…so sang the inimitable noise rock duo, Happy Flowers on their 1987 album, My Skin Covers My Body, which also featured timeless chestnuts like “I Wet the Bed Again,” “Jenny Tried to Kiss Me at Recess” and, of course, “Why Didn’t You Tell Me You Were Bringing Home a Baby!” While the `Flowers wrote blackly comedic songs from the perspective of a vexed, psychotic four-year-old, there was indeed an element of foundational truth to “If It Was Broken, You’d Be Screaming.” An expression widely shared in the wake of sudden injury, it's essentially conventional wisdom. When you break a bone, it’s usually pretty obvious.
Alas, as it turns out, and in doubtlessly many-if-not-most instances, you shouldn’t really rely on the medical counsel of the Happy Flowers.
But let’s back up, a little….
Well over a goddamn year ago, if not more, I started feeling an odd sensation in my left foot (with apologies to Daniel Day Lewis). Initially it felt, while walking around on it, like my sock was bunching up around the toe, and the “ball” of my foot was being uncomfortably compressed, in some way. Closer scrutiny routinely revealed this not to be the case, but my foot continued to feel different. With each step, it didn’t fall and land the way it previously did. It didn’t hurt — but it didn’t feel right. An expensive chiropractor I was consulting, at the time, indeed agreed that the foot appeared to be “rolling” a little. That guy ended up prescribing a pair of very expensive and roundly uncomfortable orthotic insoles that I maybe wore for a few weeks before abandoning.
But the weird foot problem continued.
I then consulted my primary care physician, who upon examining the exterior of my foot, said he couldn’t detect any readily discernible problems. It was also around this time that I was experiencing, as recounted in this brow-furrowing episode, this weirdly recurring blood-rushing-in-my-feet sensation. I speculated to my doctor that I might have gout, given my heroic intake of beer and such. He basically laughed that off, underscoring that — much like “if it was broken, you’d be screaming” - if I was experiencing gout, I’d fucking know it (gout is reportedly mega-fucking painful). “Alex,” he sighed, "you think you might have gout because, let’s face it, you think you deserve gout.” He has my number.
I never got a concrete explanation as to why that blood-rushing thing was happening, and it eventually went away. But not the ball-of-the-foot problem. That continued.
I then went to see an allegedly proper podiatrist recommended by my primary care physician. For the sake of this fraught narrative, this podiatrist will henceforth be referred to as Dr. Quip. I went in to see Dr. Quip who, as his alias might suggest, was quick with the wisecracks. I started explaining to him my problem with my left foot, and he basically interrupted my typically epic-poem-like saga, blithely informing me that what I was experiencing was “in all likelihood” a condition called “second toe capsulitis,” which, if I understand it correctly, is basically inflammation of the soft tissue in the ball of the foot. That certainly sounded plausible, and I was heartened by his immediate recognition of the problem.
In terms of next steps (pardon the pun), he said that a confirmation of that diagnosis would probably require both x-rays and an MRI, but being that it was probably capsulitis, I should just go ahead and order this other pair of orthotics (“you can get’em easily from ol’ Jeff Bezos" … hilarity) and, along with regular stretching, it’ll most likely clear the problem right up. I hit up Amazon and got a pair the very next day.
I dutifully inserted these new insoles -- considerably more affordable that my chiropractor’s ones -- into my sneakers and started basically wearing them exclusively while also regularly stretching my left foot. Unlike the previous insoles, I acclimated quickly to the new ones. The theory was that it should take about five or six weeks to alleviate the issue.
Despite my really wanting this treatment to clear up the problem — it just didn’t. Six weeks after first wearing them, my left foot was still inexplicably stiff, sore and frequently numb. But, at the same time, life was suddenly very busy again, with family issues, work demands and other stupid shit vying for my time and attention. As a result, I didn’t get the opportunity to get back in touch with Dr. Quip until a few months later.
I told him that the insoles weren’t really getting me where I needed to be, and that I was still experiencing this regular discomfort (that was actually getting incrementally worse). Again, he repeated that an MRI would really be the deciding factor, but I couldn’t do that until I’d had x-rays, so … x-rays were next on the docket.
Despite the predictable pushback dance from my frankly shitty insurance company, I managed to get coverage for x-rays and hobbled over to NYU Langone to get those radioactive pictures snapped. Those, in turn, were sent to Dr. Quip, who leisurely got back to me a few days later saying that they basically told him nothing new, and that the MRI was, again, the ticket.
As before, my insurers were pronouncedly reluctant to cover this cost, and issued disarmingly swift notices to this effect, cruelly asserting that, after supposedly reviewing the specifics, they didn’t see any tangible necessity for an MRI. In a rare moment of professional tenacity, Dr. Quip made a more compelling case to them and secured authorization, and we were off to the races.
After breathlessly showing up at the specified radiologist’s office for an after-work appointment on the other side of town, however, it was gleaned that giggly Dr. Quip somehow forgot to send them the prescription order, bouncing the appointment to the next day. Oh joy.
I eventually did get that MRI — and hoo-boy, I don’t know when the last time you had an MRI was, but that shit is LOUD — and those results were also then sent to Dr. Quip. After two or three days of my peppering his inbox with questions via the Patient Portal (or, in my case, the Impatient Portal), he wrote back the following…
“hey, it appears you have an avn, which means one bone in the bottom of the foot most likely was broken at some point and stopped healing/doesn’t have enough blood supply.”
Johns Hopkins has a slightly more grave-sounding take, as is their wont,…
"Avascular necrosis is a disease that results from the temporary or permanent loss of blood supply to the bone. When blood supply is cut off, the bone tissue dies and the bone collapses. If avascular necrosis happens near a joint, the joint surface may collapse.”
So, all that capsulitis stuff? That was basically a big fuckin’ snipe hunt.
I walk a lot. I walk forty-five minutes to my office every morning, and forty-five minutes home from my office every evening. On the weekends, I walk all over the goddamn map. I don’t run. I don’t go to the gym, and I only really ride my bike during the summer. My biggest physical outlet is walking, and I’ve apparently been walking around with broken bones in my left foot that are slowly eroding for, again, well over a year or more. While I’m completely capable of heroically injuring myself in any number of stupid instances (this one springs to mind), I have absolutely zero recollection of ever doing anything to, with or on my left foot that could have possibly resulted in the breaking of a bone therein. Once again, I figured that, if it was broken, ….I’d be screaming, but nothing like that ever happened.
Limping forward, the next step is a new kind of pad beneath the problem area in the short-term (and I’m about to depart on an invariably walk-heavy vacation, in a couple of weeks), followed by — in the long-term — probably a “cam boot” or “walking boot” for god knows how long.
Rant over.
Just remember …. just because you’re not screaming doesn’t mean it ain’t broken.
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