My return to running -- one example of a schedule

I've spent a lot of time on various running fora discussing injuries, and while the most popular topic is generally diagnosis (we love to self-diagose), a secondary topic is how to return to running post injury.

In the past, I've returned pretty aggressively - in approximately 8 weeks I'd have returned to my high mileage ways.  At the time, I thought this was good -- heck, setting PRs in your first races back from injury has to be a good thing, right?  But I'd only be running for about 2-3 months before another injury would hit.  It was never the same injury twice, and so I thought it was just my bad luck.

I've since realized that when you take time off, your body loses a lot of its ability to sustain the trauma of running.  Your hard-earned durability erodes, and you can't really jump back to where you were.  You need to think of yourself as a new runner, and rebuild accordingly -- almost like the couch-to-5K.

And so, this time, with guidance, coaching, and coaxing supplemented by acidic common sense, I came back very carefully.  It was frustrating at times, but in the end I managed to come back without rebreaking the foot.  My goal was to come back without reinjury, and I accomplished it.


When I was injured, I was constantly searching for the blogs of others who had broken a foot and then returned to running, to get some feel for the appropriate progression.  For all of you now in the same boat, here's how I did it.  Below, I've mapped out the first 14 weeks of my return (days that I actually ran are italicized).  I did my first tempo workout 7 weeks after being cleared to run and my first interval workout and race 12 weeks after being cleared.  I waited 11 weeks before cautiously running back to back two days in a row (I still only run 4 days a week, with Tuesday and Wednesday being back to back).  And it wasn't until 14 weeks back that I began to do my post-workout cool-down on the track.

This is obviously a very lengthy post, but hopefully it will be of use to others.

***

Preface: 6 weeks in a boot doing nothing but pool running, pilates (with feet not touching anything, and upperbody strengthwork.  Forecast at the time of injury was for 6 weeks no weight-bearing exercise, then 6 more weeks of biking+elliptical, before running.  Week 0 is a half-week, starting on a Wednesday when I took the boot off for the last time and started testing the elliptical, yoga, etc.

Week 0 (walking around in a shoe.  Also doing all sorts of foot/calf strengthening exercises)

• Wednesday: easy pool-running + pilates
• Thursday: pool-running (tempo) 
• Friday: easy pool-running + 5 minutes on elliptical and upper body strengthwork
• Saturday: pool-running "long run" +  5 minutes on arc-trainer and leg strengthwork
• Sunday: easy pool-running + 15 minutes on arc-trainer and upper body strengthwork.

Week 1 (cleared to run on Wednesday, 5 weeks ahead of schedule.  I opt to take another week off, as I'm still limping from a weak leg from the boot)

• Monday: pool-running interval workout + 30 minutes on arc-trainer
• Tuesday: easy pool-running + upper body strengthwork
• Wednesday: easy pool-running + 30 minutes on arc-trainer and pilates
• Thursday: long pool-run + 45 minutes on arc-trainer
• Friday: easy pool-running + yoga
• Saturday: easy pool-running + 1:45 on the arc-trainer
• Sunday: easy pool-running
  

Week 2 (1 mile land-running)

• Monday: pool-running interval workout + hour on arc-trainer and upper body strengthwork
• Tuesday: easy pool-running + lower body strengthwork
• Wednesday: "test jog" on track (alternate walk 100m and jog 100m for 4 reps, and then finish off with 400m continuous jogging) totaling to 800m of running, followed by easy pool-running + pilates
• Thursday: pool-running tempo, followed by strengthwork
• Friday: 30 minutes on arc-trainer + yoga, + "test jog" on track (alternate walk 100m and jog 100m for 4 reps, and then finish off with 400m continuous jogging) totaling to 800m of running, followed by easy pool-running.  
• Saturday: pool-running "long run" + upper body strengthwork
• Sunday: easy pool-running

Week 3 (3 miles of land-running)

• Monday: "test jog" on track (2 reps of jogging 100m/walking 100m, and then 600m jog) totaling to 800m of running, and then pool-running interval workout + upper body strengthwork
• Tuesday: easy pool-running + lower body strengthwork
• Wednesday: "test jog" on track (alternate walk 100m and jog 400m for 4 reps) totaling to a mile of running, followed by easy pool-running.   Also tiny bit of biking
• Thursday: pool-running tempo, followed by leg strengthwork
• Friday: "test jog" on track (jog 5 minutes, walk 90 seconds, jog 6 minutes) totaling to about 2000m of running, followed by easy pool-running.  Later upper body strengthwork 
• Saturday: pool-running "long run"
• Sunday: easy pool-running

Week 4 (7.5 miles of land-running)

• Monday: "test jog" on track (3 reps of jogging 5 minutes/walking 1 minute) totaling to 1.75 miles of running, and then pool-running interval workout + upper body strengthwork
• Tuesday: easy pool-running + lower body strengthwork and a yoga class
• Wednesday: "test jog" on asphalt (3 reps of jogging 7 minutes/walking 1 minute) totaling to 2.25 miles of running, followed by easy pool-running.  
  
• Thursday: pool-running tempo, followed by leg strengthwork
• Friday: "test jog" on asphalt  (2 reps of jog 8 minutes/walk 1 minute, then jogged 10 minutes) totaling to about 3.5 miles of running, followed by easy pool-running.  Later pilates. 
  
• Saturday: pool-running "long run" and also strength-training.
• Sunday: easy pool-running

Week 5 (12 miles land-running)

• Monday: "test jog" on track (3 reps of jogging 10 minutes/walking 1 minute) totaling to 4 miles of running, and then pool-running interval workout + upper body strengthwork
• Tuesday: easy pool-running + lower body strengthwork
  
• Wednesday: "test jog" on asphalt (3 reps of jogging 12 minutes/walking 1 minute) totaling to 4.5 miles of running, followed by easy pool-running 
  
• Thursday: pool-running tempo, followed by  strength training
• Friday: "baby run" on track  (2 reps of jog 15 minutes/walk 1 minute, ) totaling to about 4 miles of running, followed by easy pool-running.  Later pilates
• Saturday: pool-running "long run" and also yoga
  
• Sunday: easy pool-running

Week 6 (12 miles of land-running; also business trip)

• Monday: "baby run" on track (run 20 minutes/walk 1 minute/run 10 minutes) totaling to 3.6 miles of running, and then pool-running interval workout + upper body strengthwork
• Tuesday: easy pool-running + travel
  
• Wednesday: biking plus elliptical in hotel gym  
  
• Thursday: travel + easy pool-running and upper body strengthwork
  
• Friday: "baby run" on asphalt of 30 minutes straight (3.5 miles), followed by easy pool-running.  Later pilates
• Saturday: pool-running "long run" and also upper body strengthtraining
  
• Sunday: easy run on asphalt of 40 minutes (~5 miles) followed by easy pool-running

Week 7 (20 miles land-running; first tempo workout)

• Monday: pool-running interval workout + upper body strengthwork
• Tuesday: easy pool-running + lower body strengthwork
  
• Wednesday: 7 mile run outside plus drills and strides, followed by easy pool-running 
  
• Thursday: easy pool-running, plus upper body strength training
  
• Friday: "split tempo" -- first did 1.25 miles warm-up then 2 mile tempo on track, followed by completing tempo in the pool with 2x15 minutes tempo effort, 1 minute recovery.  Later pilates
• Saturday: pool-running "long run" and also upperbody strengthtraining
  
• Sunday: 10 miles easy land running, and then easy pool-running

Week 8 (25 miles land running)

• Monday: easy pool-running.
• Tuesday: pool-running interval workout + upper body strengthwork
• Wednesday: 7 mile easy run outside , followed by easy pool-running 
  
• Thursday: easy pool-running, plus upper body strength training
  
• Friday: tempo on track of 5.5 miles including 3 mile tempo.  Did cool-down jog in the pool.  Later pilates
• Saturday: pool-running "long run" and also upperbody strengthtraining
  
• Sunday: 12.5 miles land-running "long run", and then easy pool-running

Week 9 (23 miles land-running, also business travel)

• Monday: easy pool-running.
• Tuesday: 7 mile easy run outside, followed by easy pool-running + upper body strengthwork
• Wednesday:  pool-running interval workout 
• Thursday: 10 mile easy run outside
  
• Friday: easy pool-running
• Saturday: 5K race as a tempo (with 1 mile warm-up) then easy pool-running and yoga
  
• Sunday: easy pool-running, plus upper body strength training 

Week 10 (35 miles land-running)

• Monday: 12 miles land-running, followed by easy pool-running
• Tuesday: pool-running interval workout + upper body strengthwork
• Wednesday: 4 mile easy run outside , followed by easy pool-running and yoga
  
• Thursday: easy pool-running, plus upper body strength training
  
• Friday: 5 miles running on track including 3.25 mile tempo.  Did cool-down jog in the pool.  Later pilates
• Saturday: easy pool-running and also upperbody strengthtraining
  
• Sunday: 14 miles land-running "long run", and then easy pool-running

Week 11 (31 miles land-running; first time running two days back to back)

• Monday: easy pool-running.
• Tuesday: 2 miles easy land-running, then pool-running interval workout + upper body strengthwork
• Wednesday: 9 mile easy run outside , followed by easy pool-running, yoga class later
• Thursday: easy pool-running, plus upper body strength training
  
• Friday: 6 miles of land-running on track including 4 mile tempo.  Did cool-down jog in the pool.  Later pilates
• Saturday: pool-running "long run" and also upperbody strengthtraining
  
• Sunday: 14 miles land-running "long run", and then easy pool-running

Week 12 (29 miles land-running; first track intervals workout and first race)

• Monday: easy pool-running.
• Tuesday: 6 miles of land-running on track, including 6x800m interval workout, followed by cool-down jog in pool + upper body strengthwork
• Wednesday: easy pool-running and yoga
• Thursday: 9 miles land-running followed by easy pool-running, plus upper body strength training
  
• Friday: 5.5 miles land-running, followed by easy pool-runningLater pilates
• Saturday: easy pool-running
  
• Sunday: 8 miles land-running, including 8K race, and then easy pool-running for cool-down

Week 13 (35 miles land-running)

• Monday: easy pool-running.
• Tuesday: 4 miles easy land-running then a pool-running interval workout + upper body strengthwork
• Wednesday: 10 mile easy run outside, followed by easy pool-running and yoga
• Thursday: easy pool-running, plus upper body strength training
  
• Friday: 6.5 miles on track including 4.5 mile tempo.  Did cool-down jog in the pool.  Later pilates
• Saturday: easy pool-running and also upperbody strengthtraining
  
• Sunday: 14 miles land-running "long run", and then easy pool-running

Week 14 (40 miles land-running; first time doing some of my post-workout cool-down jog on track, rather than in pool)

• Monday: easy pool-running.
• Tuesday: 6.5 miles of land-running on track, including 1600m and then 3x800m interval workout, and cooldown jog, followed easy pool-running + upper body strengthwork
• Wednesday: 11.5 miles land-running plus easy pool-running and leg strengthwork
• Thursday: easy pool-running, plus upper body strength training
  
• Friday: 8 miles land-running including 4 mile tempo on the track and cool-down jog, followed by easy pool-running.  Later pilates
• Saturday: easy pool-running plus strengthtraining
  
• Sunday: 13 miles land-running long run,and then easy pool-running plus a yoga class

Liars and Osteoblasts and Hot Tubs

"Listen to your body" is a mantra that gets repeated a lot.  By doctors, by physical therapists, by yoga instructors, and on running boards of all stripe.

The problem is...bodies are bullshit artists extraordinaire.  Frankly, my body is a petulant 4 year old, and would like for me to do nothing save eat jelly beans and take hot showers for hours on end.  Activities that are pleasant, but do little to advance my long term health. Bodies, you see, are focused on the short term.

This short term focus leads to a two level response by one's body to stress.  First the body sends signals to the mind, encouraging the mind to do whatever it can to avoid the stress (the funniest example of this is how my nose always itches or my shoe feels loose before a hard track interval).  When this doesn't work, and you do the workout anyway, then the body adapts to meet the needs of the stress.  These two levels come into play in training all the time, as we work to push our bodies past the delaying tactics and into the place where we place stress and adapt.

By working out, we do a measured bit of destruction to our bodies, so that they can grow back stronger.  Tiny muscle tears from a workout knit back in a way that is able to handle that stress in the future; a cardiovascular system that is overwhelmed develops additional capillaries and increases blood volume.   Osteoblasts and osteoclasts work on bones to remodel them properly to handle the additional load.  The key is to push the body hard enough  to get to that adaptive level without pushing your body past the point where the destruction overwhelms it and it can no longer adapt.  And part of this is constantly evaluating whether your body is telling you the truth when it sends you "can't do this" signals.

This delicate balance of just the right amount of physical strain and stress applies to general fitness development, but also to injury rehabilitation.  In injuries, there's an acute stage, where the body part in question has been overwhelmed and needs to rest completely (hence no running and an aircast), and then a repair stage.  During that repair stage, the body part needs a certain bit of intelligently applied stress to encourage it complete the process -- avoiding pain (heeding those delaying tactics and "listening to your body") means that you're stuck in limbo, and never quite heal.

(and this is where physical therapists shine -- in hand-holding one through applying just enough stress to complete the process).

In bone injuries, this repair stage includes remodeling.  The raw material has been laid down, and "[r]emodeling of the bone occurs slowly over months to years and is facilitated by mechanical stress placed on the bone. As the fracture site is exposed to an axial loading force, bone is generally laid down where it is needed and resorbed from where it is not needed."

My foot is firmly in the remodeling stage.  So, the trick for me, right now, is to put enough stress on the foot to encourage the bone to remodel itself to support the impact of running.  I need to send the right signals to the foot, so that it refines the bone correctly -- if I don't send those signals, the bone will remain weak and unfinished.

But, I can't overdo it, or I overwhelm the remodeling process and go back down the rabbit hole into the aircast.  The big trick is to figure out how much stress is enough but not too much.  And at the same time, my foot, supported by my body, is arguing strongly for 100% jelly beans and hot tubs.

Hence the continuing dialog between me and my whiny foot.  As my doctor warned me, my foot protests when I run.  Not loudly, but I know it's there.  And there's always the constant wondering of whether my foot's achiness and mild soreness (which again, I've been told to expect as part of the process) is just noise and complaining as I push it to the correct level, or an actual indication that I'm going too far.

And so I run a tiny bit every other day, paying close attention to what my foot is saying, assessing whether it speaks truth.  It always aches when I run, but then improves.  I take every other day off; when it ached on Friday evening after jogging Friday morning, I took that as a cue to rest it an extra 24 hours, delaying my next jog until Monday morning.  

Was that the right call?  I have no freakin' clue.  All I really know is that there's a very fine fracture line between salvation and damnation here, and I don't trust the foot to tell me which direction is up.

First run

When I rode horses competitively, I used to always get a bit anxious and hyperfocused before lessons. This made a lot of sense - I would often be asked to jump courses that were larger and more difficult than anything I'd face at a show, and I was aware that if I made a mistake, there was a risk of getting seriously injured or worse.   I blamed my nerves on physical fear, decided I was a bit of a wimp, and learned to just ignore them and go on.

Much later, in my second sport of running, I noted the same feeling of dread before track workouts.  The anxiety flowed on, even though the worst that can really happen during a workout is that I have to quit it early, which isn't that bad an outcome.  It was enlightening -- so much of what I blamed on physical fear was actually fear of failure.  With this new self-understanding, I once again learned how to deal with the nerves, and execute workouts and races (a big part of this is just rationalizing: "what's the worst that can happen -- it's not like I'm going to crash and break my neck").   Getting these same feelings before a hard pool running interval workout has been oddly reassuring -- I take it as an indication I'm doing something right.

Today was my first "test run" day -- jog a tiny bit on the track outside the pool to see how the foot holds up.  And the crazy thing was, I felt that exact same sense of dread hopping onto the track that I do before any workout.  Utterly ridiculous -- all I was going to do was jog a few steps, maybe as far as 100 meters, and then drop back down to a walk.  And yet, my mind kept cycling to all the things that could go wrong -- fantasies of the bone breaking in two with the first jogging step.   Fears that I was somehow going to screw this up, even though there's really no possible way to screw up alternating slow jogging and walking (except for pushing it too hard).  Tons of performance anxiety, even though there was absolutely no performance to speak of.

It was pretty refreshing, actually.  It established, conclusively, that nerves are just nerves, and self-created without a rational basis (that last realization is the helpful part).

So, I stepped onto the track, walked 200m, gritted my teeth, and started a slow, tentative jog.  100m and I let myself stop, and whadyaknow, still in one piece. Yup.  Foot's still attached to leg.  Very good.

I walked for 100m, and then repeated the process 3 more times -- each time with a bit more comfort and authority.  Then, the big finale: 400m (one full loop) of the track at a very slow, careful jog.  Shockingly, the jogging felt normal, and not strange at all.  I felt that same surge of confidence that you get after any completed workout, though the "workout" here was barely 10 minutes total (walking time+jogging time), with a half mile of jogging.

Grinned, picked up my bag, and headed up to the pool to aqua-jog.  Another track workout dragon dispatched, even if this was just a paper dragon.  I'll try again on Friday or Saturday.

Well, THAT was a surprise...

I had my 7 week follow-up visit with the podiatrist this morning. Visits to the doctor when you're injured are a bit like visits to the Oracle.  You traverse a perilous and stressful journey (through DC traffic), make an offering (Visa copay of $30), present your question, and then wait for the Oracle's pronouncement, which is grounded in the interpretation of things beyond your ken (x-rays).

In my case, the good doctor first palpated my foot and wiggled my toes (no pain anywhere, at all) and asked me how it felt when I walked or ellipticalled (no pain at all, just a lot of stiffness, especially during the toe-off phase of walking).   So, very good.  He sent me to the next room to get the foot x-rayed for the third time in this saga.

Then I waited, and waited.  And stared at a shiny poster depicting all the things that could go wrong with my feet.  And played with my phone, stunned at the lack of reception despite being in a fifth floor room with a window on K street in downtown DC.

I was debating whether to break down and actually read a pamphlet about bunions when he strode back in (I don't think I waited much at all after the x-ray, it just seemed like an eternity).

"This looks really good."

Huh?  I had braced for the opposite.

He pulled up the x-ray on his laptop, and the improvement was clear, even to me.  The fracture was completely gone; in its place was a perfectly formed bone with a fuzzy halo around the site of the fracture.  He explained to me that what he saw was a repaired bone, with a fully formed "boney callus" around it.

To explain further, my (non-medically trained) understanding is that bone healing has several stages:

1. the reactive stage: the initial inflammation and clotting;
2. the reparative stage: formation of a soft "callus" made of cartilage around the injury site that brings the bone together; followed by conversion of the soft callus into bone -- the "boney callus".  
3. the remodeling stage:  the bone's all there, the body just needs to fine tune it and carry away the excess (at this point, stress to the bone is helpful, as it provides guidance to the body as to how to remodel the bone).

According to the x-ray, I am in the remodeling stage, which can last for up to a year.

After giving me a brief tour of my own metatarsal, he looked at me.

"If we really wanted to play it super-safe, we'd wait until the beginning of the year to start running on it.  But this looks really solid.  I think if you want, you can start running on it now.  Just be very careful - I only want you running every other day for the first few weeks, and I don't want your running to total more than a mile a day for the first week; 2 miles a day for the second week.

"It's going to be a bit stiff and achy, and that's normal -- you've got all sorts of soft-tissue adhesions that are going to break apart as part of the process.  Just keep an eye on it.  If you feel any real pain, back off for 2-3 days.  If it starts hurting, and doesn't feel better after 3-4 days of no running, give me a call and we'll discuss whether you need to come back in.  But right now I don't think I need to see you again unless something changes."

I was shocked.  I had hoped as a best case scenario that he'd tell me to come back in 3-4 weeks for another set of x-rays, and an evaluation of whether I could start running again.  As funny as it sounds, I'm not sure I'm ready to run just yet.

Truth be told, I may have a bit of injury/poolrunning Stockholm syndrome.  I've come to see myself as an injured princess runner in my deep water fortress, safe from worrying about time splits or the reality of crappy running days.  I've grown spoiled.  I'm now used to the constant affirmations of how wonderful it is that I'm trying to stay active while injured, the constant compliments on my avid poolrunning, and the people who open doors or carry bags for me.  The pool is windfree and warm, while ice and chill lurk outside.  And now I have no excuse not to shovel snow.

Additionally, aside from any mental issues, while the bone may be ready for running, I'm not sure the leg is.  Six weeks of immobilization have left the foot and lower leg very weak, and my range of motion in the left ankle is much less than the right.  It improves every day as I walk -- I hobbled the first day or two, but now walk almost normally.  But I fear that if I begin to run right now, while this bone will hold, something else somewhere will give.

So I asked the doctor if I could delay running another week or two.  This isn't as odd a question as it first sounds.  During our last visit, he had been very clear that it wasn't that I could take the aircast off and start the elliptical at the 6 week mark, but that I needed to, and that he wanted to see me after I had been walking and ellipticalling and stressing it.

In this case, though, he told me I was fine and even smart to take it slower.  I told him that I wanted to spend more time walking and using the elliptical, and just bringing that leg up to the same range of motion and strength as the right, before I began to run, and he agreed with the idea.

So, that's my plan for right now (unless coach objects).  The next week or two will be dedicated to ever increasing elliptical and walking (I'd like to get up to "power walking" for at least an hour), plus foot strengthening and range of motion exercises, before gently starting to run (starting by going to the track and jogging the straightaways and walking the turns).

I'm registered for the National Half Marathon in late March (I registered this past July, to take advantage of the discounted fee) and the Cherry Blossom 10 Miler in early April, but I am operating under the assumption that I won't be running either.  Maybe I can race the 5K associated with Cherry Blossom, and maybe I'll be able to head up to Philly take a crack at the Broad Street 10 Miler in early May.  But it's still way too early to hope, and the priority remains on getting totally healthy.

As for how I managed to cut 12 weeks healing time down to 7?   Doctor pointed out that I was a) very compliant and b) very aggressive in treating this. A few examples:

• During the initial injury, within about 30 seconds of the foot going "pop", I called it a day, and began icing.  The foot didn't hurt at all, and I felt silly at the time, like I was overreacting.  But apparently that willingness to shut stuff down ASAP saved this from being much worse than it could have been.
  
• Once I had the aircast, I stayed in the aircast.  I've heard stories of a lot of people "cheating" on it, or trying to cycle or elliptical with it.  Nope.  It was hard, but I stuck to the pool.
  
• I'm well aware of my tendencies towards lousy circulation, as well as my Raynauds (fun picture of an attack here).  Both indicated a problem with healing, which is so dependent on blood flow.  So I addressed these by constantly keeping a heating pad on the foot and hopping in a hot shower anytime the Raynauds hit.  I think my heavy regimen of poolrunning also helped a lot here in keeping the blood moving.
• I also made the affirmative decision to accept weightgain during my down time.  I calculated early on that I could either a) try to diet to keep from gaining weight during this period of decreased activity, or b) focus on sufficient protein and calcium and calories, and if that meant a few pounds, oh well.  I chose B.  7 weeks later, the jeans are tight, the rear jiggles, and the scale is a few pounds up.  But I'm cleared to run, and I'm more than happy with that trade-off.
  
• Finally, the magic machine: the Exogen 4000 Bone Stim.  It pulses ultrasound to the bone, promoting healing.  My podiatrist wanted me to get one from day 1, due to my circulation problems and Raynauds. 
  
  I spent the first week coordinating with the Smith and Nephew rep who was trying to get my insurance (BCBS) to cover it.  During this time, I did some research online, and it became pretty clear from BCBS's published coverage memos that they were NOT going to cover it until I had gone 3 months no healing.  This was unacceptable.  So I went to the medical provider of last resort -- Ebay -- and purchased a slightly used device for ~$350 (about the same as my copay would have been, had BCBS covered it).  
  
  The research was based on using it once a day, but my doctor told me to be more aggressive, and so I zapped my foot every 8 hours (5 am, 1 pm, 9 pm) with religious zeal.  Did it work?  Honestly, no way to tell from this sample size of one.  But research (published on S&N's website, and I've also verified independently) indicates a reduction of healing time of up to 38% from consistent use of the bone stim.  38% of the original projection of 12 weeks is ~ 4 and a half weeks less -- which is about where I'm at right now.  Hmmmm. 

The Oracle has spoken.  Now for the elliptical.

An intro

So, on November 2nd, 2010, I was running at moderate pace on a treadmill.  I was doing 8 miles at marathon pace, and at the very end of the workout, my left foot went "pop".  Not snap or crackle, but pop.  It wasn't particularly painful; it felt like any joint cracking.   But, the foot felt slightly uncoordinated, so I decided to skip the cool down, and hit "stop".  Went back to the locker room, showered and changed, and then requested some ice from the front desk.

At the time, I thought the injury was at worst a mild sprain.  I have a history of osteopenia, but a decade of working out hard plus good nutrition have managed to improve my femur and hip to the point where they are OUT of the osteopenic range (no small feat for a woman in her later 30s).   Plus I had gotten a free bone density scan of my right foot a few days before at the Marine Corps Marathon Expo, and had been told that the foot bone density was great.  And, though the top of the foot was growing increasingly sore, and the bottom was cramping a bit, there wasn't any excruciating pain to the touch,and I had not had any previous pain in this foot.  It had to be acute tendonitis (which I've had several times before), or possibly a sprain.

I  went to the podiatrist the next morning.  This podiatrist is a runner, and a fairly accomplished one -- I believe he ran 3:04 at Boston this year (others check out their doctors' medical degrees; I check out their PRs).

I've seen him several times before for my injuries, and I've always appreciated his honesty, and his focus on getting someone up and running as soon as practical, rather than the hyper-obsessive focus on rest that I associate with doctors who treat primarily sedentary patients.   He palpated, and then had some x-rays done.

The fracture was clear as day on the x-rays.  Oblique fracture of the shaft of the second metatarsal of the left foot.  The podiatrist gently instructed me that he expected 6 weeks in a boot, with no weight-bearing exercise, and 6 more weeks of cycling and elliptical, before I could run.  I got the boot, hailed a cab home, and sat in shock.  And that was when the foot started to really hurt.

(I didn't cry until I also got a call from the plumber that the replacement of my hot water heater would be delayed another 24 hours.  I could handle no hot water.  I could handle a broken foot.  Together, they were too much).

In the days since then, I've acquired a boot, crutches, various pool memberships, a running coach, fancy machines to accelerate healing, and now a blog.