James Marsh micro thread
Hey Coach Patrick -
Just wanted to follow up on the phone conversation we had regarding the ball of my left foot. It has been getting irritated slightly of late so have been trying to limit some of my longer and harder runs. Running hard seems to create more pain. I am running in fairly new Hokas (same model as I used for my Ironman last year). The shoes were purchased at a running store and seem to fit appropriately. I have a slightly high arch.
The origin of the injury is a little unclear, but seemed to coincide with a lot of walking in flip flops during a vacation. At that point, the foot was very painful and I couldn't really put pressure on it. I iced it and tried to stay off of it. It was aggravated following a speed workout on the beach. All of this came on the heels of some peroneal tendinitis following a half marathon race (this required a walking cast and was painful but has not recurred in any meaningful way). The pain with the ball of the foot I have today is very modest, but I feel like it could be a hard run away from more substantial pain. Because of these injuries, my run training last year was suboptimal (I think I only ran 350 or so miles LY). I love the concept of your 'run durability' plan, but want if I am durable enough to start it!?
It seems to have been aggravated following a 5k turkey trot in November. I have been trying to be careful with it. Icing it. Stretching it. And trying to remain very aware of it. Lately, I have been avoiding longer or harder run workouts. I have also transitioned to a treadmill (a Woodway 'slat belt' model that supposedly is better to run on) to help limit the impact and give me the flexibility to stop my run if it hurts (rather than be stuck 2 miles from my home and having to limp back).
I think I need to take a week or so off from running and want to get your best ideas on what I should be doing. I can focus on more strength and core workouts. I could start doing some more swimming. Or amp up my bike workouts. Hoping to get some advice here. thanks.
Comments
I also recall saying that you could use a slightly bigger shoe (by 1/2 size) per our call, and you might want to check your cadence to make sure you are close to 180 steps per minute (90 for one leg).
Also, how do you define "hard" running that aggravates it. What zone is that?
Let's get this worked out!
~ Coach P
I went to my local runner's shop and had them look at the fit of my shoes and they said they were 'fine.' (she did suggest maybe going to the Hoka Vanquish that has a little more support than the Clifton I am currently running in the next time I need a pair of shoes). I am trying out some SuperFeet orthotics (green) for my Hokas as well. I wore these around on Monday during the day and ran at an easy Z1/2 pace on the treadmill on Tuesday morning and felt no pain or discomfort in the left foot. The arch in the right foot feels slightly uncomfortable but I think it just needs to conform to the orthotic. I am going to run for 70 min tonight on the treadmill and see how it feels.
My cadence seems good and pretty consistent (last three runs 89, 90, 89), so not sure that is the problem.
As for "hard", it seems I suffered some problems after:
1) NYC Half Marathon last year (8min pace) suffered some peroneal tendinitis. i was a little out of shape and pushed too hard in hindsight.
2) a 5K "turkey trot" where i ran 7:25s seemed to aggravate the left ball of my foot.
3) frequently any time I am Z3 or Z4 there seems to be some soreness.
I am going to keep testing the orthotics and adjust my running load accordingly. I will adjust distance and pace depending on how it feels.
I think your plan to generally add load is perfect...please keep me in the loop!
Update on the left ball of foot problem...
First, I am pretty sure it is just Metatarsalalgia which is getting aggravated by some atrophying of my plantar foot pad. I had my gf examine both of my foot pads and the left one is shaped a little differently and is a little thinner than the right foot. So the first metatarsal is a little more exposed and so I think creates the discomfort. The pain is very manageable at this stage but I recall from last spring that it can quickly evolve into a more painful injury.
Second, I have been following the program from Athletes Treating Athletes website. Lots of foot and calf stretching. I am also taking a full week off of the run just to let it heal. I have been icing it and also soaking it in some epsom salts. I have been adding a bit more bike and core in place of running.
So I feel like I am on a path to getting this resolved. Maybe some custom orthotics that add a little more cushion under the ball of the foot might help. Any advice would be helpful.
More importantly, I am wondering what you want me to do this week. Technically it is my "test week". I am prepared to do bike test. I am wondering more about the run test. Recall I did not actually do an initial run test but took my time from a recent 5k 'turkey trot' which I thought was representative of my fitness at the time (plus my foot was a little sore so didn't want to add another hard run on it). The question I have is "should I run a fairly hard 5k test?" or skip this test and just ease back into running. Or maybe stay off the foot for another week or so?
The last question I have relates to running form and the sore ball of foot. Personally, I think my running form is pretty good. Good 180 cadence. Largely midsole/heel strike. But is there some obvious problem with my form that might manifest itself into this injury?
Honestly, I'd look at a more cushioned shoe like Hokas, and I'd go a 1/2 size bigger than normal so your foot can move in the shoe (if you haven't already). In terms of orthotics, if you have high arches (likely) then you'll do better with a rigid (plastic) one that will engage your arch...it's not meant to be molded to your foot when you stand...but when you run, your arch will hit it and "activate" vs placing all the weight on the metatarsal alone. So my orthotics are hard plastic heel and arch...they end there before the ball of the foot.
I recommend padded slippers around the house, no bare feet please.
No run test...rest it up and let's get you back on a manageable (sustainable) run program over the next 3 to 4 weeks..I can help you with that here if need be.
I don't believe it...you are predisposed to it from my experience, although a doctor might disagree...watch shoe choice, terrain choice and rest as needed.
Few updates:
1) the ball of foot is feeling better. two weeks in Run Jail. icing, soaking, stretching, etc. seemed to help.
2) I am headed to Mexico tomorrow with gf. I will bring bike and try to ride outside. I will do runs and maybe a little swimming. Let me know if you think I should focus on anything in particular.
Thoughts?