Friday January 7, 2011

Foot Arthritis: The Specialist's Verdict

This morning I had an appointment with Dr George Dracopoulos who is an Orthopaedic Surgeon for Orthopaedics SA. He was recommended to me by my physio and independently by a friend who has been treated by him.


Background on foot condition:

  • Pain started in left ankle August 2010. Increased pain over a couple of months running
  • Saw GP in October who recommended time off running initially
  • Consulted with my physio who also recommended taking time off to alleviate pain before commencing with treatment/management
  • After about a month off running, still presenting with the same pain. Ordered a bone scan. Results came back as arthritis
  • Followed up with an x-ray, which confirmed arthritis and showed up small bone spur(s?)
  • GP recommended to quit running altogether. Physio suggested we explore other options and recommended a specialist
  • Got a referral to a specialist to see what my options are and booked an appointment (with a bit of a wait to see him)
  • While waiting for appointment to come around have been seeing physio regularly to manage pain and try out orthotic support and a few other techniques
  • After 10 weeks of not running and only 3 weeks until the specialist appointment we introduced some short run/wallks back into my routine to see how my foot coped.
    • I got up to 200m jog/100m walk over ~4km distances. If I did this on flat, paved surfaces I could sometimes get away with minimal pain. Off-road/inclines triggered pain and would typically hang around for a couple of days afterwards. Experimented with ice baths/massage/strengthening exercises/supplements to minimise pain
  • Big day finally rolls around and I get to talk to the specialist!


Specialist Verdict:

Upon looking at my bone scans and x-rays he said that unfortunately there is no fix for this. I have arthritis in my ankle and small bone spurs. If the bone spurs were larger he could surgically remove them, however because they are small, he did not believe there would be any benefit in operating and the scars that would leave could cause further issues. 

He advised hanging up the running shoes and finding a new sport. If I ignore this, the consequences are likely having to have my foot fused as a 40 year old (I am 30 now). 

He gave me three options:

  1. accept that my body is not up to it and give up running
  2. keep running and deal with the consequences later
  3. surgery (but that he didn't believe it would actually achieve anything and scarring could have negative effect)

 

From here:

I asked if I was an elite athlete what they would do, and he said (to paraphrase) if I was being paid big money to run then I might decide that the short term financial gains are good enough to sacrifice my long term mobility and continue on with it. That's the sacrifice that some athletes make, so I need to weigh up what it's worth to me.

I explained to him that I've recently dropped to a 4-day working week to pursue some big sports goals (looking at doing an Ironman, which involves a 42km run) and asked what might happen if I decided to spend the next 6 months/year training for that and then hanging up the running shoes for good after I've completed it. He said it will have a detrimental effect, but obviously doing 1 Ironman is better than doing 10 Ironman events, so if that's what I need to do to get it out of my system, that's my choice to make. I would need to consider pain management to get through the training, and know that it's speeding up the degeneration of my ankle. 

So... I have some big decisions to make. 

At this stage I am still finding it very difficult to come to terms with not running again and also giving up my dream of completing an Ironman triathlon, so I am considering going ahead with that and then saying goodbye to my running lifestyle. I would be doing so knowing it's not good for my foot though, so I'm going to give it some time and think on it. 

What would you do?

 

Related articles:

25 Oct 2010: A Short Break from Running (previously posted article)
24 Nov 2010: Foot Injury Diagnosis (previously posted article)
26 Nov 2010: A Second Opinion (previously posted article)
09 Dec 2010: Trial Run (previously posted article)

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Comments on this article:
Submitted by andy - June 24, 2011
HI
IM 45 YEARS OLD AND HAVE BEEN RUNNING FOR 30 YEARS HAVE DONE ULTRA RACES MARATHONS MOUNTAIN RACES RUNNING HAS BEEN A PART OF ME FOR SO LONG AND AFTER SEEING SPORTS DOCTOR ABOUT ANKLE PAIN AN X RAY WAS TAKEN THAT SHOWED AN ARTHRITIC SPUR AND EARLY ANKLE ARTHRITIS.I NOW HAVE PAIN IN ANOTHER PART OF MY ANKLE SO SEEING HIM AGAIN NEXT WEEK AND FIND OUT FOR SURE WEATHER THIS IS THE END OF RUNNING OR FACE ANKLE FUSION IN A FEW YEARS TIME.
Submitted by rundave - February 1, 2011
Hi Nina. Just stumbled on your blog through the SARRC twitter account. I'm an Adelaide runner and have probably seen you around a few of the events. I reckon you should get a second opinion. I would also question whether surgery should be ruled out. If you are 30 now and have at least 40-60 years life ahead of you, then your ankle is going to be stuffed long before then and you'll need surgery anyway. I wouldn't want to be approaching old age with reduced mobility and the prospect of major orthopaedic surgery. Better to get it done now when your chances of recovery are better and as an added bonus, you might just be able to do the IM. That's just my contrary opinion.
Submitted by Emily Stevenson - January 8, 2011
I reckon do the ironman and go out with a bang, who knows what could happen in the next ten years anyway. My running was going alright, I have been running up to 40 mins, however yesterday I did get some leg/ shin swelling which is concerning...off to get my foot casts next week.
Submitted by Ben - January 7, 2011
Thirded here. While it sucks giving up running when you're really getting into it, it'd suck more to not be able to walk properly for 40 years. And as Steve points out, there are lots of avenues to explore the competitive sports that aren't going to ruin your ankle.

Still, tough thing to be facing up to. Sucks.

- Ben
Submitted by Dan - January 7, 2011
What a decision to make...

I agree with Steve. If I were in your position I'd be inclined to focus on the other things I might want to do down the track which could be impacted by doing Ironman, no matter how much I want to run now. (As much as it sucks...)

I'm curious to know if there were any discussions with the specialist about the impact on day-to-day walking and other activities if you were to still do Ironman? These day-to-day aspects may be another factor to consider with your decision.

Keep us updated with your decision! I'm sure there are lots of people who will support you, no matter which path you take.
Submitted by Steve - January 7, 2011
You are 30, current life expectancy is what, around 85! Goals have to move to accomadate problems in life, we are forced to accept these all the time. You have cycling and swimming to focus your competative nature on of which both will be kinder to your ankle.
It is always hard to change ones targets as within ourselves we percieve it as a failure, this is not true its just what we all feel! If you persue this now then you will be hindering yourself in any endeviour you follow in later years to keep fit and we all know its going to be harder then than now.
So, think of life as a triathalon and keep something for the end!
I would stop running now if I were you but once again it is always your views and opinions that matter, you have to make that choice, no one else can make it for you!