That little bump (“bony prominence”) on the back of my heel, called a Haglund’s deformity, has plagued me off and on for a number of years now. It’s been the cause either directly or indirectly of most of my injuries. The bump presses on the Achilles tendon causing soft tissue inflammation which then sidelines me from running and other activities for months at a stretch. Things flared up particularly badly a couple of years ago but my excellent sports podiatrist, extracorporeal shockwave therapy (ESWT), and a hiatus from running brought complete resolution. A glorious stretch followed where every run was a joy and I seemed to set a new PR every time I raced.
Around a year ago, with little warning, the familiar telltale tightness in my heel returned. It seemed less severe than in previous episodes so I initially tried to run through it while getting the ESWT that had worked so well before. Quickly though, I found myself sidelined by knee pain from unconsciously compensating for my altered ankle movement. Months passed with occasional short test runs where it would seem things were improving slightly only for my heel to rebel soon after, not only from running, but also walking on the beach, up any incline, and sometimes for no obvious reason at all.
One of the trickier aspects of this injury has been that my heel never hurt when actually running. A few minutes into a run all discomfort would disappear only to rudely announce its return hours later. Then one day in September when attempting a short easy run, I felt a sudden sharp pain half a mile in which left me limping for weeks. I realized things had turned a corner, but definitely the wrong corner. Having already tried and exhausted all conservative measures (multiple rounds of ESWT, low level laser therapy, ART & Graston on my calf, constant icing, NSAIDs, months of cessation from running, all manner of sacrifices to the running gods), it was time for surgery.
There is something deeply counter intuitive about being fit, healthy, and perfectly ambulatory yet actively seeking someone to cut you and render you unable to walk for many weeks. Yet, here I am. Running has been my solace and constant companion for so many years. While I love the social aspect, the health benefits, and feelings of challenge and mastery that come with hard workouts and races, it’s the mental release and clarity that most of all I don’t want to live without.
During prior injury periods, the loss of running has left me bereft, with the sort of grief felt after a relationship breakup. Since that day in September, I haven’t run at all except for a quick jaunt around the block twice on Christmas Day which felt immediately intoxicating but left me no doubt later that day that my heel was not better at all. Somehow though, I have coped unexpectedly better this time around. Swimming and cycling with friends both new and old has filled the void much better than before. So much so that I can’t remember why I stopped doing triathlon in the first place. I have also been able to better appreciate the great blessing of my otherwise excellent health and fitness.
The last few months have also made clear that my heel is not going to hinder just running. After two weeks in New Zealand going on the typical walks my family does for nice day out, my heel had become progressively more irritated. A couple of hours walking on only moderately hilly terrain with my (very fit but over the age of 70) parents would leave me limping by evening. It made me realize that the epic hikes and overnight backpacking trips that my husband and I like to do would not be realistic in my current state. All of which has brought me to a date with a foot surgeon this coming week It’s actually been on the calendar for months but until very recently I still believed I would avoid it. (I’m an adherent of the principle that there is nothing like scheduling a medical appointment to make something heal on its own).
I’ve seen Haglund’s surgery described as “a simple surgery with a long recovery” and that seems about right. In my case, the surgeon will split my Achilles tendon, smooth down the bump, clean up and repair anything else going on in the heel, anchor the tendon, and sew it all back up again. I’ll be in a cast and then a boot, and will be non-weight bearing for 4-6 weeks. The first 3-5 days (at least) I’m supposed to keep my foot elevated above my heart as much as possible, i.e. I’ll be stuck inside on the couch the whole time. I’m most worried about this aspect of recovery. I loathe being stuck inside all day and struggle to make it through a movie without getting up to walk around. The foot surgeon has emphasized to me that the better I am at resting and keeping my foot up during this stage the quicker the incision will heal and the quicker I can get back in the pool. Talk about an incentive. Hopefully that exciting development will happen around week 2. I am trying however not to get too focused on exact time frames as I know I’ll end up massively disappointed and distraught if things don’t go according to plan.
I have acquired multiple modalities to navigate my non-weight bearing period: the iWalk, a knee scooter, and regular crutches (the forearm variety, not the dreadful underarm kind which, like the imperial system, the United States clings to despite the rest of the world having moved on to a much better system). I’m extremely grateful that the iWalk and knee scooter will allow me to weight bear on my upper leg and thus avoid unnecessary muscle atrophy, and of course keep my hands free to do things. The inclination to plan and prepare is one of my most deep rooted qualities. In keeping with this, I have been practicing with all three modalities around the house for the last couple of weeks. Nothing can compare to having two good legs but I’m definitely going to be able to manage most things.
Around 4-6 weeks post surgery, I will start partial weight bearing, (ironically this means I will probably start using the regular crutches far more), and transitioning to full weight bearing over a period of weeks. After that there will be weeks of rehab to be able to walk again, then finally run. Oh, and did I mention this is my right foot? So, no driving for 6-8 weeks as I have to be able to brake sharply and forcefully without reinjuring my heel or causing an accident. This is going to be super frustrating but, thank goodness, we live in the age of Uber and I live within a few miles of two pools, the gym, Publix, and work.
I’ve seen various time frames kicked around for return to running. Accounts from those who have had the surgery vary wildly, but 5-6 months seems the earliest realistic expectation I should have. Both the foot surgeon and my regular sports podiatrist have cautioned that it will take a year to feel normal. It was this lengthy recovery that deterred me from even considering surgery in the past. When I’ve mentioned this time frame to several running friends recently, I’ve been met with shock and pity (an understandable reaction when you are still happily existing in a world where two weeks off running for a niggle is heartbreaking and a stint in a walking boot truly unthinkable). Since I really can’t run now anyway and haven’t in months, I’m actually quite at peace with this concept. I’ll be able to cycle (on the trainer) and swim in modified forms within weeks and will be able to do both fully and well before I’ll even be able to walk properly. In other words, life should get back to what has been my recent normal within a couple of months. Hopefully it will be an upward trajectory from there.