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Broken heel, running and arthritis (Read 2881 times)

bendavison

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Broken heel, running and arthritis
December 29, 2018, 10:21:27 am
I broke my heel 4.5 years ago and find that I limp the morning after a run or a long walk. The pain/limp normally eases off after an hour or so, but it sometimes takes a few hours if the run/walks are particularly long or repeated for several days. I *think* that the pain is focused around the achillies and feels more like tissue pain rather than from the subtalar joint.

I guess that I'll get arthritus in it someday. My dad (a GP) suggested that running might expedite this, and that maybe I should consider running less (I usually run for a couple hours a week, sometimes more, sometimes less) or stopping altogether to try and delay the onset of arthritus. Though without a crystal ball, it's anyones guess how quickly it might set in in either scenario.

So, I thought I'd appeal to the collective UKB wisdom... Has anyone had similar injuries and get similar pains? Do you think my dad's suggestion is reasonable? Has anyone developed arthritus on old injury sites and can comment on how bad it is? Any suggestions on how to delay the onset? Anyone got a crystal ball?

Thanks all!

webbo

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#1 Re: Broken heel, running and arthritis
December 29, 2018, 10:35:41 am
I recently saw my GP with a pain in my hip. I was informed it was mild Arthritis and I should therefore keep exercising.
I had a period of doing very little exercise over Christmas to see if the numerous aches and pains I currently experience would improve. However if anything I felt worse.
So Thursday I used the turbo trainer for an hour, yesterday I did 25 easy problems on my board then light weights followed by a 7 mile walk with the missus.
I feel better than I did on Wednesday aches wise this morning.

Oldmanmatt

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#2 Re: Broken heel, running and arthritis
December 29, 2018, 11:11:30 am
I lost part of my right big toe, to frostbite, cica 1992. About two years ago, xrays showed some nasty osteoarthritis, or Halux  rigidus. It’s degenerative and the lumps are now clearly visible.
I went to the GP originally, because of chronic pain. It was susceptible to “stubbing” pain, so at first I just thought it wasnot recovering between stubs.
Irritatingly, favouring it (I believe) lead to me tearing the MCL in the associated knee, after a few months.
However, the pain turned out to be a funtion of grinding the bone lumps against soft tissues, rather than inherent to the condition.
Running was by far the biggest problem, but soft shoes (trainers, running shoes etc) in daily use, were aggravating it into sheer hell. I thought I was fucked.
The NHS Chiropodist was brilliant and solved my issues in a ten minute consultation.
Stiff shoes,preferably with rocker.
ie, approach shoes or good walking shoes.
Oddly, aggressive climbing shoes are not a issue, my toes curl that way without problem and once there, don’t flex much. My Anasazi’s are more of an issue, as is smearing, so I do less.

I had to change my running habits, though.

I switched to Yomping/Tabbing/Speed marching. There are several organisations that put on events in this category. You could call it “Fell running with a fucking heavy rucksack”.
Most of these events require you to wear boots, to limit foot and ankle flex.
Running in boots, whilst seeming odd to those unaccustomed, is not as weird in practice, certainly not over rough ground and mountain terrain. Boot tech has moved on as much as trainer tech has. Although many of the best come with excessively macho names that involve words like “assault” or “tactical”, that merely represents the main driving force behind their development, not their practical application in mountain racing.

So, it’s possible to keep going, or even compete at national level, without bending your foot joints too much.

Restricting flex on a day to day basis, reduces the chronic pain (but needs a good stretching routine to keep mobility).

Obviously, an ankle is different, but I can imagine similar precautions would benefit.

Get it xray’d though. If it’s not Osteoarthritis, if it’s rheumatoid, then drug management is going to be more effective.

Oh, yeah, I got pair of stiff Salomon, trail runners (XA pro 3D) and I use them for Hill sprints, when training. Doing that on a very steep hill and limiting myself to ~ 1k of running, keeps me in shape, without too much rent to be paid.
« Last Edit: December 29, 2018, 11:22:18 am by Oldmanmatt »

tim palmer

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#3 Re: Broken heel, running and arthritis
December 29, 2018, 12:16:28 pm
I fractured the articular surface of my ankle a year ago (so possibly a slightly different injury to yours) and experience pretty similar sounding pain after activity.   

As you rightly say no one can give you a completely accurate prediction of what will happen in the future but I/you will be at greater risk of osteoarthritis.  I used to run a reasonable amount but I have decided not to anymore because I would rather be able to climb for longer.  But I thìnk seeing your GP or surgeon (did you have an op) is a good idea in case there is a simple explanation/ fix.

Quote
If it’s not Osteoarthritis, if it’s rheumatoid, then drug management is going to be more effective.

Is this worth raising?  Rheumatoid is a reasonably distinct entity from OA and sounds like it would be fairly far down the differential diagnosis in this context.


Oldmanmatt

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#4 Re: Broken heel, running and arthritis
December 29, 2018, 12:28:37 pm

Quote
If it’s not Osteoarthritis, if it’s rheumatoid, then drug management is going to be more effective.

Is this worth raising?  Rheumatoid is a reasonably distinct entity from OA and sounds like it would be fairly far down the differential diagnosis in this context.

I think so. My son stress fractured his knee a couple of years back and then went on to develop juvenile rheumatoid in that joint. The specialist seemed sure that there was a link, though there have been several suggested causes, ranging from systemic viral infections, to localised infections at the break. Fortunately, it seems to have been reactive,rather than idiopathic and he’s been symptom free for around 12 months. Unfortunately, we won’t know that for sure until he passes through his life without recurrence...

He’s a dedicated footballer, who trains four days a week and just qualified for the Devon Cross country team, so I’m thinking it would have reared it’s head again by now, if it’s going to.

Edit:

His knee grew to approx 3x the size of the other and became bizarrely hairy! I had no clue that hair growth like that could happen in a pre-pubescent 10 year old.

tim palmer

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#5 Re: Broken heel, running and arthritis
December 29, 2018, 12:32:05 pm
I thought juvenile rheumatoid was by definition an idiopathic autoimmune disorder.

Juvenile or adult RA doesn't seem likely a man in his ? Twenties with single joint pain following severe trauma.
« Last Edit: December 29, 2018, 12:41:06 pm by tim palmer »

Oldmanmatt

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#6 Re: Broken heel, running and arthritis
December 29, 2018, 01:06:53 pm
I thought juvenile rheumatoid was by definition an idiopathic autoimmune disorder.

Juvenile or adult RA doesn't seem likely a man in his ? Twenties with single joint pain following severe trauma.

I have no clue. We went through months of conflicting diagnosis from just about every quarter. Father-in-law is (retired as of three months ago) Surgeon Captain (RN), married to a Consultant Rheumatologist (is that right? It’s that or something very like it, it would be embarrassing to text her now to check, after six years... She also treated my Reynauds, quite successfully, but I’ve never seen her business card).
We got bounced around NHS consultants, because Grandad wasn’t convinced by some pretty wishy-washy answers, before landing up at Bristol. There we finally got a “Yes. This is idiopathic juvenile arthritis” and began months of treatment.
At some point in that, several months in, an MRI showed evidence of a prior stress fracture, which we were able to pin down to a time frame (actually the point where we had assumed symptoms had first begun). At this point, the whole diagnosis swapped to RA.

Of course, all of this is filtering through the brain of an Engineer. I hadn’t even heard of RA prior to this, so it’s probable that conflating RA with idiopathic Rheumatoid is false equivalence of the highest order (you know Engineers are even less likely to admit ignorance than Doctors, right?)

Which is a round about way of saying, I reckon an xray is in order before assuming it’s Osteo.

Oh, yes we were told to, and were constantly expecting it to appear in other joints. It never did.
« Last Edit: December 29, 2018, 01:17:52 pm by Oldmanmatt »

tim palmer

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#7 Re: Broken heel, running and arthritis
December 29, 2018, 01:43:23 pm
That sounds horrendous, hope it all works out/ stays settled.

I suppose my point was (from my narrow understanding as a pathologist) that Rheumatoid arthritis and osteo is a distinction which requires more than an x ray, they are clinical diagnoses which require a full history, examination, serology etc as most diagnoses are.   In fact even if an x ray shows barn door OA I am not sure this generally bears much resemblance to the severity of symptoms, so x ray may not be very helpful at all. But then again it will be more accurate than a thumbnail portrait on an internet forum. I think raising the possibility of a severe inflammatory joint disease in this context is a bit much although I appreciate your experience gives you a different perspective.


Hence my approach would be to see a GP/the surgeon and get properly looked at if it is causing real trouble, if it is only minor discomfort go easy maybe. 

« Last Edit: December 29, 2018, 01:55:03 pm by tim palmer »

duncan

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#8 Re: Broken heel, running and arthritis
December 29, 2018, 02:06:38 pm
RA seems highly unlikely. OA is highly likely in the long term.

I have OA in my left ankle, probably related to injuring it in 1984. It wasn't broken but got a decent whack after falling 120' or so. I've had a bit of swelling and what felt like soft tissue pain for the last decade and it's been a bit more painful in the last 18 months after tweaking it when I dropped off the victory jug on Supersonic. X-ray showed about 50% of the cartilage thickness gone.

Current evidence is running is not damaging for the joints and may be mildly protective even when there is mild OA. Most of the research is on people with knee arthritis but I don't see why it shouldn't apply equally to ankles.

That's the science, such as it is. What do I do? My ankle is typical of any joint with moderate OA: no activity makes it sore, a rapid increase in activity makes it sore but if I build up gradually it is fine and better than just resting it. Much like webbo. I'm not a great runner but keen walker and I'm certainly not going to give up hill walking because I think it might wear out my ankle. I ran for a bit last summer to get fit for a couple of hill walking exploits. I took care to increase the mileage slowly and my ankle was fine. I do a little ankle strengthening/balance work on a soft surface when I'm not in the hills to keep things ticking over.

In your shoes, I wouldn't stop running completely but I might do shorter runs more frequently, like on alternate days. If your ankle is swelling and hurting the following day you've overcooked things a little.

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#9 Re: Broken heel, running and arthritis
December 29, 2018, 02:52:10 pm
My experience with ankle surgeons has been quite frustrating, their options appear rather limited and outcomes not particularly well established.   Initially i was told unequivocally that it would be preferable that I avoided activities which would be traumatic to the joint, but I don't know if this advice is a tad on the conservative side

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#10 Re: Broken heel, running and arthritis
December 29, 2018, 05:26:53 pm
I smashed my heel falling off the top of County Ethics, in 2013. I’ve run 1000 miles this year, much of it on the fells. I already had some damage to the talus from a previous injury. I hobble in the mornings. Long fell runs take a couple of days to recover from. When you get to 43 it becomes obvious that your entire body is getting older. My Dad had open heart surgery at age 45. Do what makes you happy now. I’ll undoubtedly get arthritis down the line, but it won’t stop me doing stuff now. Just listen to your body as much as possible.

Maybe more usefully, ‘maximal’ style trail shoes help. Depends what kind of running you do?
« Last Edit: December 29, 2018, 05:41:45 pm by T_B »

Yossarian

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#11 Re: Broken heel, running and arthritis
December 30, 2018, 11:11:13 am
I broke my heel across the subtalar joint 15 years ago in a spectacular sleepwalking/climbing accident. It aches most mornings, and standing up for long periods is not especially comfortable. But peculiarly, running isn't particularly problematic.

I'm about to embark on my annual run until I get bored / injured start to the year and, from past experience, it will probably ache a bit afterwards, but pose no problem at all whilst running.

The most irritating thing from a climbing point of view is that the heel area on that foot remained quite chunky, making squeezing it into rockshoes a bit of a challenge. And I have a lump on the rear of the heel which eats through trainers at an alarming rate.

bendavison

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#12 Re: Broken heel, running and arthritis
December 30, 2018, 05:39:54 pm
Thanks all for your suggestions and for sharing your own experiences. I'm certainly not a mad keen runner, but I do enjoy it. I'll have a look into getting stiffer, more supportive and/or more padded running shoes and will try and be aware of what pisses it off and what doesn't. Sounds like it's certainly possible to work around it. And, as T_B pointed out, you start to break as you get older anyway... As others have said, I definitely find that doing nothing doesn't help it. It stiffens up and it's a bit uncomfortable to then 'break in'.

Fingers crossed that we can all keep powering on for many years to come!

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#13 Re: Broken heel, running and arthritis
January 03, 2019, 09:39:44 am

Maybe more usefully, ‘maximal’ style trail shoes help. Depends what kind of running you do?

No experience of the injury but was going to say the same. Getting some of these (a mate has a Morton's Neuroma and couldn't run at all without pain, got a pair of Hokkas (can't remember which model) and did Lairig Ghru without pain (from foot anyway) in under 6 hours. Some custom footbeds might help too.

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#14 Re: Broken heel, running and arthritis
January 03, 2019, 10:01:11 am
Yeah many of the major shoe brands now do highly cushioned shoes. I do a lot of my easy running on trails in Brooks Caldera (28mm heel stack). Hoka are still the brand for maximal shoes, but Salomon also do a few models, as do Sportiva (e.g. the Akasha).

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#15 Re: Broken heel, running and arthritis
January 03, 2019, 10:49:05 am
I might need to try some for longer runs, might manage to retain a few more toenails.

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#16 Re: Broken heel, running and arthritis
January 03, 2019, 11:13:02 am
Toenail lossage may be more to do with your shoes being too tight? It's taken me a while to get out of the rock shoe mentality and start buying running shoes that actually fit  ::)

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#17 Re: Broken heel, running and arthritis
January 03, 2019, 12:05:42 pm
I'm sure that's part of it. They were sized in the shop as my first pair of proper running shoes, so are reaching end of natural life now anyway. I've only had issues after longer (HM) road races, i think I get a bit "slappy" towards the end of these when time is ticking out too, and it's a spring finish.

Got some new ones to start trying out over next few months.

 

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