As previously posted, the initial diagnosis of my ankle/foot injury made with MRI imaging was a Ruptured Peroneus Longus Tendon and surgery was scheduled for this Monday...  However, there have been further developments...

At a preop (pre surgery) appointment 10 days ago the doctor felt that my strength and range of motion was not indicative of the complete rupture that was diagnosed via MRI.  He ordered an ultra sound study to confirm the initial diagnosis.  3 days later that study was changed to a ct scan with the assistance of contrasting dye.

The cat scan study was performed by injecting contrasting dye via a needle into the sleeve around the peroneus longus tendon.  Other than a small pin prick it was painless and the entire study took less than 1 hour.

On Thursday at a followup / preop I was given the good news.  I have 3 near complete partial tears at 3 different points along the peroneus longus but not a complete rupture.  The surgery was cancelled (for now) to give the conservative rest treatment a chance to heal the tendon. 

Since the tendon is in approximation (ie it is attached or very nearly attached) the body is capable of filling in the gaps with scar tissue.  My new marching orders are fairly similar to my previous marching orders -- RICE.  Rest, ice, compression, and elevation.  Any walking I do is to be done in a walking boot.

On the personal side, every day the ankle/foot has been feeling a little better... It is still a achy and if I overdue it one day I can tell immediately.  Luckily I work with computers and sitting in front of my computer with my foot extended does not inflame the injury.  This morning I am off to try swimming.  I won't be kicking and my biggest concern is actually getting into and out of the pool carefully.  If this goes well I will be exercising extensively via swimming, knee pushups, and upper body weight lifting.

I would like to thank Lawrence M. Oloff, DPM of SOAR - Sport Orthopedic and Rehabilitation for his diligent and careful evaluation of my injury.  I am glad to not be having surgery and even more glad to be in a weight bearing recovery.  I was not looking forward to the prospect of 2 months on crutches.

The picture shows normal peroneal tendons on an unknown person. This is not am image of my foot.

Originally posted 2008-06-21 06:06:09. Republished by Old Post Promoter

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So as I mentioned in my weigh in post, on Tuesday I was playing volleyball at the local community center....

It was a 3 on 3 game and we were receiving.   My teammate passed the ball to the setter and I was backing up to position for the approach for the spike (licking my chops too I might add as the pass was perfect)… When I changed directions to start my approach (not even a very athletic move) there was loud pop and I thought who just throw a rock at the ground at my foot (the pop was so loud I assumed it originated behind me as I approached the net.)   In addition to the sound, there was a minor tingle on the outside of my ankle heading towards the front of the foot and a split second later I immediately knew something was very wrong...  Nothing like any athletic injury I had ever had before. (Believe me, I have had more than my fair share of sprained ankles and the like.) (This is ~1:30pm pst.)

In that split second when I realized it was not a normal problem I chose to simply catch the volleyball instead of jumping and spiking it...  The bizarre part is that I was not experiencing acute pain...  I immediately started RICE (rest, ice, compression, and elevation), a routine I know well from past injuries...

I called 3 orthopedic doctors to attempt to get in to see one asap...  I also called a trusted physical therapist that had been used by family in the past... Trudi at Functional Rehabilitation and Sport Therapy (FRST) agreed to see me at 6pm.  While waiting to see Trudi, I was contemplating going to the ER (6 hour wait when I called to check), one the doctor's called back and had an opening for 2 weeks from then (I told them were to fly their kite)...  Then at 5:oopm just prior to leaving to go to FRST, I got a call from SOAR - Sport Orthopedic and Rehabilitation - which happens to also be the medical provider for the San Francisco 49ers.  They had an opening at 8:10am the next day...

I saw Trudi, she immediately knew the same thing I did, which is that this was not a minor injury such as a sprain.  She also, concluded that it was not the Achilles tendon (a good thing I guess.)  Most doctor's might disagree, but in my book athletic trainers see more injuries immediately after they happen than doctors.  I would trust the initial unassisted first opinion of a sports therapist as much as a doctors initial unassisted opinion. After documentation (XRay, MRI, etc.) quality of the opinion is obviously not the same comparison, but initially they are usually spot on.  Trudy and her staff were awesome...  They went above and beyond...  In addition to an informed opinion of my injury I also got a whirlpool session, ice, electro stimulation, ultra sound, and a massage.  AND SHE WOULD NOT TAKE PAYMENT for the visit...  (She probably knew what was coming... but what an incredible gesture.)

As it turns out, my doctor at SOAR, Lawrence M. Oloff, DPM, is the absolute best foot and ankle orthopedic in the Bay area and he is used to large individuals (49ers)...  I arrived for my 8:10am; was seen quickly; and immediately given an xray.  The X-Ray was negative and an MRI on the ankle was scheduled.  I was also fitted for a walking boot (putting weight on my ankle caused my only real pain at this point.) The MRI on the ankle saw a tendon that was thinning (Peroneus Longus) but the end of the tendon was not in the picture so another MRI of the mid foot was scheduled for the following day. 

48 hours after the initial injury my foot was still not swollen and I still had most of my strength and mobility, but the pain was significantly higher.  I asked for pain medication after the second MRI and was prescribed generic Darvocet-N 100 with 650 mg of APAP.  Ahh... relief.

Dr. Oloff called at 6pm Thursday with the news...  Complete rupture of the peroneus longus tendon...  Rupturing the peroneous longus is highly unusual, but even more than that... Rupturing the peroneus longous in the location I did (where the tendon attaches to the foot) is virtually unheard of.  The doctor (THE specialist in the Bay area) had only ever seen one other case and it was in a 49er.  Here is a rendering of the peroneus longus to give an idea of the location of the tendon.

Basically, the peroneus longus is a muscle that starts at the top of the fibula and turns into a tendon near the ankle.  If curls around the outside of the ankle and occupies the same fiber channel as the peroneus brevis.  It is responsible for helping to move your foot out and up.

So what next?  Dr Oloff is going to surgically repair the tendon...  It is an intricate procedure with a long recovery...  After surgery I am in a cast and completely non weight bearing for 2 months.  After that in a walking boot and partial weight bearing.  After that he expects a minimum 6 month rehab to return to normal... If, after the surgery the tendon becomes detached or scar tissue develops a 2nd surgery will be required to tie the peroneus longus to the peroneus brevis and a crazy long rehab will be required. Yowzars...

So where does that leave me...  Needing to find a way to exercise without putting weight on one of my legs.  The crutches themselves will be good exercise and Trudi has an arm bicycle and I can lift upper body weights...  But outside of that I am not sure I have very many options... Any ideas?

Regardless I am sticking to my diet and trying to lose more weight... The less I weigh the easier getting around on the crutches will be.  This is yet another reason why I should have lost weight months if not years ago.

I will continue my regularly scheduled programming and I will also continue to inject progress reports...  These progress reports are sure to be a little more exciting that simply the fact that I lost 7 pounds in a week (or 0.6 as the case may be.)

To end on a positive note, with this injury being so rare... my care and recovery will almost certainly be turned into a medical case study.  I will at least get the pleasure of knowing that future orthopedics will study my case and may even be tested on it... 

Originally posted 2008-06-06 13:50:09. Republished by Old Post Promoter

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• Torn Peroneus Longus Tendon As previously posted, the initial diagnosis of my ankle/foot injury made with MRI imaging was a Ruptured Peroneus Longus Tendon and surgery was scheduled for this Monday...  However, there have been further developments... At a preop (pre surgery) appointment 10 days ago the doctor felt that my strength and range of motion......
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So I am very pleased with my weight loss this week...  With my ruptured tendon I was unable to exercise much, but I still managed 1.8 pounds of weight loss...  In addition to my ankle, I was finding myself stress eating (the injury and the prospect of surgery was stressing me out), but I was able to limit my cheating to protein witch I think helped continue my weight loss...  I am a stress eater and I need to confront this head on if I am going to fix my eating habits permanently. 

Here is a graph of my weight loss (if you are reading this in the future this graph will have updated for future weigh ins as well)... Clicking the image will open to a larger image.

As for exercise...  I didn't get much... I went to the FRST and did a little exercise including the arm bicycle... twice...  I need to go more.  Next week 3 times... I swear.

I was told not to get my hopes up, but I may not need surgery... Surgery is currently scheduled for a week from Monday...  At the preop the doctor thought that I had excellent strength and range of motion in the ankle...  He is scheduling an ultrasound study and a follow up prior to confirming surgery...  Here's hoping.

I am also going to partake in the Get Fit Slowly 100 pushup challenge: following this 6 week program...  With my ankle I will have to do knee pushup, but it would still be pretty amazing to be able to do 100 knee pushups consecutively.  That starts Monday...

I set next weeks goal at 5 pounds, but I think it will be a stiff challenge to meet given my lack of ability to exercise normally.  Until next week...  Stay sexy fit blogosphere.

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