Twelve years ago, I decided to have tendon transfer surgery on my right ankle in the hope that someday I might be able to run marathons again. My dream of completing a marathon in all 50 states was in serious jeopardy after No. 16, potentially perishing on South Carolina's beautiful Kiaweh Island.

I finished that painful marathon, but it was clear my gradually deteriorating right posterior tibial tendon was shot. This strong cord, which connects the calf muscle to bones in your feet, is essential for walking, standing on your toes and, of course, running. After four months of post-marathon rest, ice, orthotics and flat shoes brought no relief, MRIs showed the inevitable: Surgery was the only answer if I ever wanted to run again.

In April 2010, Houston Methodist's Dr. Kevin Varner, chair of orthopedics, took a tendon connected to my toes and grafted it to the nearly ruptured posterior tibial tendon in my right leg. The surgery saved my running career — and sanity.

Dr. Varner never promised me I'd run again. In fact, he told me that although he'd performed hundreds of FDL (flexor digitorum longus) transfers like mine, not one of his patients had returned to marathon running.

Of course not every FDL patient is a runner. This degenerative, diseased tendon could happen to anyone. Running didn't necessarily cause it.

I interpreted Dr. Varner's answer — he didn't say it couldn't be done — as a sign of hope. With aggressive rehabilitation and a methodical return to running, I figured I could resume my 50-state quest.

The surgery required a heel osteotomy to realign the heel with the tendon transfer. The surgery was tough and left me in a heavy cast — purposefully twisted at the ankle to keep it tight — from my foot to nearly my knee.

I was an obedient but not always nice patient

My husband, mother and kids waited on me — serving me meals, wrapping my cast for a bath, wheeling me in my wheelchair to work. I was miserable and frustrated — and sometimes it showed. After one of my shameful moments, my husband delivered my dinner tray, leaned down and hissed in my ear, "Be good to the help."

Six weeks in a cast were followed by 18 rehabilitation sessions with Houston Methodist physical therapist Matt Holland and his team. They delivered inspiration and hope along with gradually intensified physical therapy sessions. About six months after the surgery, Dr. Varner said I could start running again, a quarter mile at a time.

The return to running was tedious, slow and painful. My legs and feet forgot how to run; my breathing was shallow and ragged. Though family and friends encouraged me and tried to keep me in a positive place, recovery seemed to take forever.

But a little less than two years after Dr. Varner operated and Holland got me back to the track, I ran the Chevron Houston Marathon, finishing teary and triumphant in just under four and a half hours. The dream had returned.

It was a dream 25 years in the making, born during the Methodist Health Care Houston Marathon on January 12, 1997, a wicked marathon that became known as the "Ice-a-thon" because of freezing rain, iced trees and streets and frigid temperatures the city seldom sees. I was a novice 38-year-old runner attempting my first marathon because I read somewhere that Oprah Winfrey finished a marathon. "Well, if she can do it," I thought.

Despite the conditions, I finished in just under four hours — and became hooked. To me, long-distance running was a great form of exercise, stress relief and social interaction. I initially focused on Texas marathons with all my new running friends: Austin. San Antonio. Marathon. Surfside Beach. There are all manner of marathons in Texas — at least 45 — and each one I did was unique and fun.

Each running trip created joyful memories

Somewhere along the way, my crazy but always inspirational running buddies introduced me to the 50 States Marathon Club. To join, runners must complete certified marathon in 10 states. By 2007, I was a member.

Those first states were a breeze. A family member or friend was always happy to tag along, and these quick trips were a blast: Chicago with my husband; San Diego with him and our two children; Boston with my running friends; North Carolina with my mom and aunt. Also unforgettable: the Niagara Falls International Marathon in Buffalo that ran across the Peace Bridge into Canada.

All runners suffer injuries at some point, but we usually 'doctor' ourselves or 'doctor shop' until we hear what we want to hear. We would get sidelined for a race or two, but then we'd be back at it, training in the predawn streets of Houston and looking forward to our next race. A broken-down tendon was the last thing I expected to experience.

After the surgery and rehabilitation, I steadily completed more marathons, finishing six states in each of 2014, 2015 and 2016. I celebrated my 60th birthday running the Kona Marathon on Hawaii's Big Island with several family members and my best friend cheering me in. It was 80 degrees and like running in a hair dryer, but it was a fantastic destination marathon, only possible thanks to my not-so-new tendon transfer.

On July 16, 2022, I crossed the finish line of the King Salmon Marathon in remote Cordova, Alaska, one of just 13 marathoners on that rainy, windy 50-degree day. My extended family was there to run me in, taking turns jumping out of their vans to run a mile, talk to me, encourage me to keep going. They wore shirts that read "Run Patti Run" on the front and "Alaska 2022/Mission Accomplished/50 States!" across the back.

My mom — my biggest cheerleader — had died in January. I pinned her photo to my running shirt and told her we made it to Alaska.

The last marathon brought a flood of emotions: relief, gratitude, joy. What a gift it was to see our beautiful country on foot and to share the journeys with so many people I love. To say the ankle surgery at Houston Methodist saved my life is not overstating things. Quality of life is as important to patients like me as a beating heart or healthy pink lungs to some other patients. Dr. Varner and Holland gave me the confidence to trust my new and improved tendon, and I know it can handle whatever I decide to set for the next running challenge.

Patti Muck is PR program manager with Houston Methodist's public relations team.