Light at the End of the Tunnel: Towards an Acceptable Level of Pain

While on a hard & fast walk twenty-nine days ago, I suffered an extremely painful foot injury. I call it an injury, even though no actual damage was done. Please allow me some time to explain. 

For the past year-and-a-half, I’ve been an avid walker and that habit has done me a whole bunch of good. My blood pressure is awesome after years of being pretty terrifying. I no longer have poly-ventricular contractions: extra, errant, unwanted heartbeats. My total cholesterol is “of the gods.” My liver and kidney functions score better than they have in decades – perhaps since I was a child. My A1C dropped from 7 to 5.9, and was low enough that I was able to quit the med I was on for diabetes. And – and – I lost 40 lbs in the process. 

All the above is the absolute best of results for any exercise program – my healthcare providers loved me – but these successes, via my walking regimen, came with a cost: foot-pain; recently, unmanageable foot pain. 

~~~~

Friday, July 19th, I was thirty minutes into an hour-and-a-half walk when I rounded a corner and felt explosive pain – stop-you-right-in-your-tracks pain – in my left foot. I couldn’t tell if it began from the bottom or the top of my foot, or if it originated on the inside and shot out in both directions, and I swore – literally screamed some pretty bad words – thinking that I must have broken a bone or snapped a tendon. Fortunately I was close to a trailside park bench and didn’t have to limp far. 

I feared my beloved and essential walking-routines had come to an end. 

I took some time off. I didn’t want to at all, and it aggravated my already and always-present depression, but I needed answers and figured changes were in order. 

~~~~

Imaging done during an appointment with a podiatrist showed no bones were broken and no tendons were damaged, but it was revealed that I have much higher arches than normal. I’d brought my walking shoes with me; the doc took one look and told me what I was using for my walks wasn’t supportive enough, and they were way beyond worn out, and they needed replacement ASAP.

The lack of support and length and intensity of my were great contributors to the pain I was experiencing. (I already knew my diabetic neuropathy was a big component, and the imaging that was done reminded me a fair amount of arthritis is present as well.) The podiatrist told me that much of the pain I was experiencing was due to the uppermost bone(s?) of my feet pressing on nerves and tendons more than they would if supported. This made sense to me as my pain was primarily on the very top of my feet and running down to the toes.     

The podiatrist recommended being measured/fitted for professional shoe inserts. He also prescribed a compounded prescription, a cream combination of 2% baclofen, 3% diclofenac, and 5% lidocaine, to be used multiple times a day as an analgesic and anti-inflammatory. The doc believed that this RX, along with new shoes and more supportive arch supports, would get me back to 90% ASAP. 

~~~~

During the necessary down time, I bought a pair of Brooks Glycerin GTS 20s. I dearly love Brooks shoes, but these were more cushiony than arch-supportive, so I ordered a pair of aftermarket Valsole high-arch inserts. The combination of the two went a LONG way towards providing pain relief. I have to say that I’ve been disappointed thus far by the compounded drug. I can’t say that it brought much at all in the way of pain-relief. I’ve talked to multiple pharmacists and they don’t see how that can be; they’ve suggested giving it more time.

This takes us up to now. 

Friday evening I did a brief walking experiment: five laps around a local park; forty-three minutes. I did quite well in regard to pain and felt empowered to try a longer and faster walk the next day.  

Yesterday, Saturday, August 17th, twenty-nine days after I experienced the worst foot pain of my life, I took an eight-mile walk in 90° afternoon heat. At two hours and twenty minutes, it was far from my fastest time, but not too shabby at all for someone in pain and having taken nearly a month off. I called it a roaring success and a great indicator of my being able to “get back in the game.” 

I intend to follow through on getting professionally fitted orthotic inserts, but that will take time and the cooperation of my primary care provider. (Medicare requires an MD signoff on such a request, and my podiatrist is not an MD.) I have a trusted friend who has such a business, so when my PCP gets on board I know who I’ll be going to.  

I’ll keep an open mind and continue to use – for now, anyway – the compounded RX foot cream to see if that takes me anywhere. I didn’t mention it before, but my PCP and I agree that we can play with the timing and dosage of the gabapentin I take for my neuropathy to see if that makes a difference in pain-control. 

At the risk of sounding fatalist, at 67 years-old and having diabetic neuropathy that's not going away, period, I’m resigned to the fact that some level of pain – maybe a fairly high level – is going to be a part of my daily life from this point on. If I can keep it close to where I’m at right now, I can live with that. Physiologically and psychologically, walking means too much to me to give it up without trying every remedy possible, first.