This week was 4 miles of running and 16,000 yards of
swimming
-- training log is
here.
(what follows is a long discussion of my right foot –
probably not of much interest to others).
I’m posting it because a) it’s my blog and I can post whatever I want –
nobody has to read, b) it’s helpful for me to have the notes for later, and c)
if someone else ever deals with a similar issue in the future, this may be
helpful to them.)
My silly right foot was the issue once again this week. For those of you scoring at home, the
symptoms are basically:
- At rest, a small bit of tenderness if you push really
hard on the “corner” of the foot between the backside and the underside. Right at the back lower edge of my
heelbone/calcaneous, if that makes sense.
No tenderness anywhere else.
- When I start running, a bit of stiffness on the
outside back of my heel, where the peroneal tendon is. Really not a big deal.
- After a bit of running, I develop a burning
feeling all over the heel – basically the back third of my foot, including both
sides and underneath, feels like it’s been dunked in boiling water. Feeling gradually subsides when I stop
running.
- The softer the shoe, the more my foot hurts –
feels fine walking around barefoot, but if I put on running shoes, it starts to
get sore on the outside. And the more
built-up and “traditional” the shoe, the more it hurts.
I spent most of the week trying to get my foot to “settle”,
with just a few 2 mile runs to test things out.
The inflammatory period of an injury is between 3 and 10 days – I’ve
learned, sadly, that as you age, things shift closer to the 10 day side of
that. Nothing to do but wait.
(I hate
waiting).
In the meantime, I kept my cardio fitness up with swimming,
and my leg strength up with yoga classes.
My swimming has definitely slowed in the past month, which makes sense –
I haven’t been doing it as much. But
what I really care about is the cardio effect (which hopefully transfers to
running), not the splits, so a 100 yard split of 1:4x works as well as 1:3x – I’m
breathing hard either way.
I got back in to see both my PT and my podiatrist this
week. PT continues to believe that the
heel issue is in part my weak left leg throwing off my gait, and in part my
right ankle locking – the right ankle just doesn’t flex smoothly the way the
left one does. Plus maybe some referred
pain – when you have something that burns, but you can’t find a tender point
anywhere on the foot, that points towards a nerve somewhere. So, more ankle mobilization and back
stability work, focusing on the quality of the movement, rather than the number of reps.
My podiatrist also checked out my foot – this was helpful,
because he saw it right when it was inflamed during Cherry Blossom (he was
working the med tent at the race) and then again 3 days later. After
looking at it, he thinks that it’s some combination of insertional Achilles tendonitis
and plantar fasciitis. I had seen him
with the purpose of getting another PRP injection, but he talked me out of it –
he uses PRP for injuries that won’t heal – this is something that clearly heals
but gets reaggravated. Thus, we don’t need to provoke healing – we need to fix
the cause. His recommendation was
continued PT focused on my ankle. He
also agreed (at my suggestion) to cast me for orthotics, in the spirit of
trying everything.
He also suggested that I try running barefoot for a short
distance, just to see how that felt. He
never normally recommends that for plantar/Achilles issues, but given that the
foot feels better barefoot and worse with shoes, it’s worth a careful try just
to see what happens. I haven't gotten brave enough to do that yet.
I also went to see a second podiatrist. It’s not that I don’t
trust (and will continue to work with) my first – it’s just that this heel
thing has been on and off for long enough that I want as many opinions as
possible. Second podiatrist believes that it’s my
peroneal tendon, but that the tendon is also referring pain to other parts of
my foot – hence the confusion. His
recommendation was to play around with shoes some, looking for shoes with
a) a slightly higher heel drop (6-8 mm would be good) and b) as little cushioning as possible.
The second recommendation really surprised me given the
source – I’ve felt all along that my foot hurt much more in cushioned shoes,
but conventional wisdom is that cushioned shoes are better for the injury
prone. And I know from this doctor’s
blog that he normally likes more traditional shoes. He explained to me that cushioning was just
allowing my heel to sink and shift in the shoe, and amplifying the stability issues (which matches what I felt was happening). I need as firm a shoe as I can find – ideally
I would find a very thin and light shoe
with very little cushioning that also had a slightly higher heel.
So that explains why higher heels haven't worked for me previously and have made things worse –
because the shoes I’ve tried with higher heels (Brooks Ghost, Saucony Ride, Mizuno Wave Rider) are also more cushioned than the
light shoes that feel best. But it’s also a
bit tricky to find a shoe that has both a higher heel and very little
cushioning – they usually go together.
He suggested sticking with my Pureconnects and just sticking a very
slight heel lift in them; alternately I could try to find something that was
both minimally cushioned and a bit of a higher heel.
I went for both options (and I'll also try my orthotics when I get them).
Heel
lift stuck in the
Pureconnects, and I also picked up pairs of the
Adidas AdiosBoost, the
Mizuno Hitogami, and the
Nike Lunar Racer (I can try all three
because Roadrunner will let me return the ones that don’t work within 90 days
of purchase, no questions asked).
Of the
three, so far I REALLY like the Hitogami, which is essentially a racing flat with a 9mm drop (my Pureconnects had 4mm).
We’ll see if that opinion persists.
Dailies
Monday: In the morning, 3000
yards of swimming, including 8x100 on 2:00, followed by 10x50 on 1:00. Splits
were 1:40.87, 1:42.04, 1:43.22, 1:43.71, 1:43.27, 1:44.87, 1:43.89, 1:41.90 and
50.16, 49.95, 49.97, 50.05, 49.97, 50.77, 50.62, 50.67, 49.42, 49.69. Foam rolling at night.
Tuesday: In the morning,
yoga and strengthwork, followed by PT/dry needling.
Wednesday: 3000 yards of
swimming, including 600 yards split as 6x75 easy/25 hard followed by 6x50 on 70
(splits were 47.87, 47.87, 46.83, 48,14, 48.02, 47.75 for the 50s), followed by
yoga. Foam rolling at night.
Thursday: In the morning, 2
mile test run, a yoga class, and 1500 yards easy swimming. Foam rolling at night.
Friday: In the morning, 3000
yards swimming, including cruise effort 6x150 on 3:00 and 10x50 on 1:00, (splits
were 2:34.91, 2:38.77, 2:40.81, 2:38.43, 2:38.34, 2:37.09 and 50.03, 50.12,
51.37, 52.34, 50.72, 51.20, 52.22, 52.59, 51.92, 52.34), followed by yoga. Foam rolling in the afternoon.
Saturday: In the morning, yoga,
a 2 mile test run, and 1500 yards of swimming. Foam-rolling in the afternoon.
Sunday: In the morning, 4000
yards of swimming, including 600 as 75 easy/25 hard and a pyramid set of
150/100/50/100/150/100/50/100/150/100/50 at moderate effort (splits were 2:40.32,
1:47.51, 54.12, 1:48.70, 2:45.25, 1:48.70, 53.65, 1:48.90, 2:45.17, 1:50.10,
54.15), followed by a yoga class.
Massage at night.
