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My Right Toe

Sunday, April 8, 2012

D'jever notice how, when everything is coming down all at once and you're scrambling like a long-tailed cat in a room full of fiddlers, that's exactly the time your body chooses to say, "Slow down there, cowgirl, you have to sit down sometimes, too."

Would that it were something I could catch and then get over. Usually that's how it goes down. You get sick when you overdo it. Not me. Nah. What my body came up with is fancier than that: hallux rigidus, or osteoarthritis in my right big toe. Which doesn't sound like a big deal unless you have it, and then it is. As someone helpfully pointed out in a Facebook thread, "Hey! It's not cancer!" Which is true. It's not. It's something else, though.

I had it coming to me. I run every dang day. Or make that, I ran every day. I loved it so much. I got out there no matter the weather and I knew by the temperature and wind speed exactly which fleece or long-sleeved tee I'd wear. 51 and sunny? Short-sleeved tee and the gray fleece I got in a Woodward, Oklahoma Walmart, ugly but functional, perfect for running. 48 and misty? Long-sleeved tee and that same fleece. 34 and windy? Put the blue Nike jacket over the whole ensemble. And out I'd go and I'd listen to the birds and see who was singing and who had arrived or maybe who had just left and I'd come home and scribble down three or four haikus, every time. I'd have my morning to-do list completely figured out and I'd bite into the day like a hungry gator, spinning and twisting off big mouthfuls of my to-do list, gulping them down and reaching for more. That was running, and me.

When I was about three my dad was cutting a big tree in our yard in Kansas City Kansas and he misjudged how it would fall. It spun on its bole and came down right on top of me, standing safely with my sister way out and over to the side. I was freaking out and screaming because I wanted so badly to run away from that tree; I was terrified but my mom told my sister to hold me tight so I wouldn't get hurt and BAM that tree fell on me and smashed my right foot to jelly. I can only imagine what my parents felt as they lifted that huge limb off my back, wondering if they still had a youngest girl. They did. I had a stripe all the way down my spine where the bark had taken the skin off, and I had a cast up to my hip all summer but eventually everything healed OK. Marked by a tree. Not for the first time.

 For 50 years, everything was basically OK. In the meantime in the late 1970's I was a contra dance gypsy for three summers and I piled in cars with a bunch of other young hippies in tank tops and long cotton skirts and felt crusher hats full of feathers and pins and flowers and we went from dance to dance all over New England. I had the smoothest swing of anybody and the pivot point was the metatarsal joint of my right big toe. I wore holes through my tap shoes and patched them with duct tape, right there under that big toe joint on my right foot. And my feet hurt after a dawn dance but everybody's feet hurt after a dawn dance. Especially when you've been leaping for the rafters in great balletic arcs in your talented partner's arms and landing on your right big toe.

me and my best friend Ruth who has also gone on to be a musician and mother and is one of the most hilarious people I ever knew. Martha's Vineyard, ca. 1977

Years went by and the dance gypsy became a renter and then a homeowner and along the way I dropped a refrigerator shelf I was washing, on edge, right on that same metatarsal joint and it hurt like hellfire. And then one night in the late 90's we were having a music party and one guitarist got excited and tipped over a tall CD cabinet and guess where the knife-sharp top edge landed? Yep. On my right big toe, neatly separating the metatarsal joint. I lay on the floor in a fetal position and bawled like a baby, didn't matter if there was a party going on or not.  It was as if Fate had its fingernail right on that one toe of mine.

Enter running, two years ago this July, and in finding my bliss amidst the mist and the rain and the cold and the warm and the birdsong I finally wore out all the cartilage that was still left to pad that joint. And for the past week I have had exactly one night's sleep. The rest, nastily diced up by shooting pains in my big toe joint, pains like there is a crazy leprechaun with an ice pick and he's driving it into my poor old foot and the tears just roll down the side of my face and the leprechaun just laughs at 800 mg. of ibuprofen. He just laughs. And he saves it for the middle of the night, usually 11 pm to 4:30 am, go figure.  I had no idea what was going on but by dawn of Good Friday by God I was going to find out. I found an orthopedic surgeon who would see me the same day and the kind nurse X-rayed my foot and said, "I don't see a bunion, but I do see arthritis." And the doctor seconded that, and showed me how the two faces of the metatarsal joint were not nicely rounded but flat against each other, banging together with each movement, and even looking at the X-ray hurt. There were some little bone spurs like shark fins which were to be expected, but he said all the pain was coming from that worn-out joint.

Then, speaking of hurt, he laid me down on the gurney and took out a needle and shot cortisone and Lidocaine right into that poor old joint and I thought of every foul word I have ever heard but somehow didn't yell them at the ceiling. I squeezed the kind nurse's hand very hard and she got me through it. It was a giant paper wasp with its stinger driving right in the tenderest, most abused part of my body. But whoops! it was Good Friday and it was time to fill the Easter baskets so I spent the next five hours after the shot running all over town buying stuff to put in Easter baskets, my foot quickly swelling past recognition. By the time I got home I was hobbling and by evening I was crawling and by night I was flat on my back weeping and Bill made dinner and Phoebe dug some Vicodin out of her cabinet, left over from her wisdom tooth extraction and I took one and last night I finally slept, slept the sleep of great dead singers and people without osteoarthritis in their toes. And the leprechaun went away.

But he'll probably be back in three months, which is how long a shot like that lasts. In the meantime I have to figure out what to do about it all. Do I stop running? (You might as well ask me to stop watching birds and writing haikus and leaning against old gravestones and thinking).

 Do I walk? Do I slowly lose my mind? Do I schedule a surgery where they'll screw those worn, flattened metatarsal ends together so nothing moves? Do I borrow a bit of cadaver cartilage and have a surgeon put that in there? I pore through papers in the Journal of Podiatry and the surgeons are in total disagreement as to what to do with "young" active runny adults like me. Fuse or implant? The one thing they agree on: It doesn't get better. Well, I don't want to be around when it gets worse. Because that stank. It isn't cancer, but it stinks.

Just this evening (Saturday) I have gotten up out of my chair and have forgotten my toe ever hurt. Which is a beautiful thing, even if it's cortisone-induced. I don't know if I'll run again. I sure want to. It's already shot, that joint. Will running make it worse?

It scares me, the thought that some doctors want to use screws and some want to use cadaver cartilage and nobody seems to have the answer. Nobody seems to know what to do with my poor big toe joint. Except the leprechaun, and he'll be back.


You're such a cute, cute hippy dancer.

That toe might stop you in your tracks for a few moments in time, but I doubt you will allow it to slow you down much. Your mode of locomotion may change a bit, but you will find the pot of gold that wicked leprechan is hiding.

Happy Easter to you and yours.
Wish there was a way to retire and be your assistant.

(but you already have the very best assistants with Bill, Phoebe, and Liam)
Kathy in Delray Beach

Posted by Anonymous April 8, 2012 at 3:23 AM

I hope (assume?) you've already looked up your condition on Google and YouTube - I find there's a ton of info available (more than my docs ever provide) on the Net for any new ailment I experience (you still have to separate out the junk info from the useful stuff). Good Luck!!! (we 'feel your pain')

On a separate note, I'd like to think mini-rants in comments sections do some good (though no doubt just coincidence): yesterday I finally found a newly-minted stack of your book at my local Barnes/Noble -- Hooray!

I know your pain all too well. I missed all birding trips, hiking, and running last year thanks to a bunion. Cortizone didn't work for me and I finally got it fixed (shaved off some bone, moved the bone over, put in a titanium plate) and after six weeks I get my cast off in 8 days. Much like you I'm sure, getting out is more than just exercise for the body for me, it's exercise for my soul and brain.

How about a mountain bike? When my foot was screaming it's the only way I could get out into nature pain free. You can travel the same gravel roads as on your run, but go farther in less time. You can even carry a camera. I'm already staring longingly at my bike, hoping I can get out there before the warblers finish passing through.

Most of all, good luck with that toe!

I will have to Google "contra dancing".

I think all of your fans who care about you, not just because of your amazing product, but because we have come to know you and your wonderful family,even virtually, ... feel some of your pain.

I predict the comments on this post will be long ones.
Mine is.

Your toe has led an amazing journey so far in it's young life ... like some retired Navy Seal recounting wounds and harrowing exploits.

I feel for you on the decision making side too.

As for screws ... I have a titanium one in my finger after a almost complete amputation. It held a severed phalange together during healing and is now part of me.
Verdict: not even aware of it anymore.

Fusing: No experience there.

Cadaver tissue: Once years ago, a dentist wanted to pack cadaver bone into a mandible socket left from a tough wisdom tooth. I put it off, because it creeped me out.
In the meantime the cadaver lab was busted for horrible mishandling of corpses...blechhh.

The good news is that I just bought my copy of "The BB Effect" for Mother's day, so you will be able to pay for whatever solution you choose.


I love the picture of the two pretty girls with the strikingly handsome yellow dog in the background.

jeez, what a painful read for those of us who live, in part, off your inspired/inspiring energy...sending healing vibes and confident that you will turn disability into something life-enriching, as you have, on your blog, already begun to do.

Posted by Anonymous April 8, 2012 at 7:29 AM

Well, from someone who had reconstructive surgery on their foot 2 years ago... find a GREAT surgeon. I had a majorly big bunion and due to the pronation of my foot, they fused the joint at the center of my foot (two big titanium staples) and took a couple of slices out of the bone leading to the big toe (3 screws in big toe). No weight bearing for 3 months, etc. but now, two years later, I'm walking better than I have in too many years with only very minimal pain when I have been on my feet too long. I'm convinced getting the best surgeon is the key.

I can also say that I should have had the surgery years earlier. So that's another suggestion, don't put it off because you don't want to deal with the surgery... it will just exacerbate the situation and take longer to heal when you do have something done. Figure out a space in your calendar where it works and get it fixed!

Great idea on the mountain bike in the interim, too. Gets the wind in your face out amongst the trees and fills those spaces in your heart. ;0)

Sorry this is so long, as a long time reader I just wanted to let you know my experience in the foot department. Take care and good luck!!

I'm fortunate I have never experienced the pain you have but I did tear my ACL in my left knee about 10 years ago. I had the option to just leave it alone or the cadaver achilles tendon repair. I chose the repair because I expected to play sports that required lateral movement. The procedure was a success. No issues with the tendon or with the screws that keep it attached to my leg bones. Not the same kind of injury you've got but if the surgeon uses the proper materials (which most do), that part of it shouldn't cause you worry.

Mountain bike time. I don't run so well these days either, hips mostly, but by golly I can ride a bike! Mine's a road bike, and hey, you cover a lot more ground, still hear birds (yesterday it was White-eyed Vireo, Louisiana Waterthrush, and a very persistent Red-shouldered Hawk), and pack a lunch to boot. I figure you would do better with the mountain bike as apparently your roads are a bit less civilized than mine.

I severed a ligament
in my knee in college and I can't run either. Also have a bad hip.

I'd definitely vote for a hybrid bike. It's fast enough to keep you happy on pavement and grabby enough to keep you upright on dirt/gravel roads and paths. You can still get the endorphin rush - you'll just probably have to go 15 miles or so.

Sounds to be like it time to start going bionic.

Hope you can get back to a life you'll enjoy.

Shall we hobble together? I had a follow-up visit with orthopedic surgeon on Good Friday, deciding what to do with 63 year old knee which has torn meniscuses (menisci?)and a shredded ACL. I hopped off the front of the stage at school and did 6 things to my knee. Lidocaine and cortisone is lovely, isn't it. It has helped, as is physical therapy, only surgery that will fix it is knee replacement, but not yet.
I am too stubborn to let it win, you too, I bet.

Hang in there, happy spring, have you seen your Planting Bird yet?

Haven't we gotten to the point where we can put synthetic cartilage in there? So disappointing.

Keep us posted on developments.

Myself, I'd avoid the fuse. That'll probably require you stop doing most everything. Had a friend just got the top bits of her spine fused. She can't twist her spine. Sucks something rotten, all the things she can't do now.

Wish the best for you. Maybe technology will come through?

Really sorry to hear about this development, Julie! I hope you find the best possible solution to facilitate your mobility and your life, in the way you choose to live it. :)

As far as this condition not being cancer, I realize that was a shot of perspective from an FB friend. But, I've lived long enough to understand the repercussions of many things that aren't cancer but which, nonetheless, cause debilitating stress and distress. I wish you speedy healing, in whatever form it takes.

I know what you're feeling. I have osteoarthritis in several of my toes. I can still get out and walk and sometimes I can run, but I pay for that.

The old school doctor recommendation is that if you are doing something that hurts, you should stop doing it.



Oh well this sucks. I'd say get some opinions from orthopods that specialize in sports medicine. And I'd get more than one opinion. As you're seeing there's not always agreement among surgeons about the proper course of things. Lay people probably find this curious but the truth is that medicine is as much art as science and there are a lot of variables to consider. Hope you find your answer that makes most sense to you and your lifestyle soon. I believe that's the key, to find what works for you. And yeah, Vicodin is a good thing for the Leprechan kinda pain.

Hang in there, sister. You'll find a way out.

Wow, Julie, you've had some big time accidents and pain. So sad that it's all coming together in one giant achy joint. So not fair. Not sure why, but I vote "no" on cadaver cartilage. As Jenn in an earlier comment asked, "Haven't we gotten to the point where we can put synthetic cartilage in there?" My mom had cortisone injections in her thumb joint for years. It worked; she could take the tight lid off of jars when she needed to. I always check the Mayo Clinic website for the latest medical interventions and advice. Maybe they'll have some info for you. Wishing you much pain-free good luck.

I have been prone to "gout" off and on for several years now, and I usually get back on track by riding my bicycle. No heavy pounding of the knee or ankle joints or stubbed and injured toes. Good Luck! And, also, I have just finished reading "The Bluebird Effect". Several good stories in there. I especially appreciated the ones about the ivory-billed woodpecker and the turkey vultures, two of my favorites. I live in a very wooded area next to part of the Hocking State Forest and we have many pileated woodpeckers around. JPL

Posted by Anonymous April 9, 2012 at 3:44 PM

Both my big toes are fused and no pain!!! But no running, marathons, or tennis or racket ball or rock climbing. Everything else is great! Everyting else except fusing is just temporary relief. But the fusing takes 3 months with 2 of them in a large cast. IN the begining the pain is awlful but the vicoden takes care of it. I'm just saying. Leah in Cali. happy at last.

Ah, what frustrating news, Julie! And the sort that there's really no getting around. Sounds like lots of folks have left good suggestions and shared experiences to help guide your decision, though. Good luck with it! Hope you're back out traveling your road again soon; I know just how useful that time is for thinking and planning, as I do the same.

I've met that leprechan! I had osteo in my left toe and now I have a pin. For me the surgery was worth it because now there is NO pain. I suggest putting it off until early winter because you can't fully walk on it for about three months. You don't want to mess-up your summer, fall and spring. Also my husband got me an inexpensive stool with wheels (doctor style) and I was able to easily get around the house.


Posted by Anonymous April 9, 2012 at 10:37 PM
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