Shinankle-itis

I eluded to a problematic left shin/ankle in my last post and unfortunately, I continue to deal with it.  I made the decision to race through the "throb" at St. Anthony's and I'm okay with that choice. Of course, I knew in the back of my mind that I would have to deal with the aftermath this week.  The good news is that I don't think that I made anything worse by racing St. Ants.  I also definitely didn't make anything better.  I am now in the midst of my fourth season of endurance sports and like most, have not been without my share of injuries.  Thankfully, so far I have not had any injury that has been a season ender.

In the past I have dealt with:
Piriformis syndrome-    February 2008-- only 2 months after I first got off the couch.  Relieved
                                        via Meilus Muscular Therapy (robotic treatment).
Double calf strain-        November 2008 and February 2009-- completely due to transitioning
                                        (poorly) to Newtons.  Ran "very carefully" through these injuries.
ITB Syndrome-             Dec 2009 through January 2010-- believe it or not, this was brought on
                                        by an 11 mile WALK!!  Needed over a month off from running for this.
ITB Syndrome-             November 2010-- developed "spontaneously" during Beach2Battleship
                                        Half Ironman.  Was relieved through ART therapy within 1.5 weeks.

Notice that at no time have I dealt with an anterior lower leg or ankle injury.  This is what alarmed me.  All of my injuries thus far have been posterior (calf & rear end) and lateral (ITB).

My chief complaint (in medical speak):
Intermittent pain located along anterolateral aspect of lower left leg.  Superior and slightly anterior to left lateral malleolus (ankle bone).
Pain can be classified as dull at times and stabbing at other times.  Intermittent and inconsistent in timing.
No pain upon deep palpation.
Does not appear to worsen with exercise.


In other words, it hurts here: 

Precipitating factors that might have caused problem:
1.   Two weeks ago I got the bright idea that since I would soon be training for a marathon, that adding an element of stability to my shoes might be a good idea.  Keeping in mind that for the past year I have been training entirely in Saucony Kinvara or Brooks Launch (both very neutral), I purchased a pair of Brooks Ravenna 2-- a mild stability shoe.  Stupid.  My legs, ankles and feet hurt so badly with those shoes that after over 50 miles, I called Brooks up and activated their "True Blue" guarantee.  **Note:  The doc believes my shoes are most likely to blame in this case.**

2.  I also did two speedwork sessions 1 week apart from each other.  Neither of these sessions were anything that I haven't done in the past, but who knows how much fatigue was hanging around from other training.  Fatigue is often the precursor to sloppy form.  Sloppy, atypical form leads to injury.  I'm typically a BIG fan of rest and I'm really, really good at managing my workouts so that I am as recovered as possible for the next one, but you just never know.

Yesterday I visited the ortho.  Tib-fib x-ray was negative for fracture.  The ortho doc, who rides with us every now and then, was kindly flattering when he told me that my fibula is super "teeny" in width and no bigger than his pinkie finger.  I asked him why my midsection did not get the same "small framed" memo that my lower legs and wrists/hands received.  We laughed... and then got back to business.

Doc believed that I was suffering from some tendinitis, but that a stress fracture couldn't be ruled out from the x-ray.  Since Doc has trained with me and the gang, he knows that telling me to "wait and see" is not an option, so he made some calls and was able to squeeze me in for an afternoon tib-fib MRI.

The MRI.  Interesting.  I've had two CT scans done before (unrelated to athletics) and they were fairly quick procedures.  In contrast, the MRI had me flat on my back, motionless, for a full hour.  When the test was done, I hopped in the car and called MSL to let him know that everything went well.  We hung up and he called me back less than 5 minutes later.  I guess our Doc friend pounced on my results.  What a good guy!  Preliminary analysis showed no stress fracture, but the radiologist would still need to take a deeper look.  I should have clear results at Tuesday's follow-up.

In the meantime, Doc is treating my case as tendinitis (peroneal tendons, I believe).  I cannot run until further notice (boo-hiss).  Swimming is ok as is "easy" cycling (i.e- no intervals, low resistance).  I'm using Celebrax and Voltaren Gel for pain/anti-inflammatory and moist heat to promote healing blood flow to the area.  I suspect that he will have me do some PT next week.

Keeping in mind that I do not have a definitive diagnosis yet, here's my plan of attack:
1.  I've taken four days off this week.  I haven't had this many days off in a week since last December, so although I'm freaking out about it a bit, it's probably not a bad thing.  Let's call it a mid-season break.  I was actually planning on taking an entire week off after FIT (May 14th), so it's just coming a bit early.

2.  No more "stability shoe" experiments.  I have super high arches and over-pronate ever so slightly on my right foot only.  My guess is that the Ravenna 2 was too much stability for my left foot.  Back to neutral it is.  I do, however, want a slightly "beefier" shoe for training.  I love the lightweight Kinvara (the Launch are ok too), but I miss the plush upper of a typical training shoe.  So, I'm going back to some marshmallow love... Asics Nimbus and Nike Vomero.  Both of those shoes have been good to me in the past, so we'll see what happens.

3.  Right now FIT is on for May 14th.  I'm not sure what kind of fitness I'll have left in the tank by the time the 14th arrives, but unless the doc says "no go" on Tuesday, I'm all in!