Thursday, September 13, 2012

Excuse Me Ma'am, But Is That Your Foot You Dropped?

“Things may happen and often do to people as brainy and footsy as you” 
― Dr Seuss, Oh, The Place You'll Go!

Why yes, as matter of fact that is my foot. And thank you, thank you for noticing. . . .

Oh, the things that can  (and have!) happened since I last blogged. 

Just when things were going so well for me too!

Let's break it down, shall we? 

Since I last blogged, and you last read my wise words of writ, I had just finished my 17th marathon in  a blazing (for me) 3:28. Two weeks prior to that I had some humble pie with a side of tornado and ran a 3:58 marathon. But all in all, not a bad showing for this 40 (now 41 ) year old runner. And in the months prior to that I had run a marathon personal best (3:26), a 10k personal best (43:14), a 5k personal best (20:30) and was averaging in the neighborhood of 65+ miles a week for over 10 months.

 Finally! I had broken free of the injury clink. 

And the streak of health and fitness continued: Two weeks after the GA Publix marathon I went for some cool (and free!) testing. I have never known my heart rate, VO2Max, lactic threshold or any of that other fancy data stuff.  For the most part, I don't even know what pace I run or specifically how far I am running since I don't own a Garmin and rarely wear a watch and only map out my runs when I get home most times. So the cool news, which really wasn't too surprising I guess, was that I am pretty (or rather, er was) darn fit. 

My VO2Max was 55. Which if you look a this chart you can see that is pretty  good for a 40 year old female. My max heart rate is 189 and lactic threshold is 179. Which, according to Andy, the PhD candidate that administered the testing, said that was also really good. What it sounded like to me though is that I have to run pretty dang fast to hit lactic threshold and well, I don't like that fast stuff so much. But really, it was eye opening what it felt like to hit max heart rate. I have to say that I don't ever go to that point in racing. Ever, ever. I'm not even sure I get up to lactic  before I start to panic and back off. I also think this explains why I like the marathon so much. 

But the results were not all good news. 

My weight was up-- higher than it has been since I think I had a baby. I'm only 5'5  and I weighed in that day at 134.5lbs. Usually I am in the 127-132 range ( I was 127lbs in October of 2011 at my last physical). My guess is running 2 marathons 2 weeks apart and the necessary recovery from that led to a bit of gluttony and weight gain on my part. 

Okay, I know it did. (mmm, celebratory beers)

Also, bad news was that body fat was higher than the tester or I had thought it would be too--we had both guessed 18%. 

I was 20%,  which, supposedly for women, according to this chart, is still in the "athletic" range. At any rate, I knew before he did all the weighing and Dexa scan that my weight was going to be up from what is was during peak training as my waist size was up an inch and I couldn't fit into one of my smaller Betsey Johnson dresses as a result.  

But apparently being an athletic fatty didn't slow me down too much. Two days after my testing was complete I ran a 5k/10k double and ran another personal best at the 5k (20:27, okay just 3 secs) and a course personal best for the 10k (45:15). 

Nevertheless I felt that if I wanted to see real improvement I was going to have drop some weight and body fat. Andy and I talked about a few options for me where I could improve my fitness. He explained that VO2Max goes up with lower body fat . However, VO2Max also goes down with age (and surprise surprise, body fat goes up with age. I tell you what, there is no good news about this getting old gig.)

 He indicated that my lactic threshold was actually really quite good and I probably wasn't going to see much improvement there. Basically, my best bet to get faster would be to drop some fat/weight. He said I could "healthily" go as low as 12% but we also talked about the sacrifices that would involve (beer, food). And besides, at 40 I think I kind of need  some fat to fill out the wrinkles. Too low a body fat at my age just makes you look old and saggy baggy elephant like.

Personally, I felt getting my weight down into the lower -mid 120's would bring me to a reasonable body fat of 16-17% and my Betsey Johnson dress would fit me again. I also felt I wouldn't have to make too many sacrifices to make that happen. 

To be certain. I am not going to say losing weight is easy. It isn't. At all. It took me 6 weeks to drop 8.5 lbs and get my weight down to 126. And from there I couldn't get it to budge at all. My dieting plan was as follows: no alcohol Monday through Friday (definitely hardest part), no white bread or pasta--whole wheat only, meat only once a day, more fruits and vegetables, no processed snacks ( pretels, potato chips, cheezits etc). I was already running around 60-70 miles a week and swimming once a week. I added in some cycling and added push ups (100) to several workouts each week. A key workout for me was running laps and after every mile stopping and doing 10 push ups. 

Honestly, it was a lot of effort for just a measly 8.5 lb loss. But I was pretty happy  that my dress that didn't fit before did fit and I shaved 3 minutes off my time from my personal best at the Olympic distance at this year's Peachtree International triathlon (2:43 to 2:40) which 2 minutes of that was off the run portion. I even nabbed top in my age group. A first for me in triathlon. 

Being 40  had been rather kind to me at the races: I took first overall female at a couple of 5k races,  top master at other distances and  top age group placements at pretty much every race I entered (except that one with the side of tornado and that is my own fault.) I would say I was probably the fittest I've ever been in my life and this is saying quite a bit since honestly, I have never really been unfit. 

And then I dropped my foot. 

And here is where ends what I am sure has probably seemed most like an obnoxious braggart's tale. 

So, maybe you are wondering what exactly "foot drop" means. 

No worries. I'm gonna explain it. 

Actually, you can read about Foot Drop here. But basically it means you can't flex your foot because you can't move your anterior tiblias muscle. And let me tell you, in case you didn't know it, but the anterior tiblias and the ability to dorsiflex your foot is absolutely crucial in being able to run. Really, even walk normal. 

There are varying degrees of foot drop. They have a scale for dorsiflexion. Zero means no mobility and a 5 means complete mobility. I was a zero for the first two weeks of my injury. 

Foot drop has to be the absolute craziest scariest injury I've ever had. It seriously messed with my head. One minute I'm at a party eating raw oysters in the backyard and drinking beer and playing corn hole and then an hour later my foot is paralyzed. 

I had been sitting on the steps, drinking a beer and listening to this woman tell me the longest and most tragic woe is me tale I've ever heard. I had been sitting cross legged, as I was wearing a dress and darn it sitting cross legged stretches out my hip flexor. 

After what felt like a short eternity I stood up to excuse myself and untangle myself from the grips of this woman's tale under the very useful ruse of having to use the restroom. As soon as I stood up I rolled my ankle. Initially I wasn't so worried about rolling my ankle as I roll my ankle all the time running, and most times,  just keep on running. It hurts a little but  it's just a split second pain; a tweak and then the pain always goes away.

So I take another step and I roll my ankle again and this time almost fall down. It is then I realize that I can't move my foot or ankle at all. Ryan tells me stop being a weirdo and that my foot is just asleep and I just need to go "walk it off". So I comply and take some things to the Jeep. 

Walking isn't easy. I am doing the "steppage gait" because other wise I would fall over my foot. It is like it is glued to ground. 

While I am putting the stuff in the Jeep my ankle collapses and I land flat on my back in the road. This time I rolled my ankle all the way over to the top of my foot and bloody my last three toes on my right foot. My foot is completely numb and I can only wiggle my big toe. 

I am completely freaking out.

I implore to Ryan that we must leave and he isn't happy about it because he "is winning at corn hole." He is "in the final round" and "might win 50 bucks."

 I don't so much even care a tiny bit about how well he is faring in corn hole since  my freaking foot is paralyzed, bloody and I can barely walk. To me that seems way more pressing than corn hole or $50. But I agree to wait it out a bit longer. It isn't an emergency, yet.

An hour later and corn hole still has no definitive winner and I am in full out panic and have a bit of  an adult tantrum, after which Ryan finally agrees we can go home.

I ice my foot when I get home, though the only part that hurts is my toes since they got all cut up when I fell. I take a Motrin to further combat any swelling and hope that my foot will be functioning the in the morning.

I wake up the next day and my foot is still paralyzed. I begin massive Googling and learn that foot drop is what I have and that it is usually a symptom of some other, usually serious and deadly, neurological disorder or disease. Most of what I find is related to ALS or MS. All very frightening. I do find some information that the peroneal nerve can be damaged by crossing the legs  but the damage doesn't seem to be complete paralysis like I have, but rather just some tingling. I also find that severe ankle sprains can cause peroneal never damage but my ankle is neither swollen or bruised that I can tell and I have no pain, just numbness. 

After 3 days and still completely unable to flex my foot I go to see an orthopedist upon the advice of a friend who is a physical therapist. I am, by this point, fairly convinced that I have some terrifying neurological disorder. My hip and lower back are also killing me since to walk I have to lift my knee and thigh up just so my foot clears the floor. I am in a miserable state.

An X-ray rules out any breaks or tendon damage. I tell the doctor my story: oysters, beers, sitting crossed legged listening to sad saga and  then my ankle rolling tale. He says, "Well, you're fairly thin." And I say " Well, thank you." 
He laughs and continues, "In leaner people the peroneal nerve can be superficial and easily compressed." To prove this he grabs my leg and presses on my nerve and weird nerve sensations go down my leg. He goes on to say that probably what happened is that I compressed the nerve, temporarily paralyzing my leg--like when your foot falls asleep-- but the real damage happened when I stood up and rolled my ankle. 

He then goes on to say that best case scenario is that I "stretched" the nerve and worst case that I severed it. He felt that my injury was of the stretching type and that it should come back 100%. Only he couldn't say when that would happen. I pressed him for a time line and he said "could be 6 weeks  or it could be 6 months or longer" 

 I asked what if I severed it?

"Well then, it probably won't come back but either way you have to wait at least a month and if you don't see any improvement then come back and we'll do a nerve study."

He said that he was going to recommend physical therapy and that I "seemed fairly motivated" so I would only need to go once and get some exercises. He also gave me a brace to stabilize my ankle so I wouldn't roll it again and do further damage. He said I could swim and cycle until it healed and sent me on my way. But not so happily. Not the quick or miraculous fix I was hoping for.

And what boggled and frustrated me is that I got injured just hanging out and sitting. Seriously! I run 70 miles a week and I hurt myself to the point of paralysis from just sitting around? 

The universe sure was having some fun with irony at my expense to say the least. 

And so I went to therapy, still not 100% convinced that I wasn't dying of a neurological disorder and got my prescribed exercises. The PT said to do them two times a day and she felt it was going to be an even longer recovery than the Orthopedist had though. So I decided to do the prescribed exercises 3-4 times a day instead of just  twice. And I swam. A lot. And I rode the trainer. A lot. Like 15 hours a week of swimming and riding the trainer each week. I've never put in so much time to going absolutely nowhere than I did in the month of June. I even brought the trainer to the beach. I am so very grateful I could at least swim and bike. I really don't know what I would have done otherwise. 

I guess completely lost my mind rather than only half of it? 

And I want to say that I probably would have been more accepting of my injury if the cause of it had been  from a legitimate trauma or anything other than just sitting on my ass.

The PT told me that when I was able to dorsiflex my foot 60-70% I could start trying to run on the track, provided I kept it short and I wore my stability shoes. By the last week of June, about 4 weeks after I injured it, I was finally able to run a bit. I ran every other day up to 4 miles. After a week I was able to run 6 miles on hills. 

It is weird but once the nerve started to come back it came back pretty fast. The first two weeks were definitely the worst and it felt like I wasn't making any improvement.  I don't know if it was running that helped it along or just all the other stuff I was doing but by July 4th--about 5 and half weeks after the initial injury-- I was able to run the Peachtree Road Race and run the course back. 

In retrospect, it probably wasn't the wisest move ever but it didn't prove a set back at all. The main concern with running before the ankle was 100% was a compensation injury or another ankle sprain because of altered stride and unstableness, but luckily for me that wasn't the case. 

Steph and I ran 48 flat for the race and then we beer mile-ed it back to the start with her husband Doug. I love those guys! We always have the best time at races and Steph was so nice to run with me even though we missed qualifying for time group A again by one measly second and it was completely my fault. I totally owe her.

I still didn't have 100% dorsiflexion back until probably the end of July. By mid August all the numbness was gone but I still have some strange nerve sensations--burning or alternately cold spots --and sometimes the ankle just feels tired or like it might not work, but it does. I can't tell if that part is all in my head or not. I constantly find myself flexing my right foot to make sure I still can.

The good news is in the past month I've been back running 60-75 miles a week. Nothing fast and certainly nothing fabulous but I am so, so grateful to be back out there running miles around the town on my sidewalk. The bad news is that all those speed gains I made last year?
And the weight that I lost?
Yeah, some of it has come back.
How much?
I don't know. I've been a bit afraid to get on the scale or even try my dress on.
But really, I don't care.
They are just vanity pounds.
Vanity paces too.

You know.
It really is unfortunate how I always need real life, literal metaphors-- like dropping my foot-- to make me realize what is important, where my head should be. Other people get to say stuff like, "and then the other shoe dropped."
They even get to use air quotes when they say it.

I get to say, "and then I dropped my foot."
And really mean it.
And then, I have drag that foot around; hobbled, humbled, tripping over hurdles and punished for my hubris.
And honestly, I really can never feel too sorry for myself because it really is all so ridiculous.

So yeah, I get knocked down.
But I get up again.
And I just keep on running.

1 comment:

  1. Nat,
    I don't even know you but I was already really missing your posts, specially all your race reports. I thought for a while that you had stopped blogging. Congratulations on coming back (both running and blogging! I will run my third marathon in a month and I just completed my first sprint tri last weekend. Again thank you for your blogs!