Finally, a diagnosis

I finally had my appointment with the foot & ankle orthopedic surgeon (Dr. Timothy Beals) today. I am SO glad that I went to see him. I had to wait an hour because he tends to run very late (he likes to talk, and is very thorough) but it was more than worth the wait. First I saw his PA, who was excellent as well. She examined me and asked a lot of good questions. It was her impression that the achy pain in my foot (on the bottom, proximal to the big toe joint) might be a separate injury from my sesamoiditis. Interesting...I thought it was part of the sesamoiditis, since I first felt in the day or 2 before the sesamoiditis started.

When the doctor came in the room, he examined my foot quite thoroughly. I carefully explained to him where the achy pain was located, and after he located the area with pressure (ouch! but in a "hurts so good" kind of way - it actually feels kind of good to massage it a little), he had me move my foot with pressure in the area and asked if that hurt more. When I said yes, he was smiling with an "Aha!" kind of smile. He then looked at my MRIs again, and then he was sure he'd found the answer. The PA was right. I have two injuries.

This is actually GOOD news, because the sesamoiditis is not causing me pain any more. In fact, it's Dr. Beals' opinion that the sesamoiditis is healed. When he examined the sesamoids and applied pressure, it was not very tender, and they have not been causing me any pain. But what of the MRI showing inflammation there? He said that that is misleading - the MRI will continue to show inflammation for at least a year, he said, even if everything is feeling much better and is in fact OK.

So, what is the achy pain in my foot? Turns out that I have a very unusual condition - and when the foot/ankle guy tells you it's unusual, you know it's unusual since they see all kinds of zebras. I have insertional tendonitis of my peroneus longus tendon, confirmed by the physical exam as well as the MRI. The peroneus longus runs from the lateral side of the ankle, under the cuboid bone, across the bottom of the foot, and attaches at the first metatarsal. Where it attaches at the first metatarsal is where the inflammation is in my foot. The doc said this injury typically happens only to ultrarunners (or ultraracewalkers!) and basketball players.

Prognosis? Treatment? Well, it turns out that the prognosis is very good. The doc said he'd rather have this than sesamoiditis, and it's very good that the sesamoiditis is healed. He says that with my orthotics (he said either pair will be fine; orthopedic types generally prefer the softer orthotics I got at first, but I actually prefer the ones the podiatrist made) and some physical therapy and anti-inflammatories that I should be able to continue my recovery. I can keep gradually and carefully increasing my mileage and not worry about the achy pain I've been having. He said that should gradually improve with time, and I'm not at risk of further serious injury. Of course, if the pain increases despite PT and the meds, then I should see him again, but he doubts that will happen.

This all really makes great sense to me that the achy pain is a different injury than the sesamoiditis. It doesn't FEEL the same, and the main reason I connected the two is that the injuries happened at a similar time. But it all adds up - the exam, the MRI, and the history all point to this diagnosis. What a relief to know better what is going on!

Wow! I'm SO excited about this! I feel like a huge weight is off of my shoulders. I was really worried about racewalking with that on and off achy pain, and now I can relax and enjoy my comeback. I feel so much better!!!