or reaction in the bones and the ligaments look fine”. He did say that the resolution didn’t allow for a complete assessment of the ligaments but from what he could see they were OK. He told me to give it some more time. A few weeks later with no improvement I returned for another head-scratching sesson with him that resulted in him suggesting a possible mid-foot sprain and that perhaps some PT might help. Being desparate, I agreed to try it and will start next week.

I’ve also had my chiro ‘adjust’ the foot which offers some short-term relief. I’ve tried self-massage and adjustment as well. A couple of times, while plantar flexing while pressing the cuboid from the bottom I’ve felt a little ‘pop’ and the next day have had reduction in the pain.

On days when the pain is better, I still feel like I’m one mis-step away from bringing it back.

Clearly, I need some expert medical advice but have not yet been able to find the right person locally yet.

Having had 4 months to research this, I’ve managed to alternately find hope and scare the bejeezus out of myself. A couple of thoughts I’ve had are:

  1. Ligament damage (not showing on the MRI) due too the ‘twist’ during the marathon that is taking a long time to heal.

  2. Cuboid syndrome/subluxation. When I mentioned this to the ortho doc I don’t think he knew what I was talking about. Didn’t discuss with podiatrist yet.

  3. Sinus Tarsi Syndrome / subtalar joint impingement

I have no pain below or behind the fibula so I don’t think its a peroneal tendon issue.

No one has suggested immobilization at this point by I’m seriously considering putting myself in a CAM boot for a couple of weeks to see what happens.

I’ve continued to swim and run with the exception of when I took 2 full weeks of doing nothing with no improvement. It actually seemed to get a bit worse. Neither of these activities cause any pain at all in the foot.

Its gone beyond my urge to return to running at this point and to the point where I just want to be able to walk my daughter to school in the Spring pain-free.

Anyone had a similar injury or something that lasted this long without any real improvement?

Thanks for any help or insight you can provide.

Fred

2

Your description (quite detailed at that) is SPOT on for what I would typically see with cuboid syndrome. It is often misdiagnosed (or even unaware by many docs) so don’t be surprised there.

You seem quite educated with your post with detailed anatomic landmarks and a good differential. Cuboid syndrome generally resolves in time, but depending on your day job/requirements, can take a LONG time. A CAM boot will help, but I don’t usually employ initially. Strapping/taping with a cuboid pad might be a god place to start.

3

Thanks rroof!

I’m seeing another podiatrist later this week and plan to ask about the possibility of cuboid syndrome. In the meantime, based on your suggestion, I think I’ll fashion a cuboid pad and tape it in place to see how that works.

  • Fred
4

Getting another opinion at this point is your best bet. No offense to anyone on ST, but no one here is more qualified than a specialized doctor who is there with you in person.

Of course it is good to know a few injuries that seem to fit your symptoms to ask about them so you can get the most out of your visit, and to make sure your doc knows at least as much as Google.

5

Hello!
I know this post is from a year ago but I am experiencing similar symptoms and have been injured and not able to run for almost 4 months! Did you ever figure out what was wrong? And if so how did you treat it? I have had 3 xrays, and MRI and bone scan with negative results and I am very miserable! Any information you have would be wonderful! Thanks so much!

6

Funny enough rroof is more qualified than most foot doctors (he is one)… I agree that seeing one in person is important, but having some potential ideas about the issue when you see a doctor never hurts… I usually let my doc do the evaluation and make suggestions. If it matches, great… if not I will pose questions about other possible diagnosis. If you look at a post on made a week or two ago about tread wear on my shoes, rroof basically hit most of the issues on the head, just by looking at a picture of my shoes.

Getting another opinion at this point is your best bet. No offense to anyone on ST, but no one here is more qualified than a specialized doctor who is there with you in person.

Of course it is good to know a few injuries that seem to fit your symptoms to ask about them so you can get the most out of your visit, and to make sure your doc knows at least as much as Google.

7

have no pain below or behind the fibula so I don’t think its a peroneal tendon issue.

I had peroneal tendonitis this year from running on the outside of my foot during a long run. I was trying to avoid running on a nasty blister and it went horrifically wrong. The pain I had was exactly where you describe. I had ART, Grastons, and acupuncture done by “Zev” on this forum and it sped up my healing time dramatically. I had this issue in the past (without any treatment) and the healing time was like you described, months. I am not at liberty to diagnose your problem, however, the part I found interesting was that you describe the pain on “toe off” which was exactly my problem too. And the exact points you describe were where my pain was as well.

Zev did a great job breaking up the scar tissue using Grastons and dealing with the pain via acupuncture. I was bummed because I thought I would be sidelined for the half marathon I had scheduled. It was only 2 weeks after this injury occurred. Not only did I race with no pain on race day, and have not had this issue come back since.

Good luck getting healthy.

8

Well, I wish I could tell you how I fixed things, but at 16 months out from the initial injury, I am just now seeing some hope.

After a series of dealing with what I consider incompetent medical “professionals” (2 DPM’s & 1 “sports” MD) who refused to listen when I told them that “rest” was not helping, I saw a DPM specializing in trauma surgery (I was referred to him by a mutual friend) who looked at a previous MRI that “showed nothing” and identified a small tear (<1cm) in the peroneal tendon. He encouraged me to try a PRP injection before considering any sort of possible surgical repair.

I am now 4 weeks out from an ultrasound-guided PRP injection and was feeling good about it until I slipped on some ice recently and “tweaked” the foot. Grrrrr!!! There may be an additional PRP injection in a couple of weeks if the doc thinks it would help. I am aware of the lack of concrete evidence indicating the efficacy of PRP for this sort of thing, but I am willing to give it a shot at this point. I’ll post an update in a couple of weeks.

I am also going to look into Graston and ART as has been suggested here to break up any remaining scar tissue.

Good luck and hang in there!
Fred

9

I must say I think the Grastons was the best for it. I stopped the ART as I thought it was counterproductive. The difference in pain after the acupuncture was phenomenal. I went from barely being able to walk to almost 0 pain the next day. I was shocked, impressed and amazed. I also used Zheng Gu Shui as a topical to increase blood flow… and I used Cissus as a supplement to cut down on inflammation and help repair tendon tissue (not clinically proven but I am a believer). Hope this info helps. Research Cissus as I feel that played a hand in my quick recovery as well.

10

Well, I wish I could tell you how I fixed things, but at 16 months out from the initial injury, I am just now seeing some hope.

After a series of dealing with what I consider incompetent medical “professionals” (2 DPM’s & 1 “sports” MD) who refused to listen when I told them that “rest” was not helping, I saw a DPM specializing in trauma surgery (I was referred to him by a mutual friend) who looked at a previous MRI that “showed nothing” and identified a small tear (<1cm) in the peroneal tendon. He encouraged me to try a PRP injection before considering any sort of possible surgical repair.

I am now 4 weeks out from an ultrasound-guided PRP injection and was feeling good about it until I slipped on some ice recently and “tweaked” the foot. Grrrrr!!! There may be an additional PRP injection in a couple of weeks if the doc thinks it would help. I am aware of the lack of concrete evidence indicating the efficacy of PRP for this sort of thing, but I am willing to give it a shot at this point. I’ll post an update in a couple of weeks.

I am also going to look into Graston and ART as has been suggested here to break up any remaining scar tissue.

Good luck and hang in there!
Fred

Thanks… Mine is actually getting a bit better already. I think I just rolled my ankle again. I was just more referencing the other post as rroof provided some great info online and the other poster had said going online is not a great method for finding info regarding injuries.

Hopefully things get better for you soon.

11

Did you ever immobilize the foot??

I had the same type of injury, resembled cuboid syndrome. Xrays showed nothing, and multiple times with a tuning fork and ultrasound machine did not illicit further pain. After limping around for a month+, I finally bought one of those air cast walking boots, and ended up having to wear it for a good two months, and finally it seemed to heal up. Best guess is that I tore up some soft tissue in there between the cuboid and 5th metatarsal, and needed to immobilize for it to heal.
3 months total for me.

My advice, put it in a air boot ASAP! But rroof is the expert here, so I’d listen to him as well!!

12

Well, I wish I could tell you how I fixed things, but at 16 months out from the initial injury, I am just now seeing some hope.

After a series of dealing with what I consider incompetent medical “professionals” (2 DPM’s & 1 “sports” MD) who refused to listen when I told them that “rest” was not helping, I saw a DPM specializing in trauma surgery (I was referred to him by a mutual friend) who looked at a previous MRI that “showed nothing” and identified a small tear (<1cm) in the peroneal tendon. He encouraged me to try a PRP injection before considering any sort of possible surgical repair.

I am now 4 weeks out from an ultrasound-guided PRP injection and was feeling good about it until I slipped on some ice recently and “tweaked” the foot. Grrrrr!!! There may be an additional PRP injection in a couple of weeks if the doc thinks it would help. I am aware of the lack of concrete evidence indicating the efficacy of PRP for this sort of thing, but I am willing to give it a shot at this point. I’ll post an update in a couple of weeks.

I am also going to look into Graston and ART as has been suggested here to break up any remaining scar tissue.

Good luck and hang in there!
Fred

How can you miss something that big? I can understand something a couple of mm’s but if it is 5mm-10mm (or 1cm) then how can you miss that?

It’s great you are getting better. I severely sprain my ankle 4 months ago and reaggravated it a couple of times in between. I can run on a treadmill if I am very aware of my form but it is still tough to swim (after only 200yards it hurts a little, that and not swimming for 4 months really kills your swim fitness). Probably would’ve healed faster if I straight broke it (maybe it did but didn’t go to a doctor) and been put in a boot or a cast.