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Thursday, November 7, 2019

Posterior tibialis tendon tear!

Ooof. Cannot catch a break over here. I have been having weird foot and leg pains for a while now, things I never experienced before and attributed to Achilles tendinitis or plantar fasciitis. But then it all evolved into ankle and lower leg pain, and got bad enough that I was having a hard time putting weight on it. When the pain woke me up at night, I decided it was time to see a doctor. Luckily, Tulane recently opened an extended-hours sports medicine clinic geared toward student athletes and busy professionals who are at work or at class or practice from 9-5. I got a 6:30 appointment with the foot and ankle specialist: the same doctor I saw for my last stress reaction (gosh, I'm injury-prone). I really like him - he's the head of orthopedics here, and he is the one who recommended a carbon fiber plate in my shoe, which let me run through a stress reaction all the way to one of the best marathons of my life! (SARCASM, it was terrible in every way). I was happy to get in to see him so fast, and I'm a huge fan of the extended hours offered now!

He's one of those seen-it-all doctors, so as soon as he saw my foot he said, "posterior tibialis, right?" and confirmed the tendon tear by ultrasound. Dang. Diagnosis in ten minutes! Luckily, AS USUAL, I waited so long to see a doctor that I'm past the initial injury and into the healing stage. So the tendon is well on its way to repair. While I only noticed the sudden pain and bulge the last week of October, the damage was probably happening long before, only I was blaming all kinds of other conditions.

The body starts releasing relaxin in pregnancy, a hormone that relaxes pelvic ligaments in preparation for childbirth. Unfortunately, it affects other ligaments and tendons, too, by activating collagenase . This results in tendon laxity and lengthened tendons. In my case, my posterior tibialis tendon is already a mile long thanks to my super high arches, and all of a sudden it was flopping down like loose skin. Without the support of the tendon, my feet pronated inward, pressuring the attachment point and eventually inducing a slight tear of the tendon. This was the bulge and discoloration I noticed. Unfortunately, it's just one of those pregnancy things - and it could have happened even if I was mostly sedentary. The timing sucks, though, because I wish I could run right now: the weather is finally under 70 most mornings (although it's 84F today, bleah), and I have felt MUCH better running in the third trimester than the second trimester, where every step sucked.

By the way, thought I'd mention - women also release relaxin during the second half of the menstrual cycle, meaning that you may be more prone to tendon, ligament, or cartilage injuries at this time (all of which are affected by relaxin).

I'm currently in either a walking boot or ankle brace (my choice, and it depends on my day; if I'm biking to work I pick the ankle brace) plus PT. I don't have a timeline yet because my doctor isn't sure how my relaxing levels play into this. But I hope I can get over it before the baby gets here - get in a couple of runs at least before I have some forced time off!

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