Anyone with heel/foot injuries - please read

In June of 2017, I came up short on a jump and landed pretty hard on my left heel. I immediately felt pain and knew I had at the least bruised my heel really badly. This happened on my second day of work at Windells, and anyone who knows how much time I spent away from skiing and laid up on the couch these past few years will know I was not too keen on ditching my summer plans. In retrospect, it was probably a foolish decision to stay but I was on a high of finally being able to ski again and couldn’t bare the thought of doing nothing again for the summer, especially not even hold down a job. After a week of the pain not subsiding, I went to go get it checked out. Meanwhile, I worked in the kitchen, so I got some over the counter inserts and taped/wrapped my heel for the 3 to 4-hour breakfast shift I had to be on my feet. I went to an urgency clinic where they x-rayed my foot and saw no fracture, but referred me to an orthopedic. At this point, I am able to use crutches and a boot as recommended for a little over a week. They become too much of a hassle with work and I stop using the crutches, but spend little to no time on my feet other than a few hours at work, while following a RICE protocol. At this point about 3 weeks have gone by and I get into the orthopedic doctor. He confirmed there was no fracture, likely a really bad heel bruise; a bone contusion. I mentioned that I had been using Dr. Scholls inserts and over the counter inserts and asked if I could ski. He said I shouldn’t go crazy, per his words, “I wouldn’t go dropping any 20 foot cliffs,” but that I would be ok to ski. So it was the session after the 4th of July, a month after I came up short that I started to ski. For the first week I kept it really mellow, not even leaving the ground, making switch carves, messing around. I slowly started to ski harder as I could tolerate the pain. I didn’t hit jumps, but I admittedly was still skiing pretty aggressively on rails, while also skating in afternoons, and just generally being on my feet a lot for the rest of the summer. Fast forward to the fall and my foot was not feeling good. It still hurt every day and this is when I knew I had to get it checked out again and see what I could do. Got it x-rayed again and still no sign of anything. They diagnose me with plantar fasciitis, which I later realized was probably just the label they slap on 90% of people with foot pain, recommend I get some over the counter orthotics and do physical therapy. I went on that regimen for about 2 months (Sept-Oct). I should mention that along with exercises and stretching, my PT incorporated ultrasound into my weekly treatment and even tried electric stimulation and dry needling. During this time I worked door-to-door for a recycling company, but walking and biking/swimming were the extent of my activities. I stopped any high impact activities. Early November rolled around and there was absolutely no improvement in pain. My PT recommended I get stronger imaging because he believed there was something more going on. With my luck, sure enough, I get an MRI November 14th and it shows that I had a minor fracture in my calcaneus (heel bone). 5 months after I originally cased that jump. It’s at this point that the orthopedic doctor I was working with in Utah diagnosed me with a stress fracture and still some plantar fasciitis because of how aggravated my foot had become over the past months. He recommended that I go complete non-weight bearing in a boot for 6-8 weeks and take vitamin D supplements. I ended up extending my time on crutches to at least 9 weeks (Dec-Jan), maybe even 10, to be completely sure my bone had ample time to heal (8 weeks is the necessary time for a stress fracture to heal on its own). I slowly start putting weight on my foot with crutches, and ease into walking with the boot on in early February. After a week or two I begin to put my shoe on for an hour a day and increase the time until I start walking normally. Again, absolutely no improvement in pain levels. Essentially another wasted 2 months. At this point my doctor starts to recommend a cortisone shot in my foot. I really strayed away from this because I am not a fan of cortisone shots for my own reasons – I got one in my knee before and it did nothing and the potential negatives can be permanent (cartilage breakdown, fat pad atrophy – especially scary around a heel bone) while the chance of temporary benefits are not guaranteed. So I didn’t talk to the doctor for a month and kept on a regimen of exercises and stretches that I have so easily memorized thanks to years of PT. It seems that some orthopedic doctors love to push cortisone as an option when there is no other answer and I felt this is what he was doing. Not to say it doesn’t work for some people, I was just a pessimist that really didn’t believe it would do anything. At this point I also considered chiropractic as a potential treatment and was referred to an SLC chiropractor by a friend, but he respectfully informed me that he didn’t believe there was much he could do other than provide me with a few stretches he gives patients with plantar fasciitis (which I already knew plenty). However, when injured and searching for a solution this long, when a month goes by and you haven’t been actively pursuing other options you feel pretty useless and like you have lost precious time that will keep ticking away. So after a lot of pushback, on March 1st I finally decided to give the cortisone shot a chance because I had little to no other options. Again, no improvement in pain a month down the road. This is when I start losing it, it’s coming up on a year since I originally injured it and nothing is changing. Graduation is coming up and there is so much shit I have to deal with I can’t even focus on my foot. With no improvement in pain, my doctor wanted to see if the fracture had made any progress healing since the 2 months of non-weight bearing in hopes to see if we could isolate the cause of pain. I managed to get in for another MRI on April 27th. A couple weeks after all things school died out I got back into my doctor. He informed me that there was a little improvement since the last MRI (in that the fracture line wasn’t as noticeable on imaging) but that the calcaneus fracture still had not healed. At this point he gave me two options, subchondropasty surgery (essentially they inject calcium phosphate into the injured bone area to create a bone substitute) or a bone stimulator (a device that sends a pulsed electromagnetic field into the injured area to help jumpstart the natural healing process). I have said that I will do surgery as a last resort if it really comes down to it but I want to exhaust all conservative measures before cutting open my foot – noting my surgical history. I guess this is as good a spot as any to mention that this fracture is in my left heel, the same side that I tore my ACL on years prior. However I think this is a small detail, it may have played a role in the initial fall in that my left leg may have been weaker and not as amply suited to support and provide the necessary cushioning for my left foot, but I don’t think it is holding my foot back from healing. If anything, my foot is keeping my leg muscles from staying strong because I can’t be as active I should be. I researched two other doctors to get second opinions. Both didn’t think surgery would be a good idea. The fracture was small and didn’t need screws or any restructuring of the bone. They weren’t huge fans of the calcium phosphate product that is injected either. However, they recommended custom orthotics and when told of the bone stimulator said it can’t hurt to try. I checked back with my doctor and he gave the go ahead on the bone stimulator along with the custom orthotics. So here I am, currently using the bone stimulator 3 hours a day/every day since July 13th and wearing custom fit orthotics since July 26th. I haven’t noticed any improvement yet. Looking at how my foot has responded to all this prior treatment, and how it feels every single day I walk on it, I am not very optimistic. But I don’t want to sell myself short and will keep trying. My plan is to run this treatment out at least 3 months to give it the time to actually produce results.

So this is where I stand. After all this time and treatment, my foot still hurts all the time. It has gotten absolutely no better. I even quit drinking for just under 2 months this summer to see if that would do anything. I knew it probably wouldn’t, I really just did it on principle, so that another year down the road I’m not saying hmm maybe I should have tried that. There are days when I think it has gotten worse, but ultimately I think it has stayed relatively the same, maybe a little worse just due to the elapsed time I have continued to be on it. I personally think I never gave my calcaneus ample time to heal at first/was 5 months too late to the game in legitimately completely resting my heel and pushed it into a mal- or non-union (which the bone stimulator advocates claim it can help with) and likely experienced some permanent atrophy of my heel fat pad. Over the past year all I have done are a few hikes, biked a decent amount, walked, and not enough swimming. Hiking is pretty miserable, the pain is the worst out of any activity I have done. I didn’t do it all year except for two times the family was in town and I wanted to show them around and no more than 10 hikes during a period after graduation and before I started work where I was losing my mind sitting around all day long. I have biked a good amount throughout the year - mostly to school, some to work, and other times just to friends’ places or around the city. As much as most people would think that biking would be pretty painless because of no impact, it bothers my foot more than I’d like to admit. But I can’t allow myself to do absolutely nothing when I have already done the complete rest and no weight bearing regimen with no improvement. And biking is likely the best exercise I can get with the least pain, it’s a trade off. Again, I also believe that biking will not make my foot any worse because I have gone through spells of biking for 2 months and being completely non-weight bearing for 2 months and come out feeling the exact same. Although my foot has been hurting a little more lately, I think probably from the quick spurt of hiking I did, so I have stopped biking as a commuting method and am currently trying to stray away from it. Maybe once a week for a short ride. With pursuing what seems to be the last option for conservative treatment at my disclosure, I am really trying to rest my foot within my means so that this treatment has the best opportunity to produce results.

I know this is way long and most people won't make it through it all, but if you managed to, I appreciate it. I'm just trying to take a chance on getting the word out to anyone, especially skiers in this case, because I'm stuck. If you or someone you know has been through a similar situation, whether that specifically be a non-union/mal-union calcaneus fracture lasting over a year, heel fat pad atrophy, various foot issues, or even just chronic pain relative to fractures anywhere, I am more than grateful to hear any suggestions, advice, or would enjoy a conversation. Thanks so much, peace.