Page 7 of Tacos & Toboggans
“She could have,” I agreed without commitment. “Or it could be that the bones weren’t aligned quite right, and now they’re rubbing on each other, or it could have refractured.We’ll order a scan to gain a clearer understanding of the tendons, ligaments, and bones. There are twenty-six bones in the foot, so things need to be lined up perfectly to fit together like the puzzle they are. We’ll get to the bottom of it. See what I did there?”
AJ snorted and shook her head as I examined her. I pressed on the outside of her foot, and she yelped. “That hurts badly there.”
“I’m sorry,” I said with sincerity. “That spot is right over the cuboid, so that tells me a lot. I’ll press very gently on the top of the foot. Tell me if it hurts.” She nodded, so I pushed lightly on the top of a deformity that made her yelp again.
“Yep, it hurts. That’s bad, right?”
Without answering her, I carefully lifted the foot to inspect the bottom, which had turned black and blue to match the top. There was more examining that could be done, but rather than make her pain worse and risk damaging something further, I’d get the imaging studies first. The last thing I wanted to do was manipulate the foot to the point of requiring more extensive intervention. She would need intervention by the looks of it, but I’d rather it didn’t involve a scalpel if possible.
“It’s concerning, so I’m glad you came in. There’s a bit of a deformity here over the cuboid,” I explained, motioning over the spot without touching it.
“That hasn’t always been there,” Dawson added. “At least it wasn’t there the first summer because she wore sandals with no problem.”
“And now you can’t?” I asked, and she nodded.
“That could mean it’s a cyst or a problem with the inferior extensor retinaculum, which is a fancy term for a band of tissue that holds your tendons in place. Let’s get some imaging done on it so we have an idea of what we’re dealing with before we go any further. If it’s something I can help with as an orthopedist, I’m more than happy to do that. If it’s something that podiatry should look at, I’ll page them, but we’ll get it sorted out. I’m going to order an MRI, and radiology will come get you for it.” I glanced at Dawson. “Can you wait, or do you need to go?”
“I’ll call Audrey to pick up Valor. Honor is teaching, but she can get here if need be.”
“No need to bother Honor just yet. Let’s get the scans, and then we’ll get back together once I have those images.”
“Give it to me straight, doc,” AJ said. “There’s a big problem here, right?”
Dawson bit back a smile as I turned to face my patient. “I believe so, yes. I don’t want to alarm you, but I’m worried the bone has fractured again, and I don’t mean a simple hairline crack. I think it’s now doing this.” I made a tent motion with my fingers.
“I wasn’t even running,” she said, a sigh heavy on her lips. “It doesn’t make sense.”
“It does if the fracture healed through malunion,” I explained.
“What does that mean?” Dawson asked, putting his phone away after sending a text.
“It means the bone wasn’t aligned exactly right when it healed, so the healed fracture wasn’t strong. When the original injury happened, AJ’s bones were still developing. The imaging says the fracture is healed, and the patient thinks everything is fine, but over time, that malunion starts to cause pain, limping, and deformity.”
“Until snap,” AJ said with a frown. “I shouldn’t have been so stubborn and agreed to go in this past summer.”
“Don’t be too hard on yourself. We don’t always know if it’s just pain from an old injury, which is common, or something more. They rarely fracture in this manner. That’s why I want to see what we’re dealing with via an MRI. A ligament or tendon may be too tight, leading it to break in this way. It could be that you reinjured it without realizing it. Typically, if it’s a malunion, we go in and realign everything. Then, we anchor the bone, so it heals properly. I won’t know for sure until we get an MRI.”
“Won’t an X-ray tell us that?” Dawson asked, and I nodded.
“It will, and we’ll start there, but the MRI is important. I want to check if there’s any damage to other parts of the foot, such as tendons or muscles. If a tendon has tightened due to the original injury and is putting too much pressure on thebones, we need to know that so we can address it. If a muscle is damaged as a result of the break, we must also be aware of that. I like to have the whole picture before we embark on treatment. Are we on the same page?”
“Yes, sir,” AJ said dejectedly. “I just want it to stop hurting.”
“I can’t blame you there. The nurse will start an IV, administer a shot of pain medication, and then proceed with the imaging. Nothing to eat or drink until I know what we’re dealing with, and don’t put any weight on the foot. You’ll go down for imaging on the gurney. If you need the restroom, they’ll wheel you in, and you can use the grab bars. Understood?”
Her nod was immediate. “I couldn’t put weight on it if I tried. This is not cool at all. It’s my senior year, and I’ll be in a boot for half of it.”
“I understand that it’s frustrating,” I said once I sent the order through on the computer. “But better now than next year when you’re at college. Trust me, I know this feels like a huge setback, but we’ll have you fixed and back to school in no time. Okay?”
“Thanks, Dr. Warren,” Dawson said, and I gave him a nod before I left the cubicle and headed for my office. Sad as I was about it, the Spanish Rooster would have to wait.
I locked the diner’s door with a sigh of disappointment. I’d hoped to see Major tonight since the special was his favorite, but he hadn’t made it. Too bad. Guess I’d have to eat the plate I’d saved for him. Mason had caught me stashing the rice in the fridge, and I passed it off as being for me, so I reminded myself to take it home as soon as I finished closing out the till and shutting down the lights. Mason had buttoned up the kitchen before he left, so it was an easy close for me, which was good since I had to return early tomorrow morning. Itwasn't to work but to talk to Ivy when no one else was around. Tomorrow, I close on Yaya’s house, and I need to discuss my schedule with Ivy before deciding where to stay.
Motion caught my eye, and I glanced up, surprised to see Major turn away from the door. I jogged to it and flicked the lock over, which caught his attention.
“Major,” I greeted him.
When he turned back, I saw the lines of fatigue on his forehead. “Sorry, I didn’t realize how late it was when I stopped by.”
