Sunday, May 17, 2015

peroneal tendonosis or something worse or just impatient???

Family is running the Bodies of motion 5k today and I am in starbucks keeping my mind off the fact I am injured.   According to the MRI, I got a diagnosis of peroneal tendonosis and it has to be one of the toughest injuries I have had, hands down. 

Here is the timeline from hell:

3/30:  rolled ankle at the Manassas National Battlefield and thought it was a sprain (little did I know, I had peroneal tendonosis going on).  Skipped my trail 1/2 marathon in PA, was sick too.
4/1 and 4/2: 
4/5:   Biked all week and ran 3.16 miles to test it out and didn't feel that bad.
4/6 - 4/11:  Biked this week
4/12:  Ran 4.2 miles in 38:30.  Ankle ached a little bit seemed to warm up after running
4/23 Got MRI on left ankle and received results (Negative for tears in peroneal tendons, have tendonosis)


There is mild scarring of the deep fibers of the deltoid ligament without tear.

Tendon Findings:

The extensor tendons are intact.  There is mild juxta insertional tendinosis of the posterior tibial tendon without tear.  Remaining long medial flexors are unremarkable there is a small amount of tenosynovitis about the flexor hallucis longus at the know of henry.  The peroneus longus tendon demonstrate mild to moderate degeneration distal to the fibular tip.  Peroneus brevis tendon is intact, Achilles tendon and plantar fascia are unremarkable.

Overall Impression of MRI:

There is mild to moderate degeneration of the peroneus longus tendon distal to the fibular tip without tear.  There is mild tenosynovitis about the flexor hallucis longus tendon distally.

Got a description of the difference between peroneal tendonitis and peroneal tendonosis:

The distinction between tendonitis and tendosis is important since tendonitis is more of an acute injury, and rest, ice, anti-inflammatories, etc. tend to resolve it quickly (within 6 weeks or so). Tendinosis is when the tendon itself changes (hence your MRI findings) from chronic stress and takes much longer to resolve (hence modalities like PRP injections, Graston therapy, etc.).

However, I am a big opponent to anti-inflammatories and have not used any during this time period.

4/24:  Started PT regimen
4/24 - present:  Biking as prescribed by PT
5/12:  Saw a Dr. Neufeld (he spent a whole 3 minutes with me and referred me to someone else, isn't he the specialist???  Thinks peroneal nerve entrapment)
5/13:  put ankle brace back on for immobilization, keeping it on for two weeks, no bike, just PT exercises and see how that works.
5/29:  Have appt with Dr. Lutta with OrthoVA to go over MRI results again and get a plan.

Days since ankle roll:  48
Days haven't run:  35
Days since PT:  23

So, yea, I am pretty bummed out however, I am looking for any sliver of improvement.  To tell you the truth, biking would be a godsend at this point!

Saturday, May 9, 2015

Peroneal Tendonitis - day 27 of no running

So I am up in New Castle, PA and Heather is running the Glacier Ridge 50k trail race today.  It is supposed to be 90F by midday so I can only imaging what that will be like.  She is a real trooper and hope she does well today.  Actually, when I ran the North Fact 50k a few years ago, it hit 92/94 F and that was a brutal 7 hours.  Anyway, sitting in the Cranberry, PA sbux sulking over my foot and dealing with Peroneal Tendonitis in my left ankle/heel.  Hit the Physical therapy 3 times this week and have two next week.  I had this a few years ago and rested more and it didn't take this long to heal and was back to running within 3 weeks.  However, this time around, I am looking at every bit of 4+ weeks after the ankle roll.  Here was my biking schedule:

Monday the 4th:  road 10 minutes and did all my foot exercises and heel drops plus tons of hip/core exercises
Tuesday the 5th:  20 minutes on the bike
Wednesday the 6th:  20 minutes on the bike
Thursday the 7th:  20 minutes on the bike
Friday the 8th:  20 minutes on the bike
Saturday the 9th:  15 minutes on bike and walked .5 miles with Heather after dinner

I plan to hit the bike tomorrow for 30 minutes tomorrow and see how it feels.  Getting frustrated with this injury.  Its been 27 days (day 15 of physical therapy) since I have not run but atleast I have been biking some.  Supposed to have a reassessment of my physical therapy on the 26th of May which is two weeks away.  Was hoping to be running by next week but am starting to question that.  Flexibility and strength in left foot is really good but apparently the tendons are still sore.  Hard to differentiate between aches from physical therapy or if it actually aches. 

So as the beautiful days pass, I wonder what if any running I will be doing this month.  I am doing rehab almost every day.  It was feeling better but now seems to be sore, SIGH.  My guess, I am now hoping to be running small miles in two more weeks which puts me around May 25th - a good two months after I actually rolled this thing (however started PT on April 24th).  This is not how I saw this year starting out.  Maybe ultras and marathons aren't for me, don't know but I am at a point where running a 5k would just be fun.

Saturday, May 2, 2015

Peroneal Tendonitis from a rolled ankle!

So after about a good 5 weeks of 30+ mpw in shit ass weather,  I started to ramp up my training.  As such, I have been hitting the trails almost exclusively and the ankles have been giving me some issues after runs - most likely due to the trail running.  So on 3/30/2015, I rolled my ankle at about mile 2.5 into a 7 mile run.  Nothing killer, just a decent roll and finished the trail run at the battlefield.  I got home and it didn't swell at all and thought that was a good sign.  For the rest of the week, I thought I would be ready for the 1/2 marathon up in PA that weekend.    Just so happened, I got sick, sick enough to where I didn't feel like I should run the race.  The ankle was still sore but now I was sick so I bailed on the race and decided to rest of the foot.  I ran again on 4/5 and it felt ok but not great so I rested and biked.  Another week goes by on the bike and I try to run again on 4/12, it went fine and did a decent 8:40 something pace but the ankle just wasn't getting any better.  So I went to the same orthopedist I went to when I found how about my hip labrum tears and he wanted to see if my peroneal tendons were tore so he sent me for an MRI.  Results came back with the following:

There is mild to moderate degeneration of the peroneus longus tendon distal to the fibular tip without tear.  There is mild tenosynovitis about the flexor hallucis longus tendon distally.  Plus, they said something about mild juxta insertial tendinosis of the posterior tibial tendon without tear.

Treatment:  Rest/PT - yea, that shit much for the 50k and the 50 miler I had planned coming up!

So the doctor sent me to PT which started 4/24/2015 and I am scheduled to 4-6 weeks which takes me to June, 2015.  On 4/27, I rode the bike one mile as I did on 4/29.  On 4/30, I rode it for 10 minutes and got 2.3 miles and today, May 2nd, rode it for 12 minutes for 3.3 miles.  My hope is to continue biking the rest of the week with no setbacks.  Go support Heather in her 50k race this coming weekend at Glacier Ridge ultra in PA and hopefully I can start light running in few weeks.  Whether that happens or not, we will see.

So lets take score - I stopped running on 4/12/2015 and it has been 20 days since I have run.  I stopped biking on 4/16 and took a total of 11 days off doing nothing other than core, hips, bench, etc...

As of today, I am biking 10 min to warm my ankles up, then doing ankle exercises twice a day.  If you were like me and you are looking around to see how long it takes to get rid of Peroneal Tendonitis.  Well, it depends.  If you get it from overuse, probably alot sooner than if you rolled it and kept irritating it.  From 4/17 until 4/26, I wore a ankle brace and don't know if that helped or not.  Last time I had this, it took about 3-4 weeks since the time I stopped running but it was more on the 3 weeks side.  I was just coming off a 100k trail race and it was the end of the year so I didn't mind the resting.  This time, I thought I could get back sooner and that didn't work.  That said, I stopped running on 4/12 but not resting it until 4/17 so if we are looking at that time table, I should be back to running around the  May 11th-ish time frame.  And of course, I can't just jump back into my old mileage which sucks.  Guess I will be looking forward to some cool late summer and Fall races.  Shit happens.