Parts Department

I am a physical therapist. It’s my job to understand mechanism of injury. I’m supposed to have a grasp on the biology of ligaments and tendons, muscles, bones and joints, and to apply the appropriate treatment following injury to bring about a return of function and reduction of pain. Unless of course it’s my own dysfunction and my own pain–in which case it turned out on Thursday of last week I was totally useless.

Of course when you get to be my age, pain doesn’t necessarily have to have a precipitating trauma. The warranty on various parts goes void at odd times and for no apparent reason. One part or another simply hurts. Thursday, while simply walking across a parking lot the parts-failure du jour was my left ankle.

It was mild and barely noticeable at first. I finished my business at the Jacksonville Center and went to visit a friend for lunch. I managed to walk up his front steps, but an hour later could barely make it down them to get in the car. Driving home–and especially operating the clutch with the left foot–was sheer agony. This was the second worst pain I’ve ever experienced in my life.

I was certain that I had a severe ankle sprain, and telephoned Ann in Floyd to pick up a pair of crutches. I called the clinic to cancel my patients for Friday knowing I wouldn’t be able to drive the car or tolerate a full day on my feet.

But I couldn’t for the life of me figure out what had caused this degree of pain. I have no pre-existing ankle injuries. There was absolutely no swelling. There was pain with both inversion and eversion of the ankle, where most sprain injuries will produce one or the other but not both. And the pain was getting progressively worse over a period of four hours.

Here’s the strange part: the pain suddenly went away.

Next day, I still wasn’t confident enough to drive or to risk being on my feet all day. But for the most part, my symptoms disappeared. This couldn’t possibly have been a severe ankle sprain but I had thought.

Diagnostic conclusion: gouty arthritis

Or maybe not. We had dinner with a physician friend last night. He has had three episodes of gout himself and seen many patients with it. He says it doesn’t just go away abruptly in the way I described. So what was it?

Whatever it was, once was enough. Been there, done that. And I’ve got a five dollar pair of crutches from Angels in the Attic to prove it. image from –heck: the little guy even has my initials on his shirt! But I have more hair!

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Fred First holds masters degrees in Vertebrate Zoology and physical therapy, and has been a biology teacher and physical therapist by profession. He moved to southwest Virginia in 1975 and to Floyd County in 1997. He maintains a daily photo-blog, broadcasts essays on the Roanoke NPR station, and contributes regular columns for the Floyd Press and Roanoke's Star Sentinel. His two non-fiction books, Slow Road Home and his recent What We Hold in Our Hands, celebrate the riches that we possess in our families and communities, our natural bounty, social capital and Appalachian cultures old and new. He has served on the Jacksonville Center Board of Directors and is newly active in the Sustain Floyd organization. He lives in northeastern Floyd County on the headwaters of the Roanoke River.

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  1. I too had dinner with a group of physicians last night and related your incident. The consensus was that gouty arthritis usually takes days to subside, even with treatment. I hope it doesn’t recur and remains a mystery

  2. Knees are bad for having “joint mice”–free-floating pieces of cartilage that get stuck like sand in the gears. But for the ankle, in my experience, this isn’t often encountered.

  3. Wasn’t a strong low pressure front approaching Floyd on Thursday? Any previous painful episodes with a large swing in barometric pressure? This is probably true quackery but you never know for sure.