A diagnosis at last?

Since the invention of the internet, being a doctor, physio or any other member of the medical profession must be very annoying. A stream of people at your door all knowing what's wrong with them because they read a wiki article or saw a youtube clip of a similar problem and therefore they know exactly what's wrong and what the suitable medication or treatment must be. Forget the 5 year's worth of training and experience; just google it and hey presto you've got the answer. I hate those people; the problem is, I am one of those people. Being a MAMIL with a body that is spending more time failing than working, recently I have spent a disproportionate amount of my time typing in search words to get to the bottom of an injury. I have usually been wrong. I think however, that after the best part of 3 years or so suffering with this foot injury on and off I genuinely think I have got to the bottom of it.

The red herring has been plantar fascitis. After I had been suffering these attacks for a few years without any particular trigger I was finally diagnosed by a GP with PF and  I had my orthotics made up. The problem was that the GP did not see the swelling that my foot had when I would get this coming on. By the time I was having my foot prodded it was back to normal and she looked at my high arches and simply assumed it was PF. So, PF it is. Orthotics made, carry on, treat the symptoms, be acreful and it'll go away. But of course, it never did.

This time it was different because when I went to see her my foot was like a balloon, badly swollen red and hot. As I stated in the last post she mentioned tendonitis, so that evening I decided to investigate this further and so the google search of 'tendonitis AND foot' was plugged into the laptop. Within 30 seconds I think I finally found the answer to my injury.

The peroneal tendon runs down the outside of the leg, underneath the ankle bone and then splits into two becoming the peroneus longus and the peroneus brevis. The peroneus brevis attaches to the outer part of the midfoot at the fifth metatarsal. This is EXACTLY where the hotspot of my pain is before the swelling starts in full earnest and when the swelling goes down. I cannot walk on the outside of my foot and pronate properly because the discomfort from there is so intense. If I move my foot to the side, which is part of the peroneal tendon's job I can feel tightness around my ankle bone which is EXACTLY along the line of the peroneal tendon.The other quite intriguing fact is that whenever I have iced my foot I have invariably rubbed the pack EXACTLY along the line of the peroneal tendons.

Here's a quote describing peroneal tendonitis;

Patients with peroneal tendonitis present with pain and, occasionally, swelling in the outside and back (posterolateral) part of the ankle (Figure 1). This tends to be a chronic condition, so there is often no precipitating event. However, sometimes patients will report an activity that aggravated their symptoms. Essentially, the tendons are repetitively overloaded and the subsequent inflammatory response (attempt at healing) creates pain and discomfort. This inflammatory response is the reason why patients with peroneal tendonitis will often have startup pain and pain first thing in the morning.

Patients with peroneal tendonitis will often walk with a limp. Looking at the outside of the ankle, there will may be some subtle (or not so subtle) swelling behind the lateral malleolus [the prominent bone on the outside of the ankle]. Pressing on this area will often create discomfort. Many patients will have a higher arch foot (subtle cavus foot) with increased ankle inversion compared to eversion.

This is EXACTLY what I have been suffering. OK, I don't have a medical degree and I am far too stupid to ever study for one but I feel 99% certain that this is the problem. There are far too many similarities, in particular the hot spot of pain where the peroneus brevis attaches for it to be anything else. That said, I'll still have the blood test for gout and wait for the x-ray results to come, but I'll be extremely surprised if either of those come back with anything.

So what now? Well, I'm going to stick with the 8 weeks off. This has been recurring very regularly and I feel there's a good chance that I have seriously knackered this tendon; the swelling has simply been too pronounced for it to be a light injury. The usual RICE protocol will be used but once the swelling has gone down I will also work on my ankle flexibility which should help alleviate some of the stress on this tendon. It looks like I might be visiting Amazon for a wobble board. I am concerned that I might have just done too much damage to ever be able to get back to running properly again; only time will tell on that one but I'm just glad that I think I've finally found the answer.