Sore Foot (Feet)
My feet have been hurting, but now my left foot is just plain old piss'in me off.
After LP in July, I took two weeks off. I then pretty much jumped right back into running 3 times a week and going to 2 spin classes a week. All my runs were kept to 30-40 minutes in length. Nothing fancy. Just for fun. I also got rid of some very old off the shelf orthotics and started using what comes with the shoe only. After a few weeks of doing this both my feet really flared up. Throbbing on the tops, ball of the foot was very painful. I stood down for a week, ice, elevation, some advil and slowly eased back into 20-30 minute runs, no spin classes. It has been about 4 weeks and finally my right foot is about 98% but my left foot still gets sore on top and the ball of my foot gets swollen by the end of the day. I went to see a podiatrist who thought I had just overworked my entire foot and confirmed through x-ray that there was no broken bones. Also, My feet never gave me any issues during IMLP training except for maybe slight discomfort for bike rides over 80 miles.
I went to a spinning class on Sunday just to chill out in the back of the class. All was well until I tried to stand up with the class. This resulted in slight discomfort to the top of my left foot. I am now thinking that jumping into spin classes 2 times a week with lots of "fun" standing up out of the saddle really caused havoc on my feet. FWIW I never once got out of the saddle for LP ramp up and certainly not during the race for me.
I've been iceing the foot, stretching my calves, and only 30 minute runs 3 times a week. Running shoes are 4 months old about to get new ones .
So I guess my question is...WTF? 
am I missing something here? Should I stand down all together until I'm 100%. Appt with another DR ASAP?
Looking at starting OS early 2012 for IMFL 2012.
Thanks EN!!
Comments
One question that jumped into my head immediately: Why did you remove the over the counter orthotics if you were having no pain using them? And now without them you have pain, correct?
Carrie( PT)
@Carrie, I know, I know,,,I removed them b/c they were very old and slightly torn through wear and tear. They must have been 4 years old. At the time I questioned what they were even doing for me. They were not a hard plastic type but rather a softer cushion type. I have tried to find replacements but can't seem to find the exact type. I've experimented with two other replacements but it just didn't feel right. I will keep looking. I'm thinking they were at least taking up some space that my foot got used to and really liked.
UGH.
Thanks for the thoght
Edit: I should also say that I don't have the old inserts anymore, they were torn so I threw them out. Little did I know.
Nate,
Other not quite random thougths beyond the inserts. One thought on that could this be an adaptation issue. I know with orthotics they tell you to wear then for 1 hour then increase the time. Did you use the inserts in other shoes or all the time or just in your runners?
1) You mention new shoes, did you change anything here.
2) Spin class - did you start at the same time as the running 3 X week. Do you take your own pedals and shoes to spin class or just use runners? Again if you are using your cycling shoes are they new? New cleats?
3) You mention slight discomfort on 80 mile rides at low intensity, compared to spin class I assume. The standing and hammering could be putting a lot of stress on balls of you feet or the top. Shifting weight laterally could also cause some issues. All this is just from my experience. I also scientifically studied this to a n=1 with a trial of 10 seconds by standing on the balls of my feet and shifting my weight around right now in the office to confirm my experience.
4) Finally I'm no doctor or x ray tech so take this for what its worth. If you have recently damages some of the small bones, fracture, stress fracture they do not show up on x-rays right away as I understand it. The bones actually have to be healing, So this could have been missed or may not have shown up.
5) One other thought on the throbbing on the tops of the feet. How tight are you tying the shoes? I know this can be an isses for me especially on my perviously broken leg as the foot tends to swell a little more than the other.
That's all I've got and not sure it's much help.
If it were me I'd quit the spin class and perhaps even running for a short period. Get the new shoes a go, same model/make and color if possible. Also continue to look for the same over the shelf orthotics or a suitable replacement.
I'm probably lining myself up for a "stand down" week. better now than in the OS.
My feet were bothering me as well, so I replaced my old specialized inserts with a new pair in my bike shoes and the pain is gone. They are pretty custom without being custom.
Jennifer
I have stood down for a week now and things are really only slightly better which is driving me crazy. I've been doing some icing and some advil but nothing crazy. Planning to stand down for maybe another week or so. Really need to get 100% before Feb which is when my OS starts.
Back in September I got my foot x-rayed with no signs of broken bones and the foot doctor said I had good looking feet. I'm scheduled to go back to the Dr. next Tuesday to discuss what other underlying issues might be there.
any thoughts? After IMLP I took 3 weeks off and then slowly ramped up to working out 3-4 times a week doing short bike/Run workouts. Must admit that the intensity has been close to OS type effort but nothing long and 2-3 days off each week. Is it possible I just didn't stand down long enough after LP.
Sheryl, did you go to a wider shoe also? Or change brands like Sidi (narrower than most) to another? Thx.
One thing it recommends is to really stretch the calf muscle. I know I am tight below the knee and have really worked on stretching but it is still a struggle. It also suggests that over pushing yourself could be a cause. I have been running pretty hard trying to push up my VDOT, so along with a new running form, I might have overdone it a bit.
Hope that when I heals up all the little muscles in my foot will heal up stronger than before. But really just want it to get to 100% soon.
one of the treatments is to be prescribed indiomethacin 50mg...thoughts on that? I think its like a super Advil.
http://gobarefooting.wordpress.com/2010/04/21/injury-top-of-the-foot-pain/
shorter exerpt from the article below:
The typical runner making the switch will usually complain of sore and tight calves after the initial barefoot runs. This is because the calf muscles are now being tightened and flexed. After that initial shock is gone and the calves begin to adapt, the same runners typically complain of pains in the tops of their feet. These pains are usually coming from two muscles and/or three tendons that run the length of the top of the foot, one of which actually starts along the tibia.
The two main foot extensor muscles are the Extensor Hallucis Longus muscle (EHL) and the Extensor Digitorum Longus muscle (EDL). The tendons from these muscles cross the front of the ankle, pass across the top of the foot, and attach into the big toe and lesser toes. These are the muscles that run along the top of the foot. There is also the Extensor Digitorum Brevis muscle, but it is more along the upper/outer part of the foot and not typically associated with this issue. Three tendons cover these muscles: the Extensor Digitorum Longus Tendons. These muscles and tendons all function to pull the foot upward and work with resistance from the Achilles tendon and the calf muscles (flexor muscle group) that pull the foot downward.
When these tendons are over-stressed they become inflamed and painful. Swelling may come with the inflammation but not always. Most commonly it is the extensor tendon to the big toe (EHL) that is affected. In other cases the extensor tendons to the lesser toes (EDL) are affected.
Top-of-the-foot pain is typically considered to be a form of tendonitis but can also just be a muscle strain. The most common factors that cause extensor tendonitis are excessive tightness of the calf muscles, over-exertion during exercise, and falling of the foot arch. A barefoot runner will not have to concern himself so much with the falling of arches as the forefoot strike most commonly strengthens and builds the arches. That would mean the barefoot runner would typically be dealing with calf tightness since he is now using the calf muscles more than before. So if you switch to a forefoot landing after years of heel striking, then you are suddenly activating the weak muscles opposite the strong muscles you have been using your entire life. The pain in the top of the foot is usually going to be some form of tendonitis as these tendons are not used to being pulled on and stretched. The other problem is that in switching to the fore/mid-foot strike you are also contracting the calves more than before, which will then cause stress on the opposing muscles and tendons in the top of the foot.
All of you who started out with calf pain transitioned to top-of-the-foot pain for that very reason. Your calves got extremely tight and sore. A lack of proper stretching and relaxing caused a counter balance problem, which manifested itself in the connective tissues in the top of the foot. Remember that every joint in the body is a balancing act between muscles, and the pain you feel is rarely coming from the spot you are feeling where you feel it.
With top-of-the-foot pain you should stretch the calves and arches as well as taking anti-inflammatory meds. Getting the calves to relax and loosen up should be the main focus, as this will allow the release of the muscles and tendons in the top of the foot. Icing the top of the affected foot will also help in the recovery process. As with any injury the main prescription is rest. This may be the toughest of all pills to swallow, especially for someone who has just learned the pure joy of running bare, but rest and time, stretching, and ice will heal this issue, allowing you to get back out there and do what you love.
Hope to be on the mend. Main goal is to get to 100%. Don't really want any nagging injuries prior to starting my OS. Fingers crossed.