Romancing Haglund’s Deformity: My Forever Running Partner

Scout-the-Runner
Scout-the-Runner

Vermont broke weather records last week: my car thermometer said 73° when I left work Friday afternoon, with partly cloudy skies and a pleasant breeze that carried an earthy spring scent—in February. I could be wrong, I speculated to Handsome Chef Boyfriend a few days earlier, and I know there’s still plenty of time for big snow, but this feels for all the world like spring thaw to me. Yes, he agreed, and even if it snows again, it won’t stick around long.

Call it climate change, but it feels more like weather. Winter’s fury’s still fresh in my mind: below-zero misery, the distinctly menacing sound of the heat cycling on and staying on, heart-stopping electric bills in the post office box, and the eternal fight to keep winter on the outside of the car, to say nothing of shooing it out of the house: we’ve paid our cold-weather dues, and if spring wants to move in a month early, so be it. Mud season is a thing of beauty.

Yesterday there was no cycling on of the modern kerosene heater that warms us pretty well in this tiny place. The house was blessedly quiet, with only the sound of a laptop keyboard clicking behind me, a snoring Labrador wedged next to me on the sofa, clouds drifting across the skylights overhead, and aromatic brown rice bubbling under the saucepan lid on the stove just around the corner. Later on we’d throw open the door and leave it that way, just as we do every day in summer: how delightful to enjoy this appetizer in winter, even if it’s only a tease.

Spring thaw means resuming my running habit in earnest. But where it was once part and parcel of every day in my erstwhile Southern life, in Vermont it is seasonal. Some folks manage in the winter with special equipment, but my damaged foot objects. This was a point of dispute between me and my well-intentioned doc in December: you can do it if you really want to, she insisted. I lobbed one back at her: not at my age, not with Haglund’s deformity. I know Haglund’s deformity, she persisted, and you can do it if you want.

It was another doctor, an orthopedic surgeon in Tennessee, who identified this malformation in my heels (it’s more pronounced in the left one), and another who explained why I have it. Sometimes Haglund’s is called the “pump bump” because women who routinely wear heels are vulnerable to it. I’ve never worn heels a day in my life, except maybe for the odd special occasion. I mentioned this to one of my M.D. ballet dads a few years ago when I was still teaching. How could I have something tied to the wearing of those awful shoes, when I never wear them? Well, he opined, you may not wear the shoes, but consider this: you put your foot in that position every day of the week for hours at a stretch.

He made an excellent pointe, so to speak: ballet dancers (and their teachers) maintain this position of the foot more often than not. It’s called relevé, and you can see it here in spades in an examination class at the renowned Vaganova School:

But I digress. My doctor is wrong on this one, and that is that. I’m more body aware than the average Joe and because of my badly compromised foot have exactly no stability on ice, not even on packed snow if it’s slippery. Time and again this winter I grabbed hold of trees to stay upright negotiating the topography of the back yard for Scout’s late-night pee breaks. If growing old is not for sissies, as the wisdom goes, neither is winter in Vermont with a dog.

Nor is the confounded bony protrusion on the back of the heel the only problem: it’s all the soft stuff around it—muscle and tendon—irritated by movement, sometimes angered, occasionally declaring all-out mutiny. I will make your life a living hell if you attempt to stand and walk. It occurs to me I can’t have my foot replaced.

So I won’t run in those conditions, even with special equipment, the conditions which prevailed from some time in December until only a few days ago. Instead I will respect the foot.

But mud! Mud is the perfect medium for running, a thing I remembered last weekend when Scout and I embarked on our first several runs of “spring,” as it were. The heel sinks into the soft, mushy gravel in a satisfying way, water oozing up around it, the shock absorbed mercifully and gently in the ankle, the knee, the hip, and the lower back, while blood courses joyously through the veins. Scout is a perfect running dog, happy to keep up whatever cadence I ask of him. A slow couple of miles a day feels fine for now, with some starting and stopping to honor the foot thrown in for good measure: I’m a good listener and had rather avoid mutiny down below even if the heart thumping up above urges us on.

After the rice finished cooking yesterday I laced my running shoes with Scout circling me enthusiastically. Crossing the bridge over the Battenkill I glanced uneasily at the water roaring under it in torrents, carrying runoff from the nearby mountains; later HCB and I would observe places it has already breached its banks to settle in wheat-colored fields. Elsewhere in our neighborhood the same is happening on a smaller scale, streams ripping through culverts under the roads and in some places spilling over the top of them.

Scout kept his nose skyward to concentrate new smells that surely must assault him like a freight train, stopping now and then to bury it in the warm, wet schmutz on the side of the road below. Meanwhile my foot cried out like a mythical Mandrake yanked out of its potting soil, but I didn’t let on to Scout, only slowing down now and again to shush the pain.

Once home we headed directly to the tub, where a mud-encrusted Scout suffered no pain in his first stem-to-stern scrubbing on my watch. And true to his character, he stood resolute and patient in the soapy water through it all, content to lie on the bathroom floor quietly afterwards for a towel drying and brushing. Scout ended his day as it began, hunkered down with his humans, but sweeter smelling, exercised, his belly full of turkey and kibble.

I know running will never be the same as it was even a few years ago. There will always be a twice-daily regimen of ice baths, and pain meds, and fish oil, maybe some massage, and the occasional Arnica application if I want to keep going. Two things I know for certain: I need to run. And my left hand needs a leash in it. For the time being, anyway, they’re both met.

haglunddeformity1a

New Running Shoes, Perilous Decisions

Not many weeks ago I took the first uncertain steps to resume running after an injury interrupted a many-years-long stint; I wrote about it here. I have a new pair of running shoes to prove it, hard-won shoes begat by the sweat of my own brow and a little research, and a long drive to a neighboring state.

Posterior Tib 2A

In the intervening days and weeks I have undertaken a running regimen one of my colleagues reviewed for an online publication. It’s aimed at folks who are athletic slugs with a keen desire to exercise, but without effective strategies for starting and sticking with it. The typical scenario of failure, as the program’s creator describes it, is resolving to run, and then over-reaching the first time out, soon throwing in the towel when the body balks.

That does not describe me. I am the runner who once started each day with a quick swig of water, a leashed dog or two, and then covered no fewer than four or five miles at a respectable clip before the sun had fully breached the eastern horizon. I remember the first time I ever tried this, tiptoeing out the back door a few minutes past five a.m., opening a squeaky iron gate quietly as I could to keep from waking the neighbors, stepping off the curb onto the chilly pavement with two eager Siberian Huskies whose excited breath showed in the amber light of the street lamps. The only sounds were the dogs’ toenails against the pavement, the occasional soft clinking of their tags, and our collective breathing. Somehow I did this crazy thing again the next day. And the next, and for many, many years, with different combinations of family dogs. I came to love this hour that was sometimes the only peace in my day.

We were so easily spooked in those early mornings by whatever we imagined lurked in the shadows of neighborhood trees and hedges. (Human or canine, the mind plays sinister tricks on itself in the darkness.) Out on the main road rolled newspapers sailed over the top of the paper carrier’s car in the darkness, each one set aloft by his expert arm but still landing with a quiet thwap in one driveway and then another (this action sometimes evoked a low growl in the dogs); we could hear baritone radio voices muted inside passing luxury sedans pointed towards the big teaching hospital just across the river, the doctors on call starting their rounds; we could smell other people’s toast and coffee; more than once skittish urban foxes and coyotes crossed our paths; finally we witnessed the street lamps flickering off as daylight overcame dawn. Each day my dogs and I watched the neighborhood wake up; by the time we arrived back home they were tired out, our own house was stirring, there was a child who needed to be gotten up and readied for school, breakfast to be made, schedules to follow. My quiet time for the day was over.

This lifestyle continued unchecked for years and I honestly believe brought me a measure of sanity I could derive from nothing else. But soon after I moved to Vermont for a new teaching position, and shortly before I lost my beloved German Shepherd Clarence in early 2014, chronic posterior tibial tendonitis forced me into running retirement. It’s a mouthful but mainly describes inflammation in the muscle and its associated tendon that reaches down from the calf and wraps under the heel by way of the ankle bone on the inside of the leg. Mine is painfully distended and swollen in the region of the heel itself near the attachment, and behaves badly most of the time. It does not respond well to stress, which would include long distance running. It does not take a shining to classical ballet, either, and one movement in particular, called relevé (think calf raises)—a movement that occurs many, many times over the course of a single 90-minute ballet class—is particularly aggravating. And of course it does not respond well to the other kind of stress, either—the emotional kind.

Add afternoons of teaching ballet class for a three- or four-hour stretch (actively dancing and demonstrating relevé and lots of other body-challenging movement), to mornings of vigorous long-distance running, and a congenital heel deformity that adds wear and tear to the soft tissue, and then throw in a little happy weight gain just for good measure, and the body will finally protest so loudly you can’t ignore it another second. Dang posterior tibial tendon: an orthopedic surgeon diagnosed it as compromised many years earlier, but it was decent enough to allow me to keep on keepin’ on. Now it was throwing the worst imaginable fist-pounding, screaming, spitting tantrum. It certainly had my undivided attention, as nature intended.

Posterior Tib 9A

My foot looks normal every morning but by day’s end is swollen and tight and yellow; it does this whether I run or do nothing, but it’s worse when I spend the day on my feet. Lately it has sprouted new capillary growth I can see just under the skin. But in my professional life now I spend most of an eight hour stretch sitting: this has brought welcome relief to the offending foot and heel. And in the last couple of months…could it be? I swear I could feel actual healing in that foot. The rest of me has felt like a slug, like the wanna-be runners for whom this interval training app is intended.

People rebound courageously all the time from all kinds of trauma far worse than mine, going on to reach impossible training and professional goals. I decided the “baby steps” approach of this little regimen could be the salve I needed to ease back into running again, this time without all those damaging relevés, and sadly also without a dog at the end of a leash. The first couple of times out I was giddy from the old euphoria that for me comes only from running. Other pursuits have stepped up to the plate in the last year and a half in lieu of it—yoga, weight training classes, bicycling in summer and spin classes in winter, and even swimming. Nothing does for me what running does, but I concede some of them (yoga especially) help make running better, or even possible.

Significantly, I returned home from those first few jaunts pain free: nada. zip. nothing. No pain at all, at least nothing outside of what I consider “normal” pain. Rest must have been the thing that was missing, I concluded, the thing all the dance and sports medicine professionals insist is so important for soft tissue injuries, but is so elusive for driven athletes. I finally gave this tiresome injury what it wanted, or so I believed.

Slowly and surely the pain came back.

I’m soldiering on for the time being, nearing the end of the fourth week of the training program and skipping some of the modules that feel silly to me. Last week I researched running with posterior tibial tendonitis, thinking other runners who have the same problem would report the fix: there must be some cocktail of exercises, stretching, icing, heat, or other things to make this work. In truth I have tried them all in the past (and some I still practice), but held out hope there was something I missed.

Posterior Tib 1A

Instead I found this ominous warning: Stop running, and stop now. Do not attempt to push through the pain. You do this at your own peril, risking permanent damage to your foot, damage that will change its shape and ultimately change how you walk and move. Furthermore, the very instep itself is at risk, as the tendon is what holds it up, giving it the important structure it needs to do its job.

Terrifying advice that leaves me at yet another difficult intersection.

Run at your own peril. Don’t run at all.

There is a particular flavor of nightmare I hate, and it goes like this. You wake up in your own bed and familiar surroundings, and everything seems fine. It is time to get up and start the day. And then some awful thing happens, some terrifying thing, there is a menacing person you don’t recognize standing behind the open bedroom door, or whose shadow just stirred in the hallway beyond. Then you realize, I am not yet awake—this is a nightmare. And you try desperately to stir. You open your eyes again, thinking you’re in the clear, and then that shadow moves again. You are still in the dream, imprisoned by your own mind. Eventually you do wake up and pinch yourself just to be sure, and you start your day in earnest, feeling a sense of disquiet.

Every single morning for an entire year I felt like that, the year I lost everything that had meaning to me, the year before I left Tennessee to start life over in Vermont. Every morning I was caught up in the hope that what was happening to me was only a bad dream, and every morning I was disappointed. Things got dramatically worse before they got better, loss and angst following me right into my new home state, financial ruin, emotional turmoil along with it. I have likened this to being pushed into a deep hole, somehow managing to cling to the edge with only a couple of fingers.

And then I managed to get the other hand to the top, then all ten fingers dug in, and then an elbow, and another. Then one swinging foot found a toehold, bits and pieces of dirt still giving way under it, but in the end the toes won and the other knee made its way almost to the top of the hole.

Daily I reminded myself, you can choose to sink or to swim, advice I heard often growing up in a family with a strong line of matriarchs at the helm.

In the last few weeks I have felt better (in spite of the foot) than I have in the last two years, and not just physically. At first I could not breathe and a couple of times was caught up in comical bouts of coughing that continued over the course of a day. Then gradually my lungs cleared and I felt better. Muscles began settling into a shape I recognized and my clothing felt better on me. Even my head started working better, with  renewed clarity of thought and vision.

So here is what I think about this tricky situation. I could die next week, or tomorrow, or today, for some stupid reason. I could keep on battling middle age weight gain with inadequate tools in my bag, and all the unpleasant problems that sprout from that like obnoxious little tributaries flowing from a big, muddy river. Or I could take a risk, live dangerously. It could be a perilous decision.

Or it could be life-affirming.

As Mr. Balanchine said, there is only now. I choose to live in the moment, to risk peril in a new pair of running shoes.

Posterior Tib 6A