Toe Trucker

MO 16 400px days left!

Wheel full 70pxSome of you know about the six day, 408 mile/657 kilometer unsupported ride I made earlier this summer in late June with a good friend from my hometown of Wasilla, Alaska north past Fairbanks to Chena Hot Springs.

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Wheel full 70pxThere’s a journal of the ride with a lot of “along the way” photos over at crazyguyonabike [link] that I need to get in gear on and complete- halfway done, maybe by the weekend.  Up to that time I had ridden this year a little over 500 miles/800 kilometers since the winter broke in March in local day rides to get ready for that trip and for the upcoming ride down the Mississippi River.

2017 RwGPS Stats 170810

Wheel full 70pxI’ve only been back on my Disc Trucker once since, though.  Here’s why.

For the past decade or so I’ve had a large callous on the left side of my big toe.  Since I’ve had so many other things going on with my back, legs and feet and because it wasn’t painful or otherwise a problem I more or less ignored the situation.  My feet were past the point where they would win any beauty contests in any event.  When I started wearing bicycle shoes last year in connection with my Atlantic Coast ride the callous didn’t seem to create any issues.

Wheel full 70pxNow, I am a Type 2 diabetic with the disease controlled by diet and exercise at this point.  As a result, I’ve had the good fortune to have regular diabetic foot care from a local podiatry clinic for the past three years or so.  I’ve been told that one of the issues that goes with diabetes is foot neuropathy, which is a progessive deadening of nerve sensation that usually starts in the toes and works its way up.  Sure enough, I have this condition, but mainly in my left foot and probably mostly due to an automobile accident I was involved in that happened in the late 1980s that made a complete mess out of that leg- broken femur and extensive trauma to the kneecap and knee area generally.  Another thing that happens to diabetics is ulceration- sores- that develop at the base of one or both big toes (and sometimes other toes) that often happen because of a combination of factors- the neuropathy lessens the sensation that your toes are “gripping” the floor when you walk so you unconsciously curl the toes down harder which leads to rubbing and friction in places where that shouldn’t happen.  The neuropathy also deadens the pain that usually accompanies an open wound like that, so many folks with diabetes don’t even know that there’s a problem until things have progressed to a severe and sometimes dangerous state.  The disease also slows and in some cases pretty much stops the healing process, so once those ulcers start they are frequently hard to get rid of.

Wheel full 70pxAt least that’s all pretty much- I’m no doctor- how I understood things before I left to ride last year.  The clinician I was seeing told me I needed to check my feet out carefully pretty much daily and pay close attention to things like blisters, which can often be a precursor of skin ulcers developing.  Then I went out and rode 3,600 miles/5,800 kilometers and never had blister number one.  I was pretty jazzed about this.

Wheel full 70pxBut, silver linings generally have dark clouds somewhere in the background.  Within two weeks of making it to Key West and hanging up my bicycle shoes for the year… well, you guessed it.  A blood blister appeared right behind the callous on my right big toe, and it quickly developed into an open sore that, had it occurred while I was riding, would have been at best a real pain in the, err… neck.  At worst, it likely would have stopped the ride until it healed, and that would have been, for all intents and purposes, pretty much it.

Game over

Wheel full 70pxThe great folks over at the clinic were puzzled, though, because the ulcerated area really seemed sort of related to the callous, which had nothing to do with my diabetes.  In any event, in a couple of weeks things were back to normal.

Wheel full 70pxThen I started riding this year.  I noticed pretty much right away that the callous would become irritated and sometimes painful on longer rides.  The callous also seemed to be getting larger.  No sore developed, but by the time I rode north at the end of June it was really apparent to me that something new was going on, and that this year was not likely to be a repeat of last year, riding-wise.

Wheel full 70pxBy the time I reached Chena Hot Springs my big toe was painful all the time.  While on the road I called and made an appointment at the clinic to have the situation evaluated as soon as possible following my return.  I was able, as noted, to complete the ride- bike touring, as far as I’m concerned, is a

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and I was going to be darned if I was going to let my toe interfere with the great time my friend and I were having.

Wheel full 70pxSo at the appointment I saw Dr. Matt Heilala [link] who, after reviewing some X-rays and examining my toe really closely…

…I have a huge respect for physicians generally.  That respect is even greater for doctors who have to look at folks’ feet all day.  The medical profession should only be grateful that it wasn’t my bicycle seat that was giving me trouble.  Just sayin’…

Toe post 01

…determined that I had a sizable bone spur, probably resulting from a combination of a broken toe I had 50 or some years ago and the degenerative osteoarthritis I suffer from today.  Apparently irritation was causing it to grow and change, which was in turn stimulating the callous to do undesirable things.  The bone spur would need to be removed surgically.  I discussed with Dr. Heilala my upcoming Mississippi River bicycle trip and he said that the healing process would just about fit into the time I had left before the planned start of the ride.  We scheduled surgery the next week.  I did one last ride the day before, just because I could.

Toe post 02

Wheel full 70pxBy the day of surgery the callous had developed a crack that didn’t look real good.  But before you could say “sleepytime” I was getting rolled out of the prep area.

Toe post 04

Wheel full 70pxI must have slept through the whole thing.

Toe post 03

Wheel full 70pxThe spur turned out to be pretty ugly.  It had both a pointy bit and a sharp edge that was cutting into tissue inside my toe.  I was told to stay completely off of the foot and in bed with it elevated for a week.  Any walking I absolutely had to do was required to be in one of those “moon boot” devices with all the velcro straps.  After I was allowed to be up and around a bit more I was still kept in the moon boot.  I’ll tell you that fear of screwing things up for my ride kept me probably as compliant with Doctor’s Orders as I have ever been in my life.

Toe post 05

Wheel full 70pxThe stitches stayed in for three weeks based on Dr. Heilala’s recommendation that this would give me the best shot at having the incision as far along in the healing process by the start of my ride as possible.  They came out last Thursday, the 3rd.  I was allowed that day to ditch the moon boot, which had become a real pain.

Toe post 06

Begone, foul boot!

Wheel full 70pxToday I was told by Dr. Heilala that his work was basically done and I could resume normal activities as I felt ready.

Wheel full 70pxAnd am I ready!  It’s two weeks to the day before I fly to Minnesota from Alaska, and just over two weeks to Itasca.  Time to ride!

David