Sole Crusher: Cycling Was My Life -- Until the Pain Threatened It AllJan 19, 2023
The MRI is noisier than I expected. I lie here, perfectly still, and the machine hums, grumbles, creaks, and groans. I stare at the ceiling, hands clasped over my chest, trying not to move. One twitch or spasm, and I'll ruin the picture I desperately need.
I'm not inside the MRI. There's no blank white tunnel, and I don't slide into it like a human-shaped pizza. Instead, my left foot is clamped into a small box. Weights press down on my leg. I lie on the MRI equivalent of a massage table, staring at the ceiling, as speakers play the greatest hits of the 1980s.
"You're doing great, Robert," says Tom, the technician. He's standing in a little booth, and his voice comes through an intercom. "You know what, though? I'm gonna do that last one again. I didn't like how it turned out. Just sit tight, okay?"
I give him a thumb's up.
"These images are looking real nice, by the way," adds Tom. "Take 'em over to CVS and print 'em out. You can tell people, 'See, I'm beautiful on the outside and the inside."
I appreciate his avuncular riffs. Tom is a massive guy, like a bouncer in scrubs, and his speech is pure Boston. I assume he's made this same quip hundreds of times. Which is great; I need someone with a sense of humor right now, as we inch ever closer to a diagnosis.
The machine makes its cranky noises,and all I can do is lie here and think. What I'm thinking about is cycling, and whether I'll ever be able to ride a bike again. I can imagine walking with a cane, as weird as that would be at age 42. I could live with a limp. I could stand to stop and rest more often. I've already given up running and long walks.
But living without cycling isn't living. The bicycle means exercise, transport, therapy, balance. Riding down the street empowered me through childhood, a carless adulthood, and the COVID lockdown. On bicycles, I bond with my son; I socialize with friends; I go on vacation. I even write about cycling for national publications. Cycling is my bedrock.
All of this is at stake. And only this MRI can tell my future.
"I'm looking at these pictures," Tom's voice crackles, "and there's definitely something there. Don't tell the doctor I said so. She'd kill me. But there's definitely something there."
Yes, there is, I think.* But what, exactly?*
One night, about 10 years ago, I woke up with a terrible pain in my foot.
Specifically, a pain in my big toe. The pain was sharp and severe, like a nail being hammered into the joint.
I tried to flex my toe, which only made it worse. I slipped out of bed and walked around. I was delirious, and the room was dark. Movement had no effect. The pain throbbed for hours, and I lay awake, tossing and turning, till dawn.
The torment lingered for days. Desperate, I went to the Internet, typing, "pain, toe, night." The results flickered on screen: These were telltale signs of gout.
Gout? I marveled. Is that, like, a real thing?
I knew the word "gout," but only as a funny-sounding malady. I had no idea what it was, and I'd probably mistaken it for "goiter." Apparently, gout was a form of arthritis; when a person's bloodstream contains too much uric acid, it can crystallize in the joints.
Which made me wonder: What the hell is uric acid?
Gout, I learned, is nicknamed the "rich man's disease." Uric acid is basically a waste product, derived from the same word as "urine." Crystallization takes place when body temperatures drop, which is why attacks usually happen late at night. Anyone can contract gout, but certain foods aggravate the condition - foods that, in the past, only wealthy people could afford. Porridge and pears wouldn't provoke gout, so peasants were usually spared; but red meat and shellfish made flare-ups infinitely worse, causing certain aristocrats to limp around their chateaux.
At the time, I had no health insurance of any kind, nor did I own a car. My girlfriend dropped me off at a clinic called MedExpress, and I hobbled into the waiting room. When the doctor finally saw me, I described the symptoms and my own online research.
"Yep," said the doctor, scribbling into his clipboard. "Sounds like gout to me."
He prescribed an anti-inflammatory, told me to cut back on beef and beer, and sent me on my way. Two days later, I was walking with ease. The gout might flare up again, anytime and anywhere. But for the moment, I felt only relief.
For years, my diagnosis was little more than a funny anecdote. Friends told stories about asthma and diabetes, and I'd answer them with gout. Most people had some idea what gout was, or they even knew other people with the same issue. Gout was a harmless topic. It didn't have the gravitas of, say, Celiac disease or fibromyalgia. Gout was weird. Gout was quirky. It was bloodless and invisible. I could own gout.
I could also control it in simple ways. My girlfriend - now wife - was already a vegetarian, and we never ate meat at home. Seafood is delicious but expensive, easy to save for special occasions. I transitioned from beer-heavy nights to wine-heavy nights. I already exercised whenever I could; now I had an ongoing excuse to exercise more.
Flare-ups were rare, and now I had medication. At the first hint of discomfort, I popped some pills and stayed off my feet, and the aches faded. I planned my doses around major events, like big hikes and long runs.
But the routine had its flaws: When a certain six-mile jog resulted in a surge of pain, I retired my running shoes. No more jaunts around the neighborhood. No more half-marathons with my wife. I would miss bounding down the tarmac. But as long as I had cycling, all was well.
Then I switched doctors. My new PCP, Dr. Sharma, made it his mission to downplay my concerns - any concerns, about any ailment. My formidable snore was not life-threatening, and I shouldn't bother with CPAPs or surgery. (My previous doctor had been raring to operate). Contrary to one nurse's theory, the blemish on my eyelid wasn't xanthelasma - a sign of dangerously high cholesterol - but a simple sty, which could be treated with a warm towel. Dr. Sharma waved away my of my worries, which could be cured by eating fewer carbs and getting a full night's sleep.
Then he dropped the real bombshell: "I don't believe you have gout."
I cocked my head. "You… what?"
"You are not seriously overweight," he explained. "You do not have problems with alcohol. You do not eat too much red meat. There is nothing about your lifestyle that would lead me to believe you have excessive uric acid."
"But," I protested, "the pain in my toe? In the middle of the night? Isn't that, like, the main symptom?"
"This could mean several things," Dr. Sharma said in his unflappable tone. "And when there is an attack, you may use the same prescription, and it should work just as well. But I see no evidence that your condition is gout."
I left Dr. Sharma's office in a daze. I was elated, because I might not have a serious disorder that could spread and threaten my general health, as four previous doctors had agreed was the case. But then again, if I'd wasted eight years fearing something that didn't exist, what should I be afraid of? The pain could still return at any moment, whatever its cause. And if Dr. Sharma was right, then I had to unlearn everything I thought I knew - and start again from scratch.
Of course, the worst attack came after a bike ride.
The day was sunny and warm, so I rode for two hours, along a route I'd never taken. The road undulated through the countryside. I'd affixed fresh new tires, and I decided to ride fast, something I almost never do. I stood up, pumping hard up the inclines. I ground my soles into the pedals.
The ride itself was pure joy. My speed broke personal records, and I whisked past fields and forests I'd never seen before. I coasted through an old mill town, where the road intersected with a familiar bike path. I love this sensation - of exploring nearby places, breaking new ground, learning how disparate routes connect. Twenty miles later, I barged through my front door, euphoric.
The pain came slowly, like the aura before a migraine. I started popping pills, just as my doctor prescribed, but the pain escalated. Soon, I couldn't move my big toe without squirming. The ball of my foot was untouchable. I hobbled around the house, wincing and grunting. For days, my only relief was to peel off my socks, lie on a mattress, and breathe deeply. Tears rolled down my temples as I whispered to the empty room, "Stop. Please, just stop…"
But it didn't stop. Days passed, and fistfuls of Ibuprofen barely kept the agony at bay. I pressed ice packs against my sole, avoided all socks and shoes, and invested in a "booty." Still, the pain persisted, day and night, like an endless corkscrew twisting into my flesh.
At last, I relented. I would call a specialist. Whatever my affliction, I must find its cause. And treat it, no matter what the price - even if it meant never riding a bike again.
"The good news is, it's definitely not gout," declares Dr. Sousa, my new podiatrist. She holds an X-ray to the light and points at my lower foot. "These are your sesamoid bones. You have two in each foot, adjacent to your metatarsals."
I squint at the image. The sesamoids are tiny, perhaps the size of two chickpeas. They look so trivial, compared to the matrix of bones that surround them. Even the name sounds silly; I imagine a children's show about extraterrestrials called Sesamoid Street.
"As you can see," Dr. Sousa continues, "one of those sesamoid bones does not look healthy. You see how it's gray and sort of shapeless? That could be because the bone has experienced a stress fracture. But it's difficult to tell from this X-ray. I want you to do an MRI, just so we can have a clearer picture of what's going on."
A stress fracture, I think. But when? How? I've had flare-ups for 10 years. What was I doing a decade ago that might have cracked this little bonelet in half?
No matter. In a few days, I will submit myself to the MRI. A week after that, I'll finally find out what the hell was wrong with me.
My mind reels. For so many people, foot pain is merely inconvenient. But for me - a native Vermonter, a passionate outdoorsman - foot pain is an all-consuming curse. I love to tromp around the woods with my son, in any weather. I love to run and climb and wade into water. And I love, more than almost anything in life, to hop on a bike and ride.
A chronic foot problem threatens it all. I could operate a bicycle with one hand, or one eye, or one kidney. But I need both feet to push the pedals. Our feet are our foundation. Without our feet, medical science must go to great lengths - wheelchairs, prosthetics - to mobilize our bodies. A cyclist with a foot injury is a sadistic twist of fate, like Beethoven losing his hearing, or Degas losing his sight.
Which is a tough pill to swallow, but there's a much bigger pill, which must be choked down: I'm now middle-aged.
My body has stopped being young. My twenties and thirties are behind me, and I can no longer feel indestructible. I can't shrug off regular check-ups, as so many young males do. Yes, I've withstood athletic abuse for years; but now, suddenly, I can't. Wounds won't just heal. Aches will linger. Belly fat is harder to shed. I've never given much thought to blood clots and skin cancer, bad knees and colonoscopies, but now I have to. The thousand natural shocks are catching up with me. Just like that, I'm basically kind of old.
The bicycle has always been my insurance against old age. I could give up all sorts of physical pastimes, but not cycling. I imagine cranking the pedals long into my golden years. Plenty of septuagenarians still ride their bikes cross-country, and damn it, so will I.
Except - what if I can't? What if it's physically impossible? What kind of person will I be without the ability to pedal, let alone walk? I think about my last ride through the New England countryside, the freedom I felt, and the near-biblical punishment that followed. Should I expect every little excursion to result in debilitating pain?
I lie down and take a breath. That's all I can do, for now.
I fire up my laptop and type a search into Google. Seconds later, my screen is plastered with images - of hand-cycles. Athletes sit in recumbent seats, their fingers wrapped around hand-cranks. As they turn the device with their arms, these aerodynamic tricycles are propelled down the pavement.
Hand-cycles were engineered for riders with spine injuries and degenerative diseases. I don't have paraplegia, of course, and I would never compare my condition to theirs. But a hand-cycle is still an option. And this knowledge soothes me. One way or another, I will ride again, and on into my twilight years. There's a gadget for everything, and this could be mine.
I try to imagine it, flexing my way forward with biceps instead of thighs. This new form of exercise would take practice, conditioning, trial and error.
But my God, I'd be ripped.
I could deal with that, I think. Being ripped. Maybe this won't be so bad after all.
"The bone is definitely broken," says Dr. Sousa. "The MRI was very clear. But you have two options: a cortisone shot may be all you need. Or we can remove it."
In a matter of minutes, my terror fades. The bone can be removed. The surgery is routine and will take less than an hour. Dr. Sousa claims I can leave the OR the same day; I can even drive myself home. Recovery should take six weeks.
"You will have to wear an ugly padded shoe," she says, "but I've done this surgery hundreds of times, and only one patient had any problem at all."
One step at a time, I think. Literally.
I opt for the cortisone shot. and Dr. Sousa agrees. I whip off my sock, lie back, and feel the needle jab into my sole. The steroid floods my tendons. And that's it.
Dr. Sousa advises me to order a small orthotic pad, which I can stick to the bottom of my foot. The pad is shaped like a lily leaf and made of gel; it feels like stepping in warm mud, and it works like a charm. None of these are surefire solutions; the cortisone could wear off, and surgery may still be the best plan. But for now, I can stand on my own two feet, and that's all that matters.
My first ride is short, just a three-mile loop around Roger Williams Park. But I bring my son, who has waited weeks for this moment.
The air is sweet with fresh beginnings. It's spring, but cool. Sunny, but blotted with clouds. The trees are budding, but just a little. My son is eight years old, and I've never seen him ride so well. He dive-bombs down paths and charges up slopes. We laugh and jabber. We haven't really been apart these past few weeks, but neither have we been together. This is our natural habitat - outside, wandering through the world. Like Dad, like son.
And I've heeded my warning. If I ever took my body for granted, I won't again. I don't know how to live without these moments. Come what may - injury, illness, global pandemics, whatever - all I can do is muddle through and keep going. Fate won't always let me off so easy, but I can only be grateful when it does. My son and I circle the park. We ride and ride, down the path, around the curves, and toward the rest of our lives.
Robert Isenberg is a freelance writer and multimedia producer based in Rhode Island. He writes regularly about cycling for Momentum Magazine.