Running into the Twilight

As I ran slowly uphill, I watched the safety lights of my running group flicker and disappear in the distance. I was participating in an informal, pre-thanksgiving day tradition organized by a friend. Each year, a group of runners meet at a local farmers market the day before the holiday and set out on a hilly, dark 8 mile-ish run near Wayne, PA. Post-run, we grab some coffee and some goodies from the market and catch up with old friends. The last time I participated I was at the head of the pack holding a steady 7:30 pace but now I found myself unable to keep up with the mostly younger, healthier crowd.

I watched as the other runners disappeared into the pre-dawn darkness.

My right ankle and foot throbbed as I jogged into the darkness hoping to see the sign for Lancaster Avenue. I didn’t know the course well enough to navigate the entire thing but I knew how to get back to the market once I hit the main road. As the last of the lights disappeared, I heard the traffic and saw the signs for route 30.

The annual farmer’s market run was a humbling experience this year.

I’d been living in denial for a fair amount of time even before we set out from the parking lot that pre-Thanksgiving morning. My right foot that nearly made me quit running three years ago, had been dormant and pain free until sometime late this past summer. Then the old ache caused by post tibial tendon dysfunction returned. I ignored it and ran on. Slowly but surely as I compensated for the pain in my foot, my ankle and calf became sore. The effects could be felt during and after a run. There were a couple days when only a strong dose of ibuprofen made walking tolerable. Finally, I gave up and made an appointment with Dr. Le at Dr. Lee S. Cohen Associates in Ridley Park. These people have kept me running since 2017 when everyone else said “Don’t run anymore”.

I agree with Calvin

Fast forward a few days and the one hour drive down the Blue Route and I-95 to Ridley Park. I found myself in an exam room with Dr. Le who quickly identified that my latest set of orthotics was letting my right foot pronate way inward, a condition it was supposed to be designed to help stop. She added a layer of material to correct the situation. I optimistically headed for home with my modified orthotic and hoped that this simple fix would be enough. But I think the damage had already been done. I stubbornly continued to run thinking things would improve with the repaired orthotics but (not surprisingly) my foot didn’t really feel better. I was not running long distances or even very fast. In fact, I’ve seriously considered downgrading myself from “runner” to “casual jogger” anytime I review my Stava data. Still, the constant ache in my foot and ankle couldn’t be ignored.

Mercifully, the Pennsylvania rifle deer season rolled around. This starts immediately after Thanksgiving and myself and a bunch of friends convene at my buddy Joe’s Pocono house for a full week to enjoy the woods and each other’s company. Typically, I take some running gear along and get in at least a few miles now and then on the Lehigh Valley rail trail that runs from Lehighton all the way to White Haven. It’s a beautiful trail and I look forward to some miles on it. But I decided this year, as the pain in my foot reached a crescendo, that I would forego running and give things a chance to heal. Of course, there would be miles of walking in the woods but at least I wouldn’t be pounding my fallen right arch into the ground with additional running miles.

My week in deer camp is nearly my most favorite time of the year. My memories with some of these friends go back almost 30 years and 3 different deer camps. We’ve lost many or the original crew but gained some new ones. In addition to hunting, it is a time to catch up with great friends, enjoy each other’s company, eat, drink, and be merry. For many of us old Pennsylvania hunters, we secretly look at time in deer camp as our true holidays. This year was no exception and, in fact, a little better since camp was limited last year due to the COVID-19 pandemic. (Google it if you haven’t heard of it.) All that aside, throughout the week, each excursion into the woods for me was marked with some pretty serious ankle pain. Happily, it wasn’t constant, and I wore at least one brace each time out but any time I stepped on a rock, log, or slight slope and my ankle moved outward I felt like was going to fall. The pain was pretty bad. The state of denial came crashing down and I decided I’d better take more serious action.

Common post tibial tendon pain

My conversations with Dr. Le had always been very optimistic. She and the other staff at Dr. Cohen’s office always provided a positive message about my running future. If the orthotics stopped helping, there were other things we could do. But I had my doubts. Having absorbed a lot of articles about post tibial tendon dysfunction I knew that, at some point, it may be a wise choice to consider ceasing and desisting when it came to running. The surgery performed when the tendon goes altogether does not sound like a good time. I’ll never discount Dr. Le’s advice or help, but as of 2022, my health coverage changes and Dr. Le is no longer in network for me. Also, Ridley Park is a solid hour’s drive away and at the new reality of $4.00/gallon for gas, it was time to look for someone closer.

What PTTD surgery looks like

A quick consultation with the local running crew pointed me toward Berkshire Podiatry. It seems nearly all my trusted local sources had used them at one time or another. I perused the “About Us” pages and discovered that several of the doctors were experienced runners. This is what I wanted. I knew a runner would understand and only tell me to stop running if I should really stop running. I called Berkshire Podiatry the Monday after I returned from hunting camp. Happily, I was able to get a pretty quick appointment with Dr. Kerry Casey who is an experienced runner and athlete. I was confident she would steer me in the right direction. Within hours of hanging up from the call, repairman syndrome kicked in and my right ankle pain began disappearing. Still, I knew it would return without further action and other parts of my foot still ached.

Dr. Kerry Casey

Dr. Casey performed a physical examination of my foot and we had an extensive conversation about the history of the injury, the chronic condition of my long right leg, and where exactly it hurt now. She showed me a model of the foot and explained several likely issues and then sent me for X-Rays. As we all know, X-rays are really of limited use these days but for some reason insurance still insists on them prior to using real, effective diagnostic tools like MRI or Ultrasound.

I often think if we could package up the diagnostic equipment we have now, jump in our DeLorean time machine and set the flux capacitor to go back 50 years, what would a clinician of the day think? These were my thoughts as the technician quickly captured digital X-rays of my foot checking each one like a fancy Polaroid as we went. I was sent back to the exam room to wait for Dr. Casey to check out the pictures and come back to talk.

Those doctors from 50 years ago would see some serious . . . stuff.

Not surprisingly, when she returned, Dr. Casey didn’t gather a huge amount of insight from the X-rays and suggested an MRI. She also gave me some stretches to add to my extensive stretching routine. Okay I don’t really stretch. I know. I’m a bad, bad person. She also gave me a prescription for physical therapy pending MRI results. The PT may or may not be advisable depending on what the MRI shows but she wanted me to have it in the event she recommends it. Dr. Casey did not beat around the bush. She made it very clear that I am in an advanced stage of post tibial tendon dysfunction. (There are 4 stages and I don’t remember which stage she said I was likely in but I assume it was at least 3.) She very transparently stated that we may have to consider that I do need to stop running.

When I can’t run anymore . .

The last time I was told this, it was out of the blue and earth shattering but this time I guess I’ve had time to realize that, sooner or later, that day would probably arrive. And we aren’t there yet necessarily. I enjoyed a nice nap while the MRI machine hummed and rattled yesterday morning, and am now just waiting for the call from Dr. Casey with results. It is right before Christmas and I doubt I’ll hear from her until after the New Year but one never knows. To a degree, I may be okay with a pronouncement that I should be done running. Don’t get me wrong. I love running and I adore my running friends. From a physical perspective, I don’t know how I would replace the fitness and calorie-burn I get from running. There is cycling and swimming, but running is much more portable allowing me to run when we travel, or in the cold. (I’m a big sissy when it comes to riding my bike in the cold.) Still, before COVID curtailed racing and group runs, my easy runs were a tad over 8 minute miles and I could still crank out a 5K close to the 20 minute mark. Between the recent foot issues, running more or less alone for the last 2 years, and having no real upcoming race goals, my paces have slowed by well over a minute. Maybe that has as much to do with the fact that I am closer to 60 years old than 50, but it feels more like motivation than anything. I’ve tried to jump start my training several times to improve speed and get back to some form of racing shape, but seem to have lost the desire to push myself really hard.

Does that mean I’ll be happy if Dr. Casey says “No more running”? Certainly not. I’ll be quite sad. Running has been a big part of my life for the last 12 years and I’m not really looking forward to the “battle of the bulge” that will ensuee unless I switch to a diet of sawdust and water. (Spare me the weight lifting bit. I do my best to try but find it as exciting as watching evolution in action.) But I’ll adapt. And perhaps I’m drawing the curtain on my running days too soon. I’ll have to patiently wait for the doctor to call and see what she says.

Commence waiting patiently . . .

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