Back In The Saddle

Four weeks ago today my right big toe was amputated.  Last week I was back to attending my regular exercise classes at ADAPT Training (www.adapttraining.com).  I can pretty much do everything I was doing before with some slight modifications.  Last Saturday I went for my first real run since my accident: three miles on Leif Erickson Road.  My stamina was off a little bit, but my foot felt fine!  What a relief.

When I say my foot feels "fine" I don't mean "pain-free".   There is a dull ache a lot of the time, but it's not enough to even bother with anti-inflammatories.  Maybe I'll start soaking my foot in ice water after work.  There is some phantom pain, too.  So far it has been easy to deal with; I flex and extend the foot and the phantom pain goes away.  None of my discomfort has been debilitating while I'm exercising, though.  It's just sort of in the background.  Of course, I haven't really tested my endurance yet, and a two-hour run might not be in the cards for awhile.  There's only one way to find out.

Now I know for a fact what I have believed ever since this happened: not only can I get back in shape like I was before, but I can get in BETTER shape.  I can get faster, stronger, and leaner.  There are a number of 5K to 10K trail races coming up in my area through late summer and fall. They're affordable ($20-$40 per event) so there are definitely some races in my near future.

13:11

13:11 was my time on the Misery Mile, a one-mile loop through my neighborhood with a huge uphill stretch just past the halfway mark.  Why would I be happy about a thirteen minute mile?

Because I know how close I came to losing it all: my livelihood, almost every activity I've been passionate about for the last 20 years.  Had that mower blade struck two inches lower on my foot I would have been in the hospital for weeks instead of two days.  I certainly wouldn't be back at work, and I absolutely wouldn't have just completed that micro-run.  I can't feel an iota of self-pity, only gratitude that I am in such a good place emotionally to get on with my life.

Me: I want to start swimming; when can I start?
Dr. Mah: Today.
That was the music to my ears that gave me today's burst of empowerment.  My stitches are out, and the wound is almost completely healed.  Despite my doctor's statement I am gonna wait until the scabbing is gone before I get in the water.  I'm not waiting another minute before I start running, though.  The stitches are out, and the gloves are off.

More About Shoes, Balance, and Ambition

It's been three weeks since my surgery, and my life is slowly returning to normal.  Last week I started wearing regular shoes again.  My Asics running shoes fit just fine and, as I predicted, they provide a good amount of support.  For taekwondo I wear a pair of Mooto martial arts shoes.  They fit well, and are a lot more substantial than any other martial arts shoes I've ever worn while still being very lightweight.  Unfortunately they still have the same drawback of all martial arts shoes: extra friction that makes it more difficult to pivot on the ball of my foot.  I will continue to wear them at least until my foot is 100% healed.  I'm still leaning toward going back to bare feet if possible.

Most of the fitness pros I know have asked me about my balance; so far balance has not been much of an issue.  I'm walking with a bit of a limp, but I am practicing "mindful walking" (focusing on taking slow, even steps so I'm not favoring one foot or another) after I've been awake for awhile and my body is warmed up.  Last week my lower back finally rebelled against my compromised gait by going into spasm, but it actually healed fairly quickly thanks to a re-integration routine prepared for me by the great trainers at ADAPT (specifically Andrea Iverson).  I haven't really pushed my athletic performance yet, aside from doing some TKD poomse (forms, or kata in Japanese).  I know I will have to practice hard to be able to pivot well on my right foot for left-legged techniques.  My foot still gets achy by the end of the day, but the ache is diminishing little by little.  I haven't taken any of the pain medication I was taking at bedtime for several days.

Before I really dig back into my TKD training I need to get stronger.  Three weeks of no cardio has really messed up my conditioning, and I've definitely gained a couple pounds from the forced inactivity.  This morning I got on an elliptical machine for about 15 minutes at a fairly brisk pace.  Sure felt good to get a little sweat going!  I'm not a big fan of machine-based cardio (why the hell would anyone run on a treadmill on an even halfway nice day?) but the elliptical is a good no-impact choice while I'm in rehab mode.  ADAPT Training also has some rowers and Versaclimbers; both would be good additions to my regimen.

Tomorrow morning I get the stitches out.  My plan is to get back to running as soon and as often as possible, but at a slow pace and with short distances until I get my sea legs back.  I'm also gonna start swimming a couple times a week, plus taking some swimming lessons.  I've never been a strong swimmer (I just learned how to swim about seven years or so ago), and one of the adventure races I want to do has several water-based obstacles, including a jump off a 15-foot platform.  My first official run will be a short jaunt on Leif Erickson Road this Saturday.  Of course I'll let you know how it goes.

Back To Work

I made it through the first week of work since my accident.  It sure felt good to be back on the floor at the taekwondo studio!  My students and co-workers have been incredibly supportive, and I'm grateful.  When you work in the same place for 12 years it is easy to take it for granted, or let the annoyances (small and large) make you forget what led you there in the first place.  I know I'm lucky; I love what I do, and my boss (Grand Master B. C. Kim) is also my mentor and friend.

My foot feels pretty good.  It is still swollen, and by the end of the day it is pretty achy, but it feels good.  I have remained pretty close to barefoot; my injured foot is still protected with gauze and an Ace bandage.  At the gym I wear my old standby Vibram Five Fingers ("toe shoes") on my good foot.  When I'm out and about I'm wearing flip-flops, but it keeps sliding off my injured foot.  I guess you need all your toes to make them viable.  After the stitches come out I'll go get some more substantial sandals such as huraches, but I will white-knuckle it through the next 1 1/2 weeks with what I have.

So what am I gonna wear on my feet for running?  Good question.  I had been running in Vibram Five Fingers KSO Treks, but I don't know if that's gonna work at first.  This winter I acquired some Asics street running shoes that I think will be okay in the short term.  They are designed to correct over-pronation (rotating your ankles outward as you run).  As soon as possible I would like to go back to a minimalist-type shoe with not much heel support, preferably my VFFs.

One concern I have had is balance.  The shape of my right foot has changed, so balance is gonna be different.  I have been casually playing with simple exercises such as balancing on my right foot.  Yeah, balance has been affected, but with the simple things I've done so far it isn't too bad.  I did a few steps of slow jogging on the matted floor of the TKD studio, and it felt fine.  Of course that was only a few steps, but taking them was good for my confidence.

So I'm back in taekwondo, and I now know that I'll be able to do everything I want and need to do for my work and my martial arts training.  Hell, I might have to go compete in a tournament just to test myself.  I have promised myself a trip to my beloved Forest Park on the weekend after my stitches come out, and I'm waiting impatiently to get out there.  I'm gonna have to start out very slow, very low miles, but I AM gonna start.

Prognosis, and Back To Work

I saw my podiatrist Dr. Mah this morning.  He was satisfied and pleased with the way my stitches are healing.  He gave me a great prognosis: I can start work immediately, and when the stitches come out in two weeks I can start running again!

Yesterday (Monday) I started my rehab workouts at ADAPT Training.  The folks at ADAPT were kind enough to provide me with several routines to keep me moving while my foot finishes healing.  The workouts will help me retain as much mobility, flexibility, and muscular balance as possible during my recovery.  I need to be vigilant about muscular balance.  The shape of my right foot has changed, so the way I walk and run will have to adapt to the new shape without overcompensating and creating an imbalance in the rest of my body.  This will be the biggest challenge of my recuperation.

For the last week I've been wearing a surgical boot on my right foot to protect the bandages.  The boot was way too cumbersome (plus it was two sizes bigger than I need), so I wanted to find some comfortable footwear.  If I was gonna go back to work I needed to protect my injury while still being able to move around as much as possible.  Of course most people (myself included) train barefoot in a martial arts studio, but I didn't think that was an option.  I bought a pair of inexpensive flip-flops with a velcro instep strap.

The flip-flops lasted about two minutes.  That's how long it took for one of them to fall off my injured foot.  I ended up just tossing them onto the shoe rack.  My wound is covered with a thick layer of gauze bandages that are held in place by an elastic Ace bandage.  Turns out that the Ace bandage holds everything together just fine.  I had to adjust it several times, but that was no big deal.  The floor at the TKD studio is covered by two layers of foam mats that, combined, are about three inches thick.  This is a very comfortable surface for training AND for walking around with a forefoot injury.

By the end of the day I was exhausted but very happy.  My bad wheel was a little achy but not even close to being a problem.  My stamina isn't quite back to normal, but I see signs of improvement.  Getting back to my work as a TKD instructor can only help me get it back.  Plus I miss everyone.  The staff and students at World Champion Taekwondo are part of my extended family.

I'm very excited to have a date when I can start running again!  I believe that my existing running style (not very fast, smallish stride, medium to fast tempo) will lend itself to a good recovery.  I am expecting my progress to be slow and probably a little painful.  I'm also expecting some setbacks along the way; Dr. Mah warned me that my balance will most likely have been affected by the injury.  That's fine, I'm not looking to set a world record or anything.  The most important thing for me is to just get moving and keep moving.

Unveiled

So I saw my bare right foot for the first time today.  I was gonna wait until Dr. Mah examined me in a couple days, but I had a minor mishap in the shower.  Per doctor's instructions I wrapped my whole foot in a plastic trash bag held on by a nylon belt.  The bag was watertight every time but today.  As I turned off the water I looked at the bag and discovered that it was full of water.  I said my favorite swear word, then went to the store to get more gauze (why would I have gauze in the house?  Dumbass.).

I was apprehensive, but the bandage was soaked.  I took a deep breath and unwrapped my foot.  Not so bad.  I mean, it is swollen and not real pretty at the moment.  Aside from the missing toe and the sutures, it just looks like a foot.

Now I'm thinking about being barefoot again (once it is completely healed, of course).  Of course I need to determine to what degree it is sensitive and vulnerable.  I don't mind the aesthetics.  My gut instinct is to go shoeless as soon as possible in the TKD studio if possible.  As my wife has pointed out, this is a teaching opportunity.  Our student body is skewed pretty young, and I think it is important for children to be exposed to people who don't look just like them.  I am not my missing toe, I'm still "Master Jim".

Feet, what a lovely invention

I really appreciate feet (not in any kind of fetish way, you sickos).  They are a marvel of engineering.  Next time you are barefoot, take a moment and consider your feet.  Rotate your toes in a circle.  Flex and extend your foot.  Move them every way you can think to move them.  Remarkable.

As a taekwondo practitioner since 1996 I've been training barefoot for a long time.  Some TKD players do wear thin-soled shoes at least some of the time.  I would sometimes wear them when I was teaching class all day (mostly to keep them clean) or if I had, say, cuts or bruises.  All things being equal I'd prefer to do my martial arts training totally barefoot.

A couple years ago I started wearing Vibram Five Fingers (aka "toe shoes") for my gym workouts.  I'm a big advocate of integrated cross-training: doing somewhat unorthodox movements such as climbing around on monkey bars, bear crawls up and down stairs, balance beam work, etc in addition to more conventional cardio and strength training.  VFFs excellently lend themselves to my purposes.  Being able to articulate my toes is great for balance and stability. 

I didn't start wearing Five Fingers for running until this spring; I'd tried a couple neighborhood runs (ZZZZZ) and banged up my feet more than I like.  VFFs were a no-brainer once I pretty much abandoned running on pavement and started training in Portland's wonderful Forest Park.  They provide at least as much traction as conventional shoes, with the added benefit of feeling more sure-footed in mud (we're in Oregon, so traction in mud is a year-round issue).  In the summertime I can take a refreshing wade through a cool stream, and the shoes are dry five minutes later.  Try that with your $120 mega-engineered running shoes.  Oh, and they're machine washable.  My take?  I totally love them for the gym and for trail running, but I didn't care for them for tons of pavement running or very eroded rocky terrain (they're just fine on loose gravel, though).  I did just wear them for an urban 8K that was 2/3 pavement plus a crap-ton of concrete stairs, and they performed admirably.

You get the idea.  I'm pretty in touch with my feet, and I like to rely on as little protection as I can.  I like feeling connected to the earth.  That being said, I was never one of those kids who was barefoot all the time.  I respect and understand the total-barefoot running community, but I'd rather not risk cutting up my feet, so VFFs for me.

You can see how losing a toe has the potential to really get into my head.  There are a lot of unanswered questions.  What is my foot gonna look like?  How will it feel to run?  Will I still be able to wear my VFFs, or do I need to switch to more conventional shoes?  Will the amputation site be so sensitive that my right foot will be useless for demonstrating taekwondo techniques? Will my students be grossed out by my disfigured foot?  (My knee-jerk answer is "get over it".)  How the hell am I gonna do push-ups without both big toes as an anchor point? (I do several push-up variations, including dive-bombers, SEAL push-ups, etc, so I can't just cross my ankles.)  Make no mistake: as long as it's physically possible I'm gonna run again.  For me, running on a trail isn't about speed, it's moving meditation.  Even the worst trail session is a joyful exercise in living in the moment.  I won't give that up without a fight.  First things first: make sure my wound is healed.

The Shoe

Just to give you an idea:
I don't think I'll post the bloody toe pictures, though.  Personally I don't like my steak THAT rare, if ya know what I mean.

How I Got Here

"F**K!"
That was the first word out of my mouth.  I was mowing the lawn in my side yard when it happened.  The side yard lawn is in poor condition, filled with dandelions, bare patches, and the stump of a large blue spruce tree that had been removed a couple years ago.  As I tried to clean up the area around the stump I pulled the mower backwards (insert Darwin joke here) and lost my footing.  The blade struck my right foot before I released the kill switch.
It didn't hurt immediately; the initial impact had no "sharp" sensation.  The seriousness of the injury didn't occur to me until I took off my shoe.  My big toe was shredded.  Still no pain, so I hobbled into the house so my wife could drive me to the nearest urgent care clinic.  We didn't go straight to the emergency room because (a) it wasn't bleeding very much, and (b) I was still thinking that some stitches would fix it.  Still not much pain.  The attending physician at urgent care took one look at my toe and sent us to the emergency room.
The serious pain started on the drive to the emergency room.  My injury was serious enough that they fast-tracked me into an examination room.  It was there that the doctor pointed out to me that I had an open fracture.  That's BONE?  I thought it was my toenail!  There are things that a person should never see; your own bones are on that list.  Now the pain was really starting to hit, so they gave me a local anesthetic.  You know you're screwed when a doctor tells you "This is gonna hurt".  Those lidocaine shots were the single most painful part of the treatment.  The tetanus shot they gave me was a piece of cake compared to the local.  After the on-call orthopedist saw my X-rays my mangled toe was wrapped in gauze and I was admitted as a surgical patient.
The next morning I was examined by a podiatrist.  He explained the grim truth: my toe was so badly damaged that attempting to repair the injury would be tricky, recovery would take months, and there was a good chance that the repair would fail anyway.  The other option was to simply amputate the toe.  Dr. Mah explained that such a surgery would heal completely in about three weeks.
For me, amputation was the logical choice.  I don't know if I have the emotional resources (not to mention financial) to deal with a months-long rehab, and the amputation would be relatively inconspicuous.  I would simply start wearing shoes at my job as a taekwondo master instructor.  Martial arts shoes are the original minimalist footwear, with very thin soles and not much traction.  What about kicking?  Short answer: I don't know.  After my foot heals I'll find out.  My sparring days are pretty much over anyway.  I am confident that I'm intact enough to demonstrate techniques to the students.
I want to talk a little about morphine.  I spent two days in a morphine-induced haze, and there wasn't anything even remotely pleasant about it.  I was still in a lot of pain, counting the minutes between doses.  Morphine also screws up your plumbing.  Constipation wasn't an issue, since I didn't eat anything after Sunday night.  Not being able to pee?  I'm type 2 diabetic, so you do the math.  Second most painful part of my treatment: getting a urinary catheter.
By the night of the surgery the pain was getting worse.  I was grateful when the anesthesiologist
handed me the mask so I could really sleep.  I awoke in the recovery room a couple hours later with a large wrap around my right foot and much less pain.  Surgery came off without a hitch.  The first few moments of my new normal.  Dr. Mah later informed me that even if I had chosen to "stand and fight" that the toe was too damaged to save.
Today is four days since the amputation.  The pain has been minimal.  What has surprised me is how small the emotional impact has been (so far).  Last night I finally worked up the nerve to look at the injury photos the ER nurse insisted on taking with my smartphone.  Just as gruesome as I remembered, yet the picture seemed to be someone else's foot.  I'm healing now, and THAT injury couldn't possibly heal.  Of course, my foot has been under wraps since the surgery, so I haven't been able to see it.  That could very well set off some sort of emotional reaction, but I guess I'll find out.
I am blessed with the knowledge that IT COULD HAVE BEEN MUCH WORSE.  A couple inches the other direction and I could have lost half my foot, or even bled to death.  Even if I had been injured worse it still pales in comparison to what so many soldiers around the world go through.  I just had some bad luck, that's all.  I get to enjoy the rest of my life (almost) intact.
In four days I see Dr. Mah (my podiatrist) again.  I'm anxious to hear what he has to say.  I want to see what my foot looks like now.  I want to figure out what kind of footwear is gonna work best (my guess: probably off-the-rack running shoes).  I am already chomping at the bit to get back to my new passion: trail running.  I'm missing a race on Sunday, and I'm pissed.  I'm even more annoyed that I'm losing at least a month's worth of running.  August, no less.  The monsoon season in Oregon starts in about eight weeks.  But hey, I'm gonna run again, and soon!  I have a feeling I'm gonna appreciate the rain and cold like never before.