If my FHL tendon is inflamed and irritated, should I inject the tendon sheath before my 100-mile trail race? Well, that is a great question and that is what we’re talking about today on the Doc On The Run Podcast.
If you have a big race like a 100-mile trail race, let us say you have been training for a very, very long time, you have been ramping up over the course of several years to build your fitness high enough that you think you can safely run 100 miles in a single go. Well, if you start getting pain because you have been doing lots of hill repeats or planks or something and that tendon that goes down the back of the leg from deep to the calf muscle around the end of the tibia and then goes across the bottom of your foot all the way out to the big toe to help pull down the big toe, well, if you’re running up in hill, doing planks, doing things like that, you could get irritation of the FHL tendon and specifically the tendon sheath that surrounds it where it bends around the back of the ankle.
One of the things you could do is inject it with corticosteroids and so, this runner called me and wanted to know whether or not it would be a good idea for her to actually inject the tendon sheath with cortisone before her trail race. Well, let’s say it’s the Western States 100 and you have been spending years trying to get into that race and then you get this issue. Well, maybe you would, maybe it’s worth the risk.
But here’s what you have to really think about. If you do a corticosteroid injection into the tendon sheath, there’s a very high probability you are going to decrease the swelling in and around that tendon within the tendon sheath. That is a very good thing. If that happens and that is all that happens, the chances of you completing your race without any trouble is much higher. And it’s certainly going to be a whole lot more fun because it’s going to hurt a whole lot less.
The downside of that, of course, is the risk. The risk of penetrating the tendon with a needle that could cause what we call an iatrogenic tendon tear, meaning the doctor caused it doing something during the procedure that it was a result of the procedure. It’s not malpractice, it’s just a bad outcome.
So, if we go through the tendon with a needle, it goes all the way through, it’s not really that big of a deal. In fact, if you have mommy thumb or De Quervain’s tenosynovitis, the hand surgeon will deliberately go through the tendon much of the time to make sure that they’re in the sheath and they just back off a little bit and inject it there and that works okay.
But you don’t run on your thumb and if you split the tendon and if the tip of the needle is inside the tendon and then you push down on that plunger, the hydrostatic pressure can rip the tendon lengthwise. That is not good. The other risk with corticosteroids, aside from poking it with a needle and causing a tear, is that corticosteroids, we know, can weaken the collagen and the whole tendon is just a big cable of collagen. And that could potentially lead to the kind of weakening that could allow the tendon to actually split, tear, whatever, during the actual 100-mile trail race itself.
The only reason I think that it would make sense to do this injection is if you didn’t get it better with some really simple things. It was really a race that you just felt like you had to do no matter what. It’s a once in a lifetime goal race that you don’t think you’re going to be able to get into again later. And it’s just that you’re never going to get another shot at doing this race, and it’s crucially important to you.
In that case, it’s really a simple thing. You’re trying to decide, having a discussion with your doctor, maybe even a second opinion with somebody who understands runners, who can really help you understand, like is the risk of doing that injection worth it, given the potential downsides of having something bad happen as a consequence of having the injection. But it is your foot.
It is always your decision. It’s never my decision. It’s never your doctor’s decision. It’s only your decision. You just have to understand what the risk and the benefit of those things are for you to be able to make that decision and be able to sleep at night and then go do your race.
So, if you like this episode, please like it, please subscribe and if you have a condition like FHL tenosynovitis or tendonitis, and you’re trying to figure out what to do, a thing that I always do with runners is a thing called the 12 steps. It’s a 12 step process. I actually laid it all out for you, the exact strategies I use in the 12 steps presentation that I created. You can get it for free at www.docontherun.com/12steps. So, go check it out and I’ll see you in the training.
