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).
(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.