Post #1 - Deciding to to have surgery

Due to the pandemic causing the cancellation of the Anglo Celtic Plate 100km at the end of September, my wife and I (4 months pregnant) decided we'd walk the West Highland Way, a well-trodden 96 mile walk from Milngavie to Fort William.

The last 5 miles on the final day was the moment I decided to have surgery on my right foot. It was so sore I decided to text Ian Reilly in those last painful miles, he is a an expert in podiatric surgery based in Northampton (https://podsurgeon.co.uk/) that had previously excised a giant Morton's neuroma (3 x 2.5 x 1 cm) 12 years ago in my left foot and who I've kept in touch with since. Perhaps apt it was that on arrival at Fort William, Katie and I got a picture alongside the famous 'sore foot statue'. I really knew his pain!

The route wasn't much of an endurance challenge at all but the terrain of stony and uneven ground proved challenging for my feet generally. This picture shows how swollen they were generally ('Hobbit feet'), but in particular the bunion and Haglund's deformity on the right foot and the associated corns caused by compression at the forefoot were really sore. Rubbing my feet in the last 5 miles was a carbon copy of the sore foot statue !

There pains were what I'd been experiencing over the last 1.5 years. Training for the 100km and trying to maintain some faster running proved very challenging. Both anatomical issues are caused by excessive bone growth, which isn't going to go away, so all you can do is manage this with ice, strength training, massage, foot wear and painkillers. Below I describe each issue but certainly the bunion came first and has grown slowly over the last 6 years with a pretty much steady ramp up in just seeing it, through to real pain and struggling with foot wear currently. I am not an expert in podiatry but would imagine this much dysfunction at the front of the foot could potentially cause changes in biomechanics at the rear of the foot, causing irritation, inflammation, bone growth and bursa formation as this becomes continuous.

Bunion - *warning* graphic images of injury

Below are images showing my bunion prior to surgery which has probably progressed over the past 6 years. A former long-term coach and good friend, Andy McNeill always used to go on about his bunions and I think back 6 years ago I started to see some signs on my foot, but I was in denial. Its fair to say there is some genetics at play (my mum had one and my grandmother had fantastic ones), but there is no doubt trauma caused by running will have accelerated this. Running excessively on a joint like this will likely cause some arthritis and symptoms worsen.

There are various methods to do surgery on a bunion (aka 'Hallux valgus' to use the pod lingo) and Ian is an expert in the open-surgery method of performing a variant of the typical scarf method and performs a 'trotation scarf and Akin osteotomy' to correct this the misalignment and bone growth. Here a paper he's an author on Lopez, F.M., Reilly, I. et al (2015). This paper is great to show you what he does. This video I've found is more of a generalisation but you get the gist. There are other techniques that use key-hole and are less invasive. I've gone for the open and more invasive technique as although the rebab is longer (6 months+), it means Ian can potentially do any required soft tissue work which will become important in foot strength and structure further down the line. Given I have rheumatoid arthritis we weren't sure on how much arthritis there would be and an open method seemed to allow more opportunity to secure the bones in place (small screws).

Haglund's Deformity - *warning* graphic images of injury

My understanding is that this is largely a bone growth on the posterior (back) and lateral (outside) side of the heel bone. As previously mentioned, this may be related to the bunion. But for this blog, I noticed this growth start about 2.5 years ago, this was fine for a year without pain. This also appeared with some hard skin just below. As the bone is put under continuous aggravation this causes inflammation which over time forms a bursa, which extends the inflammation around the heel. I don't believe its classified as an Achilles tendon issue, but the inflammation is located around here and so often confused. It would often balloon up after longer runs or faster runs and be stiff in the morning. Endless icing never seemed to do much. One of the biggest mitigations was actually not wearing shoes while driving as this always brought on the worst pain, particular proper shoes driving to Glasgow! I used to wear a soft shoe or similar instead and really helped, but eventually the deformity has become limiting.

I had a steroid injection by Ian Reilly in December 2019 (see below), shortly after winning and returning from the (Honeymoon) Bahamas half marathon (http://www.bahamashalf.com/ ) a fantastic race with generous prize money (useful to pay for surgeries). I rested for 2 weeks and it did give a lot of relief for 2-3 months. The photos show the decreased inflammation by 27th December. The bony growth was still there and despite icing and rotating foot wear and a progressive return to training it seemed inevitable when the pain and swelling returned in March. As well as a Haglund's I also have 'insertional Achilles tendonitis plus retro-calcaneal exostosis'.

Aside from pain and restrictions to me not being able to train to my potential (sore feet being the limit) to obtain a level of fitness that I'm capable of, there are other factors which have motivated me to evaluate the balance of risk/benefit over surgery prior to pursing it.

1. Morning pain - its tough when your feet are sore from that moment you step out of bed every day.

2. SARS-Cov-2 pandemic & race calendar - racing schedules won't be back to normal for some time and training for ultras is a tough commitment with not much on the horizon. Using this time for surgery seems sensible. Adrian Stott (Run & Become Edinburgh, GB ultra coach and good friend assures me "My Best years are still to come!". Extra fuel to have a long term approach and use this downtime wisely for the benefit of the 'long run'.

3. Baby due in February - getting this done 3 months before gives me a sufficient window to get back on my feet while Katie is still physically able to look after me (as a "big baby") before its my turn to look after her.

4. Other issues - I've had an ankle impingement on my left foot since April. Lack of access to physio but also a greater reliance on my left foot has properly overloaded my posterior tibial tendon resulting in the impingement. I am pretty confident an enforced rest of months will help significantly with this issue.