{"id":68892,"date":"2023-03-07T13:28:40","date_gmt":"2023-03-07T20:28:40","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=68892"},"modified":"2024-07-29T15:01:01","modified_gmt":"2024-07-29T21:01:01","slug":"surgery-rectifies-athletes-foot-numbness-pain","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/surgery-rectifies-athletes-foot-numbness-pain\/","title":{"rendered":"Surgery for rare foot condition that causes numbness and pain puts elite endurance athlete back on skis"},"content":{"rendered":"
<\/div>
\"Brianna
Surgery to fix dorsalis pedis artery entrapment, which caused her feet to become numb and painful when she exercised, enabled Brianna Rickert to return to her fair-weather sport. Photo courtesy of Brianna Rickert.<\/figcaption><\/figure>\n

Exceptional determination, drive, cardiovascular capacity, and pain tolerance count among the qualities shared by elite Nordic ski racers. The ability to sense one\u2019s feet doesn\u2019t typically make the list.<\/p>\n

Brianna Rickert typically perceived her feet as most of us do \u2013 as fully sensate, if occasionally sore, bodily appendages. But in early 2021, Rickert\u2019s feet started going numb and causing serious pain every time she exercised.<\/p>\n

Rickert, then 19, exercised a lot. The Gunnison resident and Western Colorado University<\/a> student had for years counted among the country\u2019s top youth Nordic ski racers, and she excelled at the intercollegiate level. Now she couldn\u2019t train without debilitating pain.<\/p>\n

\"Brianna
Brianna Rickert in the lead at the 2022 U.S. Collegiate Ski & Snowboard National Championships. Photo courtesy of Brianna Rickert.<\/figcaption><\/figure>\n

Her symptoms pointed to a problem that can happen among endurance athletes: chronic exertional compartment syndrome<\/a>, in which robust calf muscles get squeezed by the fascia surrounding them. But Rickert had already had surgery for that a couple of years earlier, and there was no sign of it now. Visits to orthopedic and vascular specialists, MRIs and other tests brought no clarity. While blood-flow problems were the suspected culprit, the standard test, called the ankle brachial index, or ABI, came back normal.<\/p>\n

Doctors told her the only way to fix the problem was to stop exercising.<\/p>\n

\u201cBasically, they said, \u2018You can\u2019t run or ski anymore or else you\u2019re going to have pain,\u2019\u201d Rickert recalled. \u201cSo that was super heartbreaking.\u201d<\/p>\n

Brianna\u2019s mom Holly, a nurse in Gunnison, wasn\u2019t about to let that be the final say.<\/p>\n

\u201cThat\u2019s when my mama-bear took over. I didn\u2019t think that was good enough,\u201d Holly said.<\/p>\n

Muscled out: a case of dorsalis pedis artery entrapment<\/strong><\/h2>\n
\"Rickert
Rickert ascends during a skimo race. Photo courtesy of Brianna Rickert.<\/figcaption><\/figure>\n

An online search led her to the story of a high school cross-country runner<\/a> in Denver with similar symptoms. Doctors at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a> (UCH) had diagnosed a rare case of dorsalis pedis artery entrapment. When she exercised, the artery got pinched between the bone and muscle tendon, stopping blood from flowing to the foot and causing numbness and pain. Surgery had corrected the problem.<\/p>\n

Holly reached out to University of Colorado School of Medicine vascular surgeon Dr. Max Wohlauer<\/a>. Soon mother and daughter drove the four-plus hours to Aurora, where Wohlauer and colleagues had planned a day for testing and diagnosis at UCH.<\/p>\n

The key test involved UCHealth vascular technologist Rebecca Swanbom performing a focused, duplex ultrasound below Rickert\u2019s ankles. The ankle brachial test, in contrast, checks blood flow above the ankle. Swanbom had Rickert extend and flex her ankle; when Rickert plantarflexed \u2013 that is, pushed her foot down and away from her body as happens when running or Nordic skiing \u2013 the blood flow ceased, Swanbom saw. The culprits, she suspected, were the extensor hallucis longus<\/a> muscles on either foot that, like many of Rickert\u2019s muscles, had grown large through heavy training. Wohlauer came in to confirm, and indeed: another case of dorsalis pedis artery entrapment.<\/p>\n

Wohlauer and Dr. Jason Stoneback<\/a>, an orthopedic trauma specialist and director of the UCHealth Limb Restoration Program<\/a>, plotted out a surgical plan. They would operate on the right ankle, wait four weeks, and then do the left. They scheduled the first surgery for June and the second for July, the aim being to get Rickert back on her skis for 2021-2022 Nordic season starting in November.<\/p>\n

The surgeries both involved removing some of the muscle fibers from Rickert\u2019s extensor hallucis longus muscles, which Wohlauer says extended further down the ankle than is the case with many patients. The surgeons plantarflexed the foot as the procedure happened to make sure blood kept flowing. The second surgery on the left foot also involved trimming a bit of tendon sheath.<\/p>\n

Surgery alleviates foot numbness and pain<\/strong><\/h2>\n

Rickert spent much of her late summer crutching around in casts and walking boots, but by October she was cleared to train. Despite having missed dryland training in the summer and fall, she had what she called \u201ca great season, which was awesome coming off this.\u201d<\/p>\n

The capstone to that season, in March 2022, came during the collegiate Nordic national championships. Rickert won the 7.5-kilometer race. Eight months after the second surgery, she was a national champ.<\/p>\n

More importantly, she was able to do what she wanted to do.<\/p>\n

\u201cThis could have been a disabling condition, one that limited her mobility and her quality of life,\u201d Wohlauer said.<\/p>\n

A year later, Rickert is doing something different \u2013 if no less rigorous. She\u2019s transitioned to ski mountaineering, a.k.a. skimo<\/a>, a sport whose races involve steep uphill climbs and speedy descents.<\/p>\n

\u201cI think I just got to the point of wanting a little bit of change,\u201d Rickert said \u201cI got a little burned out on Nordic, and then skimo also has a lot more postgraduate professional opportunities.\u201d<\/p>\n

\"Dr.
Dr. Max Wohlauer<\/figcaption><\/figure>\n

She\u2019s hedging her professional bets. Now in her third year at Western Colorado University, Rickert is studying education and aiming for a master\u2019s degree when she wraps up her undergraduate work. She wants to be an elementary-school teacher, she says.<\/p>\n

Oh, and she\u2019s also a competitive trail runner, having been sponsored with Western Colorado University teammates to compete in Adidas Terrex Infinite Trails<\/a> in Austria last summer.<\/p>\n

Rickert says she\u2019s grateful for the efforts of Wohlauer, Stoneback, and colleagues for getting her back to what she loves to do.<\/p>\n

\u201cFrom our very first appointment, it all unfolded better than I ever could have expected,\u201d she said. \u201cEspecially after being deflated and just not knowing what was wrong.\u201d<\/p>\n

\u201cShe was at the point where she was really starting to hit her stride, and then she got sidelined by this condition,\u201d Wohlauer said. \u201cNow, she\u2019s thriving. She\u2019s got a whole career ahead of her, and she\u2019s just getting started.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Exceptional determination, drive, cardiovascular capacity, and pain tolerance count among the qualities shared by elite Nordic ski racers. The ability to sense one\u2019s feet doesn\u2019t typically make the list. Brianna Rickert typically perceived her feet as most of us do \u2013 as fully sensate, if occasionally sore, bodily appendages. But in early 2021, Rickert\u2019s feet […]<\/p>\n","protected":false},"author":23,"featured_media":68897,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[4786,67,702],"class_list":["post-68892","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-general-and-vascular-surgery","tag-orthopedic-care","tag-surgical-care"],"acf":[],"yoast_head":"\nSurgery rectifies athlete's foot numbness and pain - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Rickert\u2019s feet were going numb, and she was in serious pain every time she exercised. 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