Chondromalacia

I had my post-surgical appointment with the orthopaedist today and everything is in order. He showed me the images from inside my knee of the problem and the repair job that was done. Basically the cartilage under the patella or kneecap was damaged- the image showed it looking as if it had been shredded! Chondromalacia is the term usually used to describe damage to the cartilage under the patella and it generally affects young people who engage in physical activity. I have to do physical therapy twice a week for eight weeks which should help me regain full mobility in my knee. At the moment it is quite tight and I cannot bend or stretch it out fully. I also have some pain that varies between mild discomfort and bad and which he said would take time to go away, with some days being bad and some being good! I have had a few rough nights already and I hope that is the worse it gets. He said I could go back to work next Monday, the same day I see the podiatrist and once he gives me the all clear, I will be back to work on July 23rd.

It has been six months now that I have been home! I honestly never thought I would have been away from work for so long when the MRI results in January showed a torn tendon in my foot! I am thankful to Allah that the problems with my foot and knee were diagnosed and that unlike millions of people around the globe, including right here in the richest country in the world, I have been able to receive treatment. The next step is to work on strengthening the different tendons and muscles in and around my foot and knee while avoiding over exertion. It will probably still be a while though before I can go back to the gym and resume my training programme.

Arthroscopy of the Knee

While everything has largely been going well with my foot recovery process, the pain in my knee has not decreased and has worsened as I put more weight on the foot and do more exercises at therapy. It reached a stage where it was difficult to fall asleep at night and so I took a trip to the orthopaedist on Monday. He did x-rays and neither those nor the MRI from January explain why the pain is so severe. He now wants to perform an arthroscopy of my knee to enable him to diagnose and treat the problem. For those who don’t know (and I didn’t either until he told me) it’s a minimally invasive surgery that allows the surgeon to diagnose and treat problems without open knee surgery- a few small incisions are made through which an arthroscope (pen shaped instrument which has a tiny video camera and light source attached) is inserted, allowing the surgeon to view inside the joint and if necessary operate using small instruments inserted through tiny separate incisions. As arthroscopy only requires a few small incisions, there is usually no need to stay in the hospital more than a few hours after surgery, the healing and recovery process is much quicker and there is not much scarring. Most patients are able to return to work within a week and once all the post surgery recovery exercises and steps are done, full recovery is expected.

This all sounds rather straightforward but it is a surgical procedure, something which I am not exactly enthusiastic about! I was relieved that the tendons in my foot healed without surgery but now my knee has decided to be stubborn! The doctor’s office has scheduled the arthroscopy for July 11th subject to insurance approval, but I have not yet made a final decision on if to have it done- while the pain I am feeling has me leaning towards the surgery, I still have some doubts. I am scared that I may not be able to run, play cricket, swim, scuba dive, work out at the gym or do all the travelling I plan to do in the future. I have been doing research and I also plan to go back to speak to the doctor about the lingering doubts.

As if my knee’s misbehaviour isn’t enough my foot has been hurting more than the usual since yesterday evening and today I started using the cane again to take some of the weight off of it. I can definitely see myself taking a painkiller tonight to help me sleep.

Of Achilles Tendons, Equinus and Physical Therapy

I went to the doctor today to discuss the results of the latest MRI. The good news is that the Achilles tendon is not ruptured and so it is just the tightness and tendonitis that is causing the pain. My heel and the area above it were so tight that to prevent any pain I had to keep my foot in a position where my toes were pointing downwards (equinus) and I had to put inserts in the boot to maintain that position while I was wearing it. The doctor told me that while he had allowed me to do this for a few days until the MRI results came back (to prevent further rupture in case there was a tear), now that it was clear that the Achilles tendon was not torn, I had to keep my foot in a normal position even if it was painful as failure to do so would make everything tighter and also make therapy much more difficult. He also said that I could now put a small amount of weight on my foot while using the crutches as long as it is only to go to the bathroom or kitchen. I was warned against going outside for a stroll on a nice spring day! Well, needless to say, putting on the boot when I was finished and then walking- and he stood there and made sure I walked correctly, putting weight on the heel and not gingerly on the toes- hurt although after the initial pain, it is much better and I am wearing the boot normally for the first time in a week. It may seem minor but for me it’s significant. I also spoke with the physical therapist and he is supposed to call me back to let me know when I can start therapy.

My GP and podiatrist along with a number of other specialists all share office space and the physical therapist is located in the basement, which meant I had to go down and up a flight of steep stairs. This was the first time I have done that since January and it was difficult. I am not sure how much sense it makes having the physical therapist in the basement and only accessible via stairs when many of the people he would be treating would have suffered injuries and may not be able to cope with stairs. On the other hand, therapy comes after the injury has healed or is almost healed and is meant to enable a person to regain full use of the limb etc, so it may be that the stairs are part of the therapy process!

Surgery Imminent?

I spent a large part of my day at the doctor’s office today. I got the cast taken off and unfortunately, the pain in my foot has not diminished. So, another MRI and some nerve conduction tests were done and I return to doc on Wednesday for results. At this point it seems as if I will have no choice but to do surgery as six and a half weeks in a cast has not resulted in any improvement. I will keep holding out hope till Wednesday that the MRI indicates improvement thus negating the need for surgery, but honestly, my instincts told me long before today that when the cast came off the second time the pain would still be ominously present.

Knee

Good news about my knee. Mr. Orthopaedist read the MRI report, examined my knee, did more x-rays (I have been subjected to an inordinate amount of radiation recently!!!) and his conclusion was that most importantly there is no meniscal tear and the problem is not very serious. YIPPEEEE. According to him it just seems to be some tendonitis which rest and a brace will take care of. Obviously with my cast I can't wear a brace so I will have to wear it when the cast comes off, especially when I go to the gym. I am relieved at the good news. I was grinning like a clown in his office!


Besides the visit to the doc, I spent the rest of my day watching tv, talking on the phone and came online for a little while. I love reading but somehow I wasn't in the mood to read today. I have some books on my shelf that I have not read or read a long time ago so reading material should not be a problem. When those are exhausted, there is always amazon and b&n :)

Podiatry

So, seeing that I will be home for the next 8 weeks, I have decided that I will start doing this blogging/journal thing as one of the ways to occupy myself!! I am not sure if I will keep up or get bored after a while. I will see how it goes.

Eight weeks home. I am kind of alarmed at the thought. Not as alarmed though as I was over the weekend when the podiatrist had told me I would require surgery, then have to wear a special shoe followed by therapy, all adding up to about 3 months home!

I've been having pain in my foot for a while now on and off. Went to the doctor on MLK day (Jan. 15^th) and the podiatrist was also there so he examined me right away. I had to do x-ray and MRI the next morning. When I went back to see him last Saturday (Jan. 20^th) about the results, he told me that basically I have a very badly torn tendon in my foot near my ankle. In addition the torn tendon seems to have caused “chronic altered bio-mechanics” so I have tendonitis etc in other tendons. This is what the MRI report says:

RIGHT ANKLE: Peroneus longus partial tear just proximal to cuboid tunnel with surrounding tenosynovitis. Calcaneocuboid atypical joint space narrowing, medial aspect, suggesting fibrous coalition. Tibialis anterior and posterior mild insertional tendinosis with tenosynovitis. Findings suggest chronic altered bio-mechanics. Insertional achilles paratenonitis.

RIGHT MID FOOT: Mild peroneus longus tenosynovitis. No evidence of lisfranc subluxation or fracture.

In other words, my foot seems to be royally *&(^%!!!!!!

It seems as if it was much worse that time in Barbados when I had hurt my foot (jammed it in a huge hole running for a ball on MTW’s crater filled field) and the stupid doctor said it was just inflamed, give me some pain killers and told me to bandage it when I was playing cricket. She should have sent me to do x-ray and MRI to make sure nothing was torn. So now instead of having a normal tear of a few millimetres like normal tears are, mine is just over a centimetre!!! I cringe every time I think about what I have been doing in the past 3 or so years and the damage I was doing to my foot. Only last week I was doing all manner of jumping and running at the gym. Some with weights on my ankles!!!!!!

I saw the doctor again today (Jan 24^th). He had to speak to the radiologist who did the MRI to find out if the tear is transverse or longitudinal. Luckily it is transverse which is not as bad. That means I don't have to do surgery at least not at this point. I will be in a cast for around 8 weeks and then if it hasn’t healed I will have to do the surgery. He put a soft cast on me today and I have to go back for a hard one on Monday. I am walking with crutches. I also have to go to an orthopaedist on Friday to make sure nothing is seriously wrong with my knee. Lots of pain in my knee also and podiatrist thinks the MRI results are serious enough to warrant further examination by orthopaedist. MRI report of my knee says:

RIGHT KNEE: Mild medial patellar tilt associated with subacute/ chronic sprain of inferomedial patellar retinaculum and mild patellar tendonitis. Findings are suggestive of a mild patellofemoral tracking disorder. No meniscal tear. Minimal interstitial degeneration in femoral attachment, posterior cruciate ligament.

In other words, my knee also seems to be royally *&(^%!!!!!!

I am trying to get all of this digested, its all happening so quickly! I have to figure out a way to shower, eat, shop etc as I can’t put any weight on the foot and have to use crutches. Steve has volunteered to take me shopping so I can buy a whole set of stuff. I will still have to figure out a way to get everyday perishable items like milk and bread etc. I will have to swallow my pride and ask someone for assistance. I am also fearful that 8 weeks home without activity will lead to significant regression in the gains I have made health and weight wise. I will have to try to stick to a very low fat and low calorie diet.