Callous Analysis

I'm coming up on three weeks of down time because of my injured right foot. The pain has dissipated from being focused right on the end of the second metatarsal to now being more generalized and often spread out across the top of the forefoot. I've been wearing the boot as much as possible; it does help minimize any pain and keep the foot protected, although being so rigid I have felt as if I were going to twist or break something else from stepping on the smallest of objects accidentally.


After hearing the doctor note the callous under the end of the second metatarsal and a little Internet investigation I decided to look back at a picture I had taken of the bottoms of my feet a few weeks ago after a hot pavement barefoot run. They really were not as bad as they look in the photo (mostly dust stuck to sweat) but the callouses were real. I've outlined with red where the callous was heaviest from my foot coming into contact with the ground (It looks like a smaller sole within a sole). The dashed blue line indicates where I believe my foot would have been striking if I hadn't been wearing such a motion controlling shoe. The Asics I wear fall somewhere in the middle for pronation control. I think if I had been running exclusively barefoot or in a shoe that would have allowed me to pronate over at least to the rest of the forefoot pad I wouldn't have developed such a callous where in effect I was pushing off over the second metatarsal that is not designed for such a load demand.

Barefoot running may have exacerbated the issue once this callous, that was already well-developed from running in shoes, was subjected to tens of thousands of footstrikes and push offs with the second metatarsal directly above it. Your feet can provide a lot of information. Take a look at callouses and blisters, etc. to see if they're not trying to tell you something. If you don't, I have a sweaty boot and crutches I can loan you.

Three Pounds per Square Inch

It has been two weeks since I injured my foot. I hobbled around with crutches for the first week and have spent the past week in one of those post-op boots which helped a lot to protect it and keep the pressure off. Today I had to do some big city and highway motorcycle riding so I wore hiking boots and discovered that I could actually walk in them slowly and without too much of a limp if I stepped gingerly and evenly. I can stand still flat-footed without pain which says that I can tolerate about three pounds of pressure per square inch on my foot.

I guess that's progress.

Foot Sleuth and Fancy Free

I hurt my foot running. A seemingly simple question to ask is "Why"? I ask this question because I don't want the same thing to happen again. I've been looking for answers. Most sources answer the question from the perspective of their area of expertise.

The ER doctor diagnosed the injury as "foot pain" because the Xray was negative for a break, although a stress fracture was suspected. The doctor at my regular clinic diagnosed it as "metatarsalgia", which suggests an issue with the metatarsal bones but in most literature it looks like the reference is to general pain in the ball of the foot. It could more specifically be capsulitis which is an irritated joint capsule at the end of, in my case, the second metatarsal. This capsule can even rupture. It could be a bone bruise at that same end of the metatarsal or both.

Most of what I read regarding descriptions of similar diagnoses do not sound like a similar injury. Most people seem to experience some relatively gradual build up to soreness or pain. I had a gradual build up over one day and then a sudden intensely painful event the following day. My interpretation of this is that there was some type of catastrophic failure, albeit rather localized. Much of the metatarsalgia accounts speak of the sensation of a stone in the shoe, not of a spear suddenly being jabbed through it. So I'm picturing either the ruptured capsule or some kind of fissuring of the end of the joint. Something that was definitely stressed gave out. Why?

Some might say overuse, or too much of an increase too soon, was the cause. OK, fair enough. I've had other overuse injuries and they've all gone away. Why was there this failure at this particular place in my body? Clearly there was too much repetitive pressure/stress on the same spot. In just a three week period, this particular point on this 52 year old foot struck the ground at a running gait approximately one quarter of a million times with a 180 pound cargo. Did I exceed the limit or was there some pathology that allowed this failure?

My impression is that if I ask the orthopedist I will be told that the bone rides lower than it should and could be shortened, if I ask a physical therapist I will be told that I need to strengthen certain muscles, if I ask the chiropractor I'll be told my hips are out of alignment and I need adjustments, the HappyFeet people will say I need their orthotics, the nutritionist will say I need calcium, the running shoe people will want to put me in a shoe that controls pronation which they've done for 20 years. (Analyzing the implications from the callouses on the bottom of my feet, particularly the right, I would say that my feet don't complete their pronation which should go all the way to the big toe side. Hmmm, this problem was already occurring before I kicked off the running shoes.)

I'd like to have all of the above knowledge in one person, but I think the only way to do this is for me to be that person. I need to look at some evidence: My left running shoe has always had much more significant tread wear than the right foot and since I've been running barefoot or minimalistically my right foot has become significantly more padded and calloused than the left. When I've had plantar faciitis or Achilles tendonitis they have always been worse on the right leg. I've always thought the muscles in my right leg looked bulkier than the left leg.

To me, much of this might suggest a longer left leg or maybe unlevel hips. It makes sense; shorter limbs often look more muscular. Wouldn't the foot on a longer leg scuff the ground more often than its shorter counterpart? Would the padding on the foot of a shorter leg thicken to balance things out? Hard to say. Would it thicken because the forces coming down on it were greater because it has farther to go to reach the ground? More conceivable. Tight calves supposedly contribute to plantar faciitis, which I had for a long time so presumably I've had tight calves. I read that tight calves can lead to the far end of the metatarsal riding lower which makes it take more of a load. If that takes more of a load, then a callous builds up under it. If a callous builds up under it, that callous becomes the point of propulsion instead of the big toes and the part of the pad that corresponds to it. Did wearing pronation control shoes for so long cause the middle of my foot to become the point of push off instead of allowing the big toe side of the foot to become involved? Once I took my shoes off to run and there was this big callous in the middle of my foot was now a part of my foot handling a job it wasn't designed for?

So how do I fix this? If my hips were not level, the chiropractor could adjust this and the adjustment would probably last as long as the car ride home. I could get routine adjustments, get physical therapy, and do exercises to support the adjustments, but I just don't picture all of that overriding 52 years of me being a little bit crooked, not to mention the cost nor the discipline required. How about lengthening or shortening a leg? For someone who's impatient waiting for a bone bruise to heal!?

My feet seem to be trying to correct the matter themselves by adapting. Maybe I should follow their lead. I can support them by continuing to not let the calves interfere by keeping them from tightening and pulling on foot parts. I'm picturing a little bit of orthotic padding under the termination of the first metatarsal; if that were in effect lower to the ground, when the foot pronated from its initial foot strike on the pad between the 5th and 4th metatarsal ends inward, it would roll to next point closest to the ground which would be the padding, taking the 2nd metatarsal out of the picture. The big toe and the corresponding metatarsal are significantly heftier and are intended to handle the push off. This padding would have to be tapered to nothing as it crosses the forefoot pad. This could be done inside a minimalist shoe or the Vibram FiveFinger. I could try to get my foot back to how it should be naturally without the big callous in the middle of it.

This is the state of my pondering to this point.

Metatarsalgia

IT SHOULD BE NOTED THAT THE EVENTAUL DIAGNOSIS OF THE INJURY DESCRIBED BELOW WAS A STRESS FRACTURE OF THE SECOND METATARSAL WHICH WAS CONFIRMED SEVERAL WEEKS LATER BY A FOLLOW UP XRAY.

It's been a week since the onset of Sudden Sedentary Summer Syndrome. I had assumed, given the symptoms and an Xray that didn't reveal a fracture, that I had a stress fracture in the second metatarsal. I wanted to make sure I was not doing it any harm and that I was optimizing the prospects for a speedy recovery so I made an appointment to have it checked out again.

My regular doctor apparently is on vacation but I felt confident when the alternative said she thought I looked familiar, that maybe she had seen me "on the trails". I doubt it, but at least she let me know she was a runner.

She must have asked sixty times or so whether this or that hurt when she did this or that as she felt around my foot. She clearly knew where it was going to be excruciating and she saved applying pressure there for last. Interestingly, she felt that it wasn't a stress fracture as I had assumed. Even before I started barefoot running I had a relatively thick callous in the center of the ball of my right foot. Since I've been running barefoot or minimalistically that callous and the callous in general on the foot has developed more than that of the left foot. Evidently, this center callous is related to the metatarsal directly above it. I think that mostly because of this detail and the fact that the pain is relatively localized and came on rather suddenly she diagnosed it as metatarsalgia. From what I have now read regarding metatarsalgia, it could basically be called a nasty bone bruise at the joint end of the bone.

She tried to fit me with a post-op shoe but we couldn't get it to allow me to walk without significant pain so she tried one of those big post-op boots and that allowed me to walk without any pain, although it does seem to torque the knee somewhat.

The questions now are: Is this better than a stress fracture in that the recovery time is faster? (I saw references to recovery times of 2 to 4 weeks to 5 to 6 months)Will I be prone to recurrences? Did the barefoot running alone cause this or would it have happened anyway with higher mileage? Will I be able to continue running minimalistically?

Oh, and NSAIDS are now thought to impede bone healing.

The Running Gods Have Struck me Down

For the past three days I've discovered the occasional thought coming into my head about where I'm going to run today, or how far I'll go, how much hillplay will I do, whether I'll go shod or barefoot...and it's about then that I remember that the bare foot is sadly swollen. I can walk without the crutches, but there's no pretending nothing is wrong; I can step down over a line that runs from the heel to the little toe. Any misstep with weight over the center of the forefoot reminds me of why humans invented have developed narcotic painkillers. I've been taking Naproxen, not for pain relief because it's easy enough to avoid pain, but rather to reduce inflammation. Are swelling and inflammation two different conditions? (Photo included in previous post of swollen foot compared to normal)

I should be able to attend to many to-do list type tasks while I'm not running. An hour or two, or three a day running does cut into time for chores and when I pose the question to myself: Would I rather run or figure out how to get the squirrels out of the attic or Would I rather run or restain the deck I keep (kept)choosing "run".

There is some issues I'm facing now. The main one is to limit what I eat. I had been holding steady at 176 after having come down from a lifetime high of 206 when Elliott was born 16 months ago. I can actually lose weight better by not running because I eat when I run. So I need to record calories and limit them to about 2200 a day. Another issue is whether I do some kind of alternative exercise. I suppose I should be able to walk normally in a week or so. I could pedal a bicycle as well but currently I can't imagine being able to pedal with the requisite pressure to actually make it be considered exercise.

The third issue has to do with where do I begin when I return to running. Let's say I begin to run again in eight weeks. Do I start as if I were a beginning runner? Can I accelerate the return to my former self? How much conditioning and strength does one lose in eight weeks? Will all that barefoot conditioning be lost? Do I start over again? If my foot broke, was I actually "conditioned"? Is there a chart or formula that has miles run per week before suspending running combined with weeks off that tells you where you can expect to be? So, let's say as in my case I was averaging 45 miles per week and I take three weeks off, where would I be? Eight weeks? Is eight weeks with an injury different from eight weeks without?

I had gotten to the point that I was rather undaunted by the prospects of almost any run (OK, maybe not 50 miles with thousands of feet of elevation gain in ninety degree weather); I was very pleased with my conditioning and my muscles were never sore or even tired. I was always ready for another run. That conditioning was in some sense an illusion. The weakest link is a little bone smaller than my pinkie finger. How can I have a better sense of where I really am physically and when I am at a point that I'll break? Should I just look at the data and see that I went from an average of 30 per week for a year to 45 per week for six week with a peak of 70 and realize that although I felt great, a spike in mileage like that is risky? After that 70 mile week I was actually pondering the prospects of going for 100 in a week. And I didn't think I ever got a runner's high; clearly I was high.

Sudden Sedentary-Summer Onset Syndrome

...otherwise known as a stress fracture

I got home from the emergency room about 11pm last night. Xrays from three different angles showed a perfectly normal foot. Stepping on the floor provides the unpleasant illusion of being impaled on an inch diameter stake.

I had responded to an ad on Craigslist of a fellow looking for a training partner for a 50 mile race. I answered saying I wasn't training for a 50 miler but I would be willing accompany him on any distance he wanted. We met at the Mt. Sanitas trailhead on the western edge of Boulder. The run would be a 1450 ft. elevation gain and about a mile and a third to the summit and then back down. We walked a couple hundred yards getting acquainted and started to jog as the trail began to rise.

I felt a sudden sharp pain, let out a yell, and immediately stopped, thinking I had stepped on a rock. I quickly could tell that I hadn't stepped on a rock because I would have felt as if the sole of my foot were bruised. There was a stabbing pain radiating to the top of my right foot. On my run the previous day there had been an unusual dull pain in the same area and I had felt an occasional twinge during the day. My new soon to be ex running partner said it was a bad sign that the pain was on top; he said the same thing had happened to him once and he had broken three bones in his foot. We shook hands, he headed up, and I hobbled down.

As I dragged myself up the road to the parking lot I could hear a car alarm and suddenly an SUV came speeding out of the lot; it took me a moment to put one and one together but I discovered a Jeep Liberty with a smashed out window. I called 911 but told them I wasn't going to stick around because I had my own issue to attend to.

Riding the motorcycle home was not so difficult because shifting is done with the left foot and the strongest braking is down with the hand brake. Normally I would just wait until the next day but I my impression has always been that broken bones are best treated sooner than later. I expected to see splintered bone shards in the Xray but nothing, not a shadow of a line, nor a metatarsal even a millimeter out of place.

I've read about other people's stress fractures; it seems to me they were at least able to walk. What a wimp I am if a fracture that doesn't even show up is this painful, imagine if I were to break a bone enough for it to show on an Xray. The regimen now is ice, ibuprofen, and idleness.

For anyone who reads my blog (I guess that would be my sister) you'll know that I have been running barefoot and minimalistically for about four months so if you want to add me to the statistics of those injured barefoot you can put me down in that column although I now people have had stress fractures with running shoes and increasing my weekly mileage from an average of 30 per week to 45 per week muddy the statistical waters.

More Elevation in Shadow Canyon

(We have been video filming Elliott lately so no pictures but maybe some video soon)

Yesterday I wanted to explore more of the trail that I had run on Thursday. I decided to wear regular running shoes instead of the FiveFingers because I knew it would be rockier, and was it ever. The trail eventually got to a point where it was no longer runnable. There were places that it was all rock and on the return I even had to climb down backwards in places.

The first mile and a half was the same 750 feet of elevation gain as Thursday but the next mile had another 750 feet of gain but in just a mile. I had intended to go farther but ran out of time because I had a commitment to pick up a friend of Valerie. I was content to not have gone on any more because from what I could see it was just going to be more bouldering.

I hope the pictures capture the conditions. The iphone is not a good camera and as you can imagine in a place called Shadow Canyon it might be rather dark.

(The rocky images are taken in the area behind the distant image with the devil's thumb in the middle of it. The steps photo is relatively early on the way up)

Short Runs

I'm having difficulty getting in the runs that I'd like to this week so far. One run was 7 miles but everything else has been in the 3 mile range; yesterday I ran 3.1 miles at 8:16 pace. The weather has been unfavorable for running. The temperature has been great(Ruth was on the couch with a blanket earlier), but it has been raining on and off which isn't that big of an impediment, but navigating around lighting is.

I was feeling bored with my usual runs so I decided to head toward the mountains. I like the trails around Eldorado Springs so I headed over there this afternoon on the motorcycle. Unfortunately, the darkest clouds were right over the canyon. Upon arrival I changed into the FiveFingers and slipped off my jeans. I decided that I would run until I heard thunder and then turn around.

The trail goes uphill rather quickly, but never gets so steep that it can be run. Mapmyrun had the steepest incline as 15%; the overall was about 10%. I had only run about 1.55 miles (750 ft. vertical) before I heard thunder. The sky was darkening as well. The trail was challenging for wearing VFF, descending it was very much like skiing moguls. I was all the way down, parallel to the stream, when I violated my first rule of VFF trail running: Don't take your eyes of the trail. I had come down on a different trail than I had gone up so I took a glance across the creek to see where I was and WACK; I jammed the little toe on my right foot. It was a serious jolt but I decided to just keep going.

I arrived at the motorcycle just as raindrops began to fall. The clouds had been building exponentially. On the way home I was barely able to keep ahead of the impending storm with cold drops pelting my arms.

Maybe tomorrow will be the long run day.

Miles Milestone

I skipped right over ever having a 60 mile week and ran 70.2 miles this week. I ran three times last Sunday for a total of 13.8 and today I ran 14.4 and went back out at 10:30PM to add on the last two miles to break 70. I was going to be content with reaching 60, but I ended up having to elude thunderstorms and kept getting pushed farther and farther from home. I eventually decided to run to a bus station that I knew I could catch a ride home through the storm on but ended up waiting the storm out in a laundromat (good cashews and M&Ms in those dispensers) and made a beeline home once it passed. When I realized that I was close to seventy for the week I decided to go back out after I got home from working the cart.

Half of my miles this week were either in Vibram FiveFingers, barefoot, or in Walmart Sand and Surf shoes. I am working on a blog that summarizes my four month and continuing experiment with marginally shod/barefoot running.

Barefoot Running Report

I believe that moving away from exclusively using traditional running shoes has allowed me to increase mileage and eliminate the common overuse injuries that runners typically endure. I am ready to give some definitive conclusions about my "barefoot" running and transitioning to barefoot or minimalist running.

I have not found that I can run faster barefoot, in fact I run a minute or so slower per mile without running shoes, but that doesn't mean that it hasn't contributed to improving my ability to run faster. Pushing the limits of speed seem to require some of what shoes can do for a person; after all, the whole evolutionary premise that man evolved into a runner was not about being fast but rather about being able to go the distance in the persistent hunt. Doing something we were not meant to do (run fast) requires something we were not meant to wear: shoes. But there is more to life once you're not having to exhaust your dinner before you dine. Steel-toed shoes may be required on the construction site, ski boots help keep our feet warm and our feet attached to the skis, and some pointy high heels might make us attract a mate, and so likewise for stretching a double into a triple or delivering a 10K PR we may find that specialize footwear aids in those endeavors.

If you are interested in running farther, more frequently, and without pain from overuse injuries I am comfortable suggesting minimalist footwear. The idea being that you will strengthen your feet and other parts related to proper distance running and those parts will be allowed to work in harmony and not be forced into an unnatural relationship by wedges of gel that are supposed to correct something presumed wrong with you. Injuries of the non-overuse type such as torn cartilage, stress fractures, bone spurs, arthritis, etc. are not going to be resolved by taking off your shoes; these may require repair, treatment, and rest.

If you don't even walk around indoors without some form of footwear I would start by leaving the shoes off around the house. From there, I would suggest finding some nice relatively new asphalt. Concrete is actually rather abrasive and manicured lawns may be too cushioned and not require you to make the necessary changes in your stride to run barefoot. For some, a few hundred feet may be a good start, for others, maybe a mile. You certainly don't want to run to the point that you've worn a couple of toes raw.

Some conditioning has to occur on a few fronts. The skin has to become calloused on the bottoms of your feet, the pads of your feet need time to thicken as a response to the running, all the internal components of your feet need time to adjust and strengthen, and different muscles, particularly in your lower legs need time to build. Applying the 10% increase rule may be prudent. So let's say you run barefoot for a mile three times the first week, you could up that to 3.3 miles the following week even if you're running 30 miles a week in traditional running shoes, or maybe the barefoot running is all that you do if you haven't been running. If you have been running, the barefoot miles can be included in an overall mileage increase. I would also do any barefoot miles before a shod run, not after.

Many people have opted for minimalist foot coverage like the Vibram FiveFinger foot gloves. I like them but I have found that they have the same effect on my skin as boiling water has on a potato skin so I use them within limits. I also wear an inexpensive alternative; I have found that the sand and surf type outdoor slippers work quite well although they have less traction. You need to consider where you will typical run. I don't frequently encounter broken glass but we have a nasty nugget of nature where I live called a Goathead which is a hard spiky ball about the size of a kernel of corn guaranteed to puncture a mountain bike tire or stop a dog in its tracks.The path of the car tire on lightly-travelled neighborhood streets is usually adequately clear of debris.

If you've been pounding your heel in running shoes you will quickly discover that you will not want to do this barefoot. I have found that the outer edge of my forefoot strikes the ground first and then rolls to the inside as it lands with the heel lightly coming down as well; a large calloused pad has developed behind the four smaller toes. Allowing the toughening of the skin on your feet be a determining factor in your mileage build-up is a good guide. If you use some type of minimal footwear you will not be able to base your mileage increase on the toughness of your soles.

Over the eighteen weeks that I have been transitioning my weekly average has gone from 20 miles per week for the six week prior to kicking off the running shoes (32 miles for the prior eight month period) to 45 miles per week for the most recent six weeks of incorporating minimalist running. I still run about half my miles in traditional running shoes. My body seems to be able to handle it, possibly because of overall strengthening or because the mileage in them is tolerable in that it doesn't constitute overuse. The average weekly mileage in running shoes over the eighteen week period has been 21 miles per week while my overall mileage average has risen significantly; this most recent week I comfortably ran 70.2 miles. I have discovered that alternating between running "barefoot" and in running shoes is like running on two different pairs of legs. If I run ten miles one day in shoes when I go out the next day in the FiveFingers my legs feel as if I hadn't run the previous day.

Don't do speedwork barefoot and don't race a roadrace barefoot. Minimalist running is not about fast and hard. It's about avoiding injury and going the distance. It's also a great sensory experience; you wouldn't listen to music with earplugs in, or watch the sunset with your eyes closed, or smell the flowers with a clothes pin on your nose. Allow yourself to feel the planet.

June Summary

June was a wonderful month in terms of runnng. I only missed two days, one being the intentional rest day before the Joe Colton race. I enjoyed 38 outings which means there were ten days that I went out more than once, actually nine because I had three run on one day. I read a blog in which the fellow said that running two-a-days felt like training. I'm glad I don't have that perception; they seems like luxuries to me. Actually, it probably means I didn't attend to something I should have that day.

I ran a total of 194 miles in June which averages to 5.1 miles per outing, which doesn't reflect a typical outing. Most of my runs were either clustered around 3.5 miles or around 7 miles. Most of the short runs were run in some sort of slipper pushing a running stroller. For the longer runs I was traditionally shod. Shod running accounted for 115.7 miles and running in VFF, river shoes, or barefoot accounted for 79.2 miles or a little over 40% of total running.

It sounds like my little stroller buddy is up so let July begin!