Saturday, February 15, 2020

foot pain: a closer analysis and possible self-diagnosis

Last year, I wrote about how, early in my walk from Incheon to Busan, I experienced a strange and disconcerting "popping" in my right foot. The popping produced a feeling of weirdness, but any pain associated with it proved to be short-lived. I described the popping as "chiropractic" in nature, i.e., similar to the harmless popping that occurs when a chiropractor is working on you. I think that characterization was correct because, ultimately, I was able to finish my walk with no apparent repercussions from the foot-popping incident.

This past Thursday night, I seem to have hurt my foot. I wrote the following:

I was doing my usual route along the Tan Creek to the Han River, but my foot was getting progressively achier, and then I suddenly felt and heard almost the same bone-deep popping that happened during my most recent walk to Busan (here). As before, I walked a couple minutes farther to test out whether anything had broken (like a bone) or snapped (like a tendon), and nothing had. There was just a steady ache that got bad enough for me to begin limping. I was incredulous at how quickly the pain escalated.

If the above seems vague in terms of whether the popping and the pain are connected, you're not hallucinating. I had no idea whether those two things were connected, so in the above paragraph, I was simply reporting the sequence of sensations that had arisen. Now, however, I've had an epiphany, and I think I know what's going on.

I've been in bed most of today (Saturday), feeling a bit depressed and doing my best to keep weight off my right foot. This put my brain in the right state to be open to epiphanies, and one came to me a few hours ago: stress fracture. So I went to Wikipedia to look up stress fractures, and it was as if I were reading an entry by someone who had telepathically grasped my personal situation. Wikipedia says (snippets follow):

A stress fracture is a fatigue-induced fracture of the bone caused by repeated stress over time. Instead of resulting from a single severe impact, stress fractures are the result of accumulated trauma from repeated submaximal loading, such as running or jumping. Because of this mechanism, stress fractures are common overuse injuries in athletes.

Stress fractures can be described as very small slivers or cracks in the bone; [they] are sometimes referred to as "hairline fractures." Stress fractures most frequently occur in weight-bearing bones, such as the tibia (bone of the lower leg), metatarsals, and navicular bones (bones of the foot). Less common are fractures to the femur, pelvis, and sacrum.


Symptoms usually have a gradual onset, with complaints that include isolated pain along the shaft of the bone and during activity, decreased muscular strength and cramping. In cases of fibular stress fractures, pain occurs proximal to the lateral malleolus, that increases with activity and subsides with rest. If pain is constantly present[,] it may indicate a more serious bone injury. There is usually an area of localized tenderness on or near the bone and generalized swelling in the area. Percussion or palpation to the bone may reproduce symptoms and reveal crepitus in well-developed stress fractures.

The red font indicates text that produced a "That's me!" reaction in my head.

As for getting X-rayed, Wikipedia says this:

X-rays usually do not show evidence of new stress fractures, but can be used approximately three weeks after onset of pain when the bone begins to remodel. A CT scan, MRI, or 3-phase bone scan may be more effective for early diagnosis.

MRI appears to be the most accurate diagnostic test.

The Wikipedia entry talks about the notion of "bone remodeling," which sounds like a weird form of interior decorating, but actually refers to the way bones—which are living tissue, after all—are constantly reconfiguring themselves based on the pressures and stresses placed upon them by the daily movement of one's body. One's bones are constantly remodeling, but putting too much repetitive stress on them can cause them to lose their ability to remodel, and this is part of what leads to fracturing. I'm an overweight guy who's now over 50, and I lead the paradoxical lifestyle that combines radical sedentariness with distance walking—four times the amount of walking done by normal people, as I noted earlier.

So at this point, my hypothesis—my tentative self-diagnosis—is that I have a stress fracture, and that the "chiropractic popping" was, in fact, unrelated to the buildup of pain that began before the popping and continued after it, to the point of being debilitating enough to cause me to limp everywhere (something I'm still doing).

Solution? I don't want to go in for an MRI or some other potentially expensive scan, but at the same time, waiting three weeks just to get an X-ray seems both lazy and malignantly negligent. What I think I need is an orthopedic boot or orthotic braces that will allow me to at least walk short distances while keeping pressure off my foot. To obtain such footwear, I'll need to visit a clinic sooner rather than later, so I've now resolved to visit an ortho clinic this coming Monday. I can't ask my boss whether I can telecommute for two to six weeks; he'd never say yes to my being absent from the office for that long, so getting some kind of ortho footwear is the most practical, most expeditious solution to the current problem.

In sum: I suspect the pain and the popping were mostly if not wholly unrelated. The pain probably results from a stress fracture, and the stress fracture probably results from my overweight condition's finally catching up with me (so my previous joke about expired warranties probably had some truth to it) after years of distance walking while not losing weight. I'm a bizarre mix of healthy and unhealthy habits, and the effects on my body are, as a result, equally bizarre. Wikipedia says that stress fractures happen primarily to (1) sedentary people who suddenly take up an intense activity, or to (2) athletes who abuse their bodies through repetitive stress. I'm in neither of these demographics—not completely, anyway: I'm a long-time, experienced distance walker who has traversed South Korea twice. At the same time, I'm an old, fat guy with a sweet tooth who is constantly undermining his physical activity through bad eating habits, and who has only lately started correcting that. As I said: bizarre.

Oh, yes: I'll also have to reconsider my future walking schedule. Unless and until I actually lose a significant amount of weight, I think that walking 15K to 26K steps per day, 6-7 days a week, may be too punishing a schedule. I think my feet do better with a "dotted line" schedule in which I do longer walks every other day and keep Sunday as an out-and-out rest day. Something like that schedule worked for years; it's only over the past 1.5 months—coinciding with the start of my new diet—that I've ramped up the walking. I wouldn't have thought that the new level of intensity was all that bad: during my long walks to Busan, I was doing 45K-60K steps almost every day, with scattered rest days. Apparently, my body disagrees, and here we are as a result. So I suppose I'm doomed never even to reach the level of 1.0 McCrareys. Ah, well. A man's got to know his limitations.

Expect photos of my new footwear early this coming week.


John Mac said...

Well, that all makes sense. I wasn't clear what treatment (if any) is available for a stress fracture, all the MRI or x-ray does is confirm the diagnosis. I guess it is one of those things that has to heal on its own and the footwear you mention allows that to happen by keeping pressure off the break.

Good luck! Hopefully, they have your size.

Kevin Kim said...

It seems that, depending on severity, treatment choices come down to rest or surgery. I don't think I'm on the severe end of the spectrum, so it's rest for ol' Uncle Kevin.

Yeah, I'm worried about the size thing. This is another problem with Korean health care: despite the increasing number of huge Koreans in the local population, hospitals still seem convinced that most Koreans are midgets. Larger people have trouble receiving decent care as a result.

Charles said...

Stress fracture does make sense. Good luck with the recovery.

Kevin Kim said...

Thanks, Charles.