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Author Topic: Top of foot injury  (Read 1774 times)
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aaron
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« on: August 08, 2010, 01:05:36 PM »

I am checking to see if any other VFF-ers have had foot injuries. 

First a little background:  I have been wearing my KSOs almost constantly since I got them back in January.  I transitioned slowly, building up the mileage.  Aside from the usual sore calvs, I had one "injury" to my left foot.  During a run, I had some pain on the top of my left foot.  When I got back home, it was already starting to swell.  It was too painful to run on for about two weeks.  Of course, I tried to run on it too soon and had a set back.  Eventually, the pain and swelling stopped and I got back to running as usual.  Then, in May, I got my Bikilas and transitioned to doing all of my running in them.  In June, marathon training started, and I was slowly building up the mileage.  About three weeks ago, I was up to 9 miles in the Bikilas with no problems.  Actually, I had been running really well and was feeling great.  Then, while doing speedwork at a track, I felt a sharp pain in the top of my right foot.  It was similar to what I felt in my left foot, but worse.  After limping back home, I began a regimen of rest/ice/ibuprofen.  I did this for two weeks with no running at all.   I also saw my doc (a runner) and had an x-ray that showed no stress fracture.   It started to feel better last week and the swelling seemed to have subsided, so I eased back into running.  I did two short runs (2 miles each).  My foot was sore during each run, but it wasn't bad.  There was also some swelling after each run that subsided with ice and ibuprofen.  Then, I started out for a third run that week and it all went to hell.  I felt a pop in the top of my right foot accompanied by a sharp pain.  I limped back to my office and started over with the ice and ibuprofen.  I emailed my doc who told me to rest it for two more weeks and see what happens.  If it still hurts, he will send me to to a foot/ortho doc.

I think I have a stress fracture to one of the metatarsals in my foot.  It hurts pretty much all the time, and the only shoe I can wear to support it without pain is a regular cushioned running shoe (the VFFs flex too much for right now).  The conventional advice is to rest the foot for 6 weeks and do cross training (swimming or biking) instead.  I know I should have waited longer before running again, so, here I am, resting, riding, and swimming.

I am curious whether any other VFF-ers have experienced something like this and whether anybody has any advice regarding the matter.  I honestly do not think it is the shoes.  If anything, I did too much too soon, and the muscles in the foot were not quite strong enough which lead to the stress fracture.

If anybody has any thoughts or advice, they would be greatly appreciated.

Thanks
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« on: August 08, 2010, 01:05:36 PM »

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jmijares
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« Reply #1 on: August 08, 2010, 01:14:52 PM »

Hopefully, qcassidy and JimmyHart and a few of the other forum members will jump in, but having experienced the same pain I can tell you that you're definitely suffering from too-much-too-soon syndrome.  For me, it was tarsal tunnel issues and not a stress fracture.

Top of the foot pain hit me one and a half weeks before my half marathon...  If it's not a stress fracture, then it could be the tendons, though the only way to truly tell would be a CT scan.  Take your doc's advice and avoid running in VFFs or barefoot because if you keep running like that you could make it a whole lot worse.  When you start running again, cut your total VFF weekly mileage by half or even two-thirds and build up slowly after that.  I had my injury in late May of this year and I'm only doing 1% - 5% weekly increases in mileage, and I'm only running in VFFs once or twice a week.  It takes time to strengthen the bones and tendons in your foot.
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valleygirl
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« Reply #2 on: August 08, 2010, 02:09:51 PM »

The only thing I can say is that not all stress fx are evident on xray.  Sometimes it takes an MRI which I hope your doc will order this next time around.  I don't think I would even wait the 2 weeks if I were you.  It might take that long just to get the MRI done.
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qcassidy352
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« Reply #3 on: August 08, 2010, 08:31:26 PM »

hi aaron,

I've been through this - the pain, trying to run through it, doctors not diagnosing it correctly, backing off but not stopping, the whole thing.

Because of the combination of swelling and sharp pain, I strongly believe you have a stress fracture.  It can't hurt to get the MRI (unless it hurts financially), but I don't see how it could be anything but a stress fracture.  If it were tendons or strained muscles, the pain would not be so sharp and would not come back like it has.  Tendonitis goes away with 7-10 days of rest/ice/ibuprofen. 

If it is a stress fracture, the usual prognosis is 6-8 weeks of rest IF the foot is immobilized in a walking cast.  If you continue to walk in regular shoes and barefoot around the house, you will substantially drag out the process.  Personally, I spent about 10 weeks walking normally, and my fracture only partially healed - it took another 2 weeks in a boot to really get it to heal.  And if you're in a boot, you really, really have to wear it every single time your foot contacts the ground (I guess the shower is the exception).  My doc even told me that swimming was not Ok if it involved walking barefoot from the locker room to the pool, and regular (non-stationary) biking was not Ok because of having to put my foot down when stopped.

I'm sorry to be the bearer of bad news, but I have to be honest - your injury sounds even worse than mine because of the serious swelling and the "pop" you felt.  I really think you need to be in a walking cast or this is going to drag out a very long time - and if you keep trying to run every time the swelling goes down, it could drag out indefinitely.

I should also say that I think your definition of "gradual" is similar to what mine was.  I did 4.5 miles my first day, was at a high of 7 after about a month, and was running in my KSOs every day after about 6 weeks.  It's not clear from your post when you started again after the first set back in January, but even if it was early February, you were up to 9 miles by June, 4 months later.  That feels "gradual" to an experienced runner, but when it comes to barefoot/VFFs, it is NOT.  If you're like me, you need to completely readjust your thinking.  The feet of an experienced, shod runner are literally years behind our legs in terms of strength and durability.  Imagine you'd never seriously used your legs before in your whole life.  How long would it take to get up to running nine miles?  A lot more than 4 months, I'd wager.  Well, we've never seriously used our feet.

Again, I'm sorry to be so negative, but I wish someone had said this to me as soon as my feet started hurting.  Let me know if you have any questions, and best of luck.
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« Reply #3 on: August 08, 2010, 08:31:26 PM »

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valleygirl
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« Reply #4 on: August 08, 2010, 11:12:34 PM »

I think that was some great solid honest advice.  I'd take it if I were you! Cool
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aaron
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« Reply #5 on: August 08, 2010, 11:19:01 PM »

Thanks for the input.  The responses I got pretty much confirmed my suspicions.  Although I had an x-ray, I think it was too soon.  It sometimes takes up to 3-4 weeks for a stress fracture to show via x-ray.  If I am still having pain in two weeks, I will press my doc for an MRI.  I work at a university hospital, so getting in won't be as bad as somebody coming off the street.  That's on of the perks, I guess.

Up to the injury, I had been building slowly all year.  In the previous weeks, my long runs were 6-7-5-9-7-9.  I was pretty use to those types of distances, which is what makes the injury so much more frustrating.  Aside from the sore calves I had mentioned, after longer runs, I also had some morning swelling in the soles of my feet right behind the toes.  That usually went away by noon.  

The problem with a foot injury, like one of he responders said, is if you don't stay off it completely, it will take forever to heal.  I have an active 3-year-old at home, so crutches are not an option.  A boot may be.  I'll wait to see what my doc says.  

I really hope it is just bad tendonitis and that the pop I felt was more a figment of my imagination.  I doubt it though.  The main source of pain is too centralized for that.  

Thanks again for the comments and advice.  My doc is a runner too, but, when it comes to something like this, I value the advice of my fellow minimalist runners just as much. 

Aaron
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qcassidy352
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« Reply #6 on: August 09, 2010, 10:02:02 AM »

aaron,

What I'm saying is that being used to the distances doesn't mean much if you're used to them in sneakers.  Like you, I'm accustomed to going a lot longer than that - in sneakers.  So I really didn't think anything of starting with 4.5 miles and then building up to 7 in a few weeks.  Your legs and aerobic system may be used to those distances, but if your feet are like mine, that's an order of magnitude more than they've ever had to do before starting to wear VFFs.  The fact that you got away with it for some weeks or months doesn't mean much.  I was over 7 miles with no pain in KSOs and thought I'd fully transitioned, and then the pain hit on a 4 mile run.

Crutches are usually not necessary for a metatarsal stress fracture, and you can actually get around pretty darn well in a boot.  If I were you, I'd see if I could get my hands on one sooner rather than later.  Wearing it before the fracture is confirmed certainly can't hurt.

Last thing I'll say is that sometimes doctors get this stuff wrong.  I saw two docs for my foot pain - one an active recovery doctor who is a runner and who I trust very much (has been fantastic with other injuries).  She was confident it wasn't a fracture.  The other works in sports medicine podiatry at one of the best hospitals in Boston.  He's been treating world-class athletes for decades, was a sub-elite runner himself, and is widely considered an expert.  He told me, "You don't have a fracture.  I'd send you for an MRI if I thought it would tell us anything, but it wouldn't."  So I walked around for weeks with these two opinions in my pocket, and finally, when the pain just wouldn't go away, I asked the active recovery doc to order the MRI.

Again, best of luck.
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« Reply #7 on: August 09, 2010, 11:16:54 AM »

Stress fractures from running in VFFs are very deceptive. Even if you started slow and worked up slowly, you can still be causing micro-fractures that start to add up over periods of weeks. It appears like you are going slowly enough, but your body does not repair the micro-fractures as fast as you are causing them. This causes them to slowly add up.

You could have crossed over your micro-fracture/repair threshold back when you were running 3-4-2-6-4-6. As you progressively worked up to 6-7-5-9-7-9 you were creating a slowly increasing deficit which culminated during the run you felt the pain and the pop.

Iím seriously beginning to think that the 10% per week rule is too aggressive. I believe this because on average it takes about 8 weeks of stimulation for bones to really start to add mass and density. When I begin my return to running, Iíll hold my mileage for 4 weeks at a time. Thatís just what I have planned for myself, of course you could be different.

Rgs, Jeepman
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« Reply #8 on: August 09, 2010, 07:10:54 PM »

Well, I feel like a moron. I wish I'd read this thread before I just posted my other one.

Sounds like others have had similar symptoms to mine, but maybe in different spots on the foot. I guess 10% a week was too aggressive. Especially in someone like me, who hasn't been a terribly good runner anyway.
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valleygirl
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« Reply #9 on: August 09, 2010, 08:20:12 PM »

Wow this was an eye opener.  I ran a 5k in VFFs only 4 days after I got them...BUT it was all on grass and felt INCREDIBLE.  After that I decreaed mileage to maybe 3-4 miles a WEEK while I worked on form.  This past week I thought I had it all down and in 5 days am up to a total of 10 miles.  Ooops, that's quite the jump isn't it?  I notice some weird achiness in my achilles - nothing major, VERY slight - but I will heed the warning sign and maybe go out roller blading or something tomorrow instead of a run (haha, quite the opposite than running in VFFs huh?!)  Good advice, as always guys!
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qcassidy352
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« Reply #10 on: August 10, 2010, 12:13:45 PM »

yes, definitely heed warning signs.  These problems can come on very fast - I felt fine one day, maybe a little discomfort the next, and quite a bit of pain the third.  So if you have any inklings of pain right now, you might be very close to something more serious (I say might because sometimes a little twinge is just a little twinge, but is it worth risking that?).

valleygirl, a 5k after 4 days is definitely a lot, but there are a lot of variables.  Doing it on grass makes a big difference as you'll be able to "cheat" more on your form (if you're inclined to do so) and will get a lot less force back from the ground if you're not running lightly enough (as most people aren't when they first start in vibrams).  It sounds like you backed off pretty well after that, though the jump from 3 or 4 to 10 is a lot.  On the whole, though, I don't think you've overdone it nearly as badly as some (me), so I bet you'll be just fine.

LawnDart, sometimes it's the not-terribly-experienced runners who have it easier with this transition, actually.  Reason being that to someone who thinks nothing of running 10 miles, doing just 2 or 3 in VFFs seems like taking it very slow and doing .25 or .5 miles seems ludicrous - but it's actually the smart way to start out.
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« Reply #11 on: August 10, 2010, 04:18:46 PM »

I'm a long time runner that just made the transition to VFFs, a pair of KSOs 3 weeks ago and a pair of Bikilas last week.  I was mainly limited by my calves, with little stress on my cardiovascular system except on exceptionally hot afternoons.  I could go indefinitely on my old shoes until an injury crept up.  Running in VFF I started listening to my feet and legs, walking when I got tired and rarely exceeding 1.5 miles without a walking break.  The day after I got my Bikilas I went for a 1.5 mile run at a sprint.  The strap of the Bikila created some pressure on the top of my right foot at the beginning of the run, which went from discomfort when I was running, to intermittent pain and soreness after the run.  I spent a couple days taking it easy in the KSOs, walking in a guarded manner that had me stepping on my instep to avoid creating pain.  After 4 days the pain would only occur with direct pressure or after sleep.  It's been a week and I'm experiencing no pain during regular walking but in the morning it's sore like many old injuries that I've had to various parts of my body.  I plan on taking it easy for at least another week, as I know how easy it is to put yourself out for much longer by ignoring pain.

I had originally planned on being ready for a 10k by labor day, but I'm going to back it off and if I do the 10k it will probably be in my old running shoes with my new running technique.

Taking it slow is tough, but it's the correct path.  Listen to your body.
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