It's time for the weekly Cankle Update.
The orthopedic surgeon read my MRI today. It was basically an ankle physiology lesson. He said the reason none of the other docs could diagnose it, is there's so much stuff goin' on, that there's no one diagnosis.
For starters, we got some bone-on-bone violence, the osteological version of fratricide.
Then we got the tendons and cartilage in the ankle. Roll tape: "Hmmm... looks like your tendons are mostly torn or partially torn... not a lot of cartilage in there holding them together... basically your muscles have adapted pretty well and that's what holds your ankles together, because your tendons and cartilage sure aren't doing it. At the end of races, or a long day of standing, what's happening is your muscles start to give out and that's when the ankle gets really irritated." I asked if running a half mile or 1200 yards carrying a bike cross country in stiff soled bike shoes would do it, and he said that sounded about right. The way they test to confirm this hypothesis is to "simulate end of event stress conditions." Yep, I asked. They knock your ass out with some drugs, and then "put you in stress positions until failure. You have to be anaesthetized for that because you probably wouldn't be able to put up with this if you're awake." Okay, now I understand why just about all the rugby players I've ever known who have gone into medicine (and there are many) have gone into orthopedic surgery - basically the whole field is the medical equivalent of a blind side, late hit tackle. It's borderline sadistic, except without the borderline part. We continue.
Then there's the tendons themselves - even though they don't do a lot of work, what with being rootless, torn, unemployed and sort of wandering around the joint like a homeless meth addict, this doesn't stop them from indulging in a raging case of tendinitis from time to time. No cartilage, no peace. What happens then is that the tendon sheath fills up with fluid, starting with the outside tendon then spreading to the inside tendon (since the whole ankle destabilizes, putting greater stress on everything else, kinda like when your shop is understaffed and somebody leaves for a better job). The pain then radiates down into the foot, since the tendons run from all the way up the Chocula and the Dracula, or whatever those leg bones are, all the way down the foot to the toe-sicles. This is why the pain radiates down the foot. It's not gout! Got that, Podiatrist? Yay - back onto the oatmeal!!!! I am so f***ing psyched about that! I know that's sad but having only recently discovered that good tasting food can be really good for you I wasn't happy about the anti-gout guidance. Chocolate my ass.
Then we got the scar tissue. Apparently, there's more scar tissue in my ankle joint, then there is on all of Mike Tyson's ex-wives combined. The scar tissue explains why the Cankle occasionally locks up, gets a stabbing pain front and center in the joint, followed by an enormously violent pop, and "ghost pain" for a couple days afterward, sort of an echo of the ache. Imagine sticking your hand in the hinge of your car door then trying to shut the door - that's basically what happens with the joint, except with the scar tissue playing the role of "Painful Hand" in that production.
There is also a bunch of arthritis going on too, but according to the Doc, "the pain from that, while normally significant, probably doesn't even register given everything else that's going on."
The upshot is that my ankles are the equivalent of a Third World government - corrupt, mostly useless, held together by good wishes and bad operators, but functioning surprisingly efficiently even for all that. The Doc figured they've functioned so badly for so long, that my muscles have adapted to it; and they've hurt so bad for so long, that I've sort of gotten used to that too. I feel like an abused spouse, to tell you the truth, but I'm not sure what to do. There's no shelters for ankle-less dudes, and no counseling or victim support centers either. So I guess I'm stuck with them.
Total Suckulence: It's The New Normal.
Treatment is sort of the question now that we know what's wrong - i.e. everything except the bone structure and cartilage between the bones.
For now the treatment will be to do some ankle exercises to continue to strengthen the muscles, my poor, longsuffering muscles, and to wear some ankle braces while running or racing cross. This should minimize the strain on the stabilizing muscles and let them hold up longer.
Longer term, when the cankle flares up - either cankle, because they are both bad - I'll start a course of cortisone shots to take down the scar tissue and reduce the immediate tendinitis/swelling.
Longer longer term, I'll probably need to get both ankles cut on to reattach tendons to bone, scrape out remaining scar tissue and generally tighten the damn things up.
On the positive side of the coin, the joint itself is in really surprisingly good health - apparently the muscle-y calves are doing a remarkably good job of stabilizing the Cankle most of the time. So at least I got that going for me, which is nice.
Hopefully, this is the last Cankle update for a long time. Somehow I fear they'll be protesting by March, as it comes with every change of the season, and I'll be reporting back on how it sucks to be on crutches again, and how nice it is to have controlled substances jammed into my joint at the end of an enormous needle.
That should be some fun stuff to blog about. Man, I can't wait. How 'bout you?