Plantar Fascistic is the Real Deamon

Today I did my first run in my new shoes. LEMS (www.lemsshoes.com).  These shoes are designed as: zero drop, natural shape, lightweight shoes. They are designed to provide your toes (thats right toes) room to splay.  If you have not heard the term splay before it means to "thrust or spread" or to "widening or outward tapering of something" [your foot].

Looking back at all the doctors/specialist/etc. I have been to over the years (since 2009); not a single one of them really looked at my foot and its real shape.  My personal search has been exhaustive over the years and only limited by my ability to search and those terms I am familiar with to search for.  About 3-4 years ago, I did stumble on the term "toe box" and I started buying shoes that marketed a "wide toe box".  These shoes were dramatically different than your standard shoe which tapers on both sides and "points" your toes.  

A few of the shoes I have tried over the years:
Patagonia Folios / Rover
Hoka One-One
Merrell Trail Glove
Vibriam Five Finger

Lets talk about toes.  Feet are your support structure they are the points that touch the ground for your body.  I heard this great analogy once that compares the structure of your feet to an arch bridge (truss bridge).  These bridges are seen everywhere and at all locations, they are connected at a minimum of two points.  In nearly all cases (geographical exceptions do occur) they are connected to the earth by two points (minimum, as some have multiple arches).  These points are are nearly always located at the same elevation (not higher or lower than the other).

If you take a look at the shoe industry, it has recently gotten on the bandwagon of minimalist shoes and typically this "minimalist" shoe is a zero drop (read arch connected at the same elevation off of the ground).  Now take a look at the average shoe you own.  If you are a woman ignore the high heels for a moment.  I would bet that unless you are a minimalist runner or a ballerina you probably average 1/2" drop from your heel to your toes.  Take a look at a baby, before you go consumerist on me,  they don't have shoes coming out of their mommy (read they have zero drop).  Why do you force your body to physically change from how you were genetically designed?

Now look at a plan view of you foot (that is top down view, btw).  The widest part of your foot?  probably just behind the toes.  Your foot goes from the small heel, widening out toward the ball of your feet, and tapering back as you move towards the toes.  Compare this to a baby, narrowest at the heels and widest at the end of the toes.  WHY?  Shoes? Life?

If you are interested in this topic the shoe industry is pretty interesting how it developed and moved forward over the years.  

Back to my first run with the LEMS shoes.  I have been wearing correct toes, while not running for about a month now; and have found that they provide a non-drug/chemical/herb/mineral relief to a problem I have had for years. And as an engineer, especially because I have a commercial nuclear background I have this desire to understand what is called a Root Cause Analysis.  Basically, this means to identify what the real problem or cause of a problem or event is.  Deep Dive is a term i passionately hate because it is used by people all the time who do not really understand what the problem is, could be, and really just want to have a super expensive meeting to talk about a lot of nothing.  A root cause is critically important to actually solving or addressing an issue. The body is extremely complex so a root cause analysis is not exactly the easiest thing to accomplish; I have attempted to do one before unsuccessfully.

During my run with the LEMS, Correct Toes, and toe socks;  I found that in general I felt discomfort in different locations than normal.  At the metatarsals and phalanges connection point on the outside of my foot.  Now if you have had plantar fascistic you know that the typical pain location is at the heel or in the arch.  So here is to discomfort in different locations!!

After the run I did a hot water soak, some minor stretching and put my correct toes back on.

Additional Injuries

I have not yet been to the orthopedist however, i believe i have self diagnosed my injury.  Once again it is on the left leg (same as my achilles tendonitis); but I beleive it is almost present in the right leg as well.  I was training for a 14 mile trail run when I overworked my anterior tibial muscle and attaching tendons.  This muscle and tendon are used to lift the foot and turn it inward (flexing and inversion).  When trail running there is a lot of special attention paid to foot placement and agility required on the balls of your feet. With this sort of activity it places a lot of stress on the calf muscles/tendons and feet. 

This injury is probably from muscle imbalance as well as overall weakness and overstressing a muscle. 

BALANCE:  I have mentioned in a previous post that I have been doing yoga (Bikram yoga).  Some of the yoga positions have balance poses where you are balancing on a single leg. I have noticed (since I started in January 2012) that my balance has been poor.  Much worse than it was back when I was a swimmer and even in college.  I am not sure what to attribute this to, other than most of my focus for training is bicycling where very little balance is required and your feet are guided by a pedal stroke and locked in place to a shoe.  I cannot knock bicycling to much as it has kept me in pretty good shape over the years; it has however, seemed to lead to a number of muscle imbalance injuries.  This should motivate me to change my focus' to a specific sport to multiple sports (rehabilitation).

STRETCHES:  In addition this injury has also reaggrivated my achilles tendonitis.  I have broken out the rope stretches again and leg swings to keep me limber (as much as I can). 

REHAB EXERCISES:  Strength and balance! are the focus.  Ball grabs, clock toe touches, one leg balance on balance ball (eyes closed for advancement), pistol squats, hip raises, walk backwards on heels, abdominal exercises, flexion with band, inversion with band, calf raises (single and double), bent leg calf raises (single and double).

Sorry this is not a great post but I just had to get some stuff down on paper. 

Yoga and more

Over the last 8 months while I have been living and working in California, I decided to take a new path to healing my Achilles tendinitis.  This new path did not include a single activity because I have found that no single activity provides everything that I need to overcome the self inflicted injury.  So the combination of activities included some old and some new activities.  The biggest new activity was yoga, Bikram (or Hot) yoga to be precise.  This type of yoga is performed in a heated room >100F with a humidifier running to make it hot and humid.  The class is made up of 26 poses that are repeated in the same sequence every time.  The idea behind the hot part is to loosen up the body and muscles and joints.  Although as a male it was difficult for me to initially start this routine, it has proven to be a great addition to my training.  It gives me an hour and a half of self focused stretching once a week.  I probably should go more often than that but I just cannot find the time to commit to it more than once a week.  After each class I can feel a significant difference in the way my body feels, joints and limbs fall.  I am not into the whole "spiritual" side of yoga but I do respect those who are and understand how it does help them find a relaxation in this stressful world. 

Another device that i stumbled upon were the Yamuna foot savers.  These are simple devices that help me stretch my foot.  They are basically half domes of semi hard silicone/plastic.  Standing on them and working down the foot in all location i have found it relieves quite a bit of tension.  Rather than attempting to describe it any further I suggest you look them up online.  There are some video that shown a class on them (they are terrible videos but they do get the point across). 

Bringing back some old techniques I have been using the classic foam roller on my legs, up to the hips and back.  Because if you believe that if you focus on a single point you will get better (in any sense of the word or activity or life) you are seriously naive.  Additionally I have been using a device called The Stick.  Which is a basic self massager, focused on the legs and used by many cyclists. 

At work I have also raised my desk to a stand up desk and have a raised chair to go along with it.  This helps me stretch out my legs and not to mention eliminate all the stresses from sitting all day.

Heel Spur and Plantar Fasciitis

While I was training for my Half Iron, my running was my weakest point.  I grew up a competitive swimmer which gave me a great aerobic base as well as the fundamental techniques for swimming.  That alone can be a huge advantage when competing in a triathlon. While I was a competitive swimmer, the dry-land exercises provided me with a great running background as well.  However, after I quit swimming after high school, I switched to bicycling and did not run as much.  Not to mention I got a bit out of shape my first year or so in college.  I was a cyclist though and had a good base for that part of the training.  However, a drawback of being a cyclist is that you are good at one motion, up and down with the legs, which is great however there is more to that when it comes to running, and the low impact from bicycling and swimming does not translate well into an untrained running body.  As I reintroduced myself into running, I also did a combination of other changes, which any athlete knows is the basic recipe for injury. But I did not pay any attention to that at the time, unfortunately. 

So the changes I made not only included starting to run again but also changing my foot striking technique.  The majority of runners are heel strikers.  Then there are some mid foot strikers, and lastly there are forefoot strikers.  I was, for the most part, a heel striker, though it is my belief that while I was swimming I was more of a mid-foot striker, although I can not exactly prove it.  When I started running again, I had made a decision to become a forefoot striker.  Much of my philosophy on training and living is to be as natural as possible, and as far as shoes go, they have become a hindrance and crutch for the majority of people because of the way they are designed. Thats a topic of discussion for another time and as always a preferential statement.  Since I had made the decision to go to a fore-foot strike technique I shifted my shoe choice to a low heel classic running shoe, designed after the old track shoes.  Sacuony Bullet.  I was also using some Five Fingers for a while but because of my long toes they do not work very well without giving extremely large blood blisters at the bases of my big toes.  I began my training slowly with half mile and mile runs in the park on a gravel track.  I would even train barefoot on occasions to strengthen my feet.  I was getting up in miles over the course of two months and was running 6 miles twice a week with a few shorter runs when I could get them in.  As the race neared I was still only at 6 miles and need to bump my mileage up prior to the race.  One Saturday after noon I took a nice easy paced 10 mile run up to my friends apartment prior to a GT football game.  At about the 8 mile mark I had a pain/twinge on the inside of my left ankle and had to stop for a few hundred yards and walk it out.  I did however finish the 10 miles in a relatively good pace at about 8:30 per mile. 

During the course of my running training I did not stretch as much as I should have, and the contributing factors are probably some laziness, as well as lack of knowledge on running specific training and stretching technique.  It was not till afterwards that I began researching techniques to take care of runners feet and stretches to keep the body loose and functional.  Unfortunately because of my ignorance and negligence I developed a heel spur on my left heel and some plantar fasciitis to go along with it.

It is my understanding now, hind sight is always clearer, that I could have easily prevented these two injuries with some minor stretching.  Specifically stretching of the arch of the foot with a simple technique where you kneel on your knees and toes stretching your toes forward(up) and in-turn stretching the arch of your foot.  In combination with the reverse of that stretch where you sit on your heels with your feel laid out flat on the ground, provides good flexibility and strengthening of the feet and ankles. 

Stretching

Over the past 8 months or so I have tried many different types of stretching to attempt to alleviate my injury.  Much of the reading I have done has focused on the lower body from the calf down to the toes; and although I do agree that there is great importance in stretching that area, I believe that there is more of a total body connection to injuries.  Our entire bodies are connected by muscles and tendons that push and pull constantly.  I do want to make it clear here as well that I think Chiropractors are a bunch of quacks.  There is however, some value in what they learn as far as body balance with muscle and tendon strength, joint flexibility, and total body health.

As far as flexibility goes, I have never been very flexible.  Perhaps it is because I was a tall child and am still considered tall that my muscles and tendons are under more tension than the average person.  It could just be the way I hold my body and which muscles, tendons, and ligaments I use for balance, walking, running, biking are slightly different than the normal person.  Who knows.  All I can say is that I was the most flexible during my years as a competitive swimmer where I was training 30+ hours a week.  I contribute that to a few things.  First, my coach stressed stretching before and after each workout. Second, swimming is a full body workout where you are flexing and stressing every muscle you have so there was a balance achieved when training.  Third: the cross training that was done during our dryland workouts helped build stabilizer muscles that contributed to overall fitness. 

For stretches I have done both static and dynamic stretches for the upper and lower body.  The lower body stretches are for the quads, hamstrings, hip flexors,  Iliotibial band, calfs, achilles, plantar fascia, toes and as much else inbetween as possible.  The upper body stretches are more limited to shoulder and back flexibility, with chest and neck included.  

In addition to the stretches above it is very important to have a strong core for balance and reduced strain on your other muscles. This is accomplished through abdominal workouts.  A good one to try is plank exercises.

The Injury

Now onto the speculated cause/instance of the injury.  I was following the basic training plan described in an earlier post as consistently as I could with my schedule.  I would miss a run here or there but made them up during the week or on my rest day (as I rested during the times I missed scheduled workouts).  With the race about 2.5-3 weeks out my swimming and biking were progressing incredibly well.  My distances had increased and my times were at or above my goals for this portion of my training.  My running however, had been my troubled area. Not that it was difficult for me to run, I was just not making the progress I had hoped to at this point in my training.

I should note here that I had lost some of my running form while in college.  This was a combination of my transition to bicycle racing for a few years and an injury I had while playing inter murals.  I got a stress fracture in my tibia while training and participating in my inter-mural Ultimate (Frisbee).  It got bad enough at one point, I was on crutches for two weeks.  After the injury I stopped running for a good while, probably almost a year but I cannot recall.    

Back to my Ironman training, during the course of my running training, and in the hopes to prevent further injury to my legs (including knees,hips, and feet) I had done quite a bit of research and had transitioned from a heel striker to a forefoot striker.  All those reading saying that this was a bad idea, I disagree, it was the right thing to do just not the right time or the right pace to do it in.  With forefoot striking come increase strain on the calf and arch of the foot.  These new added stresses to the calf and arch meet at the Achilles tendon!.  I did a pretty good job of taking it easy while increasing distance on the new foot striking technique.  I applied multiple strike techniques when going longer than a mile or two, heel striking and forefoot striking to keep the stress down on the calf and Achilles tendon and foot arch.

So at about 3 weeks out from the race, I decided that I was feeling pretty good and it was time to do a long run. So one Saturday I took off on a run off to my friends house 10 miles away.  more than I had every run before at one time in my whole life.

The Results

Before I get into other details, here is a basic summary of my results:

An overall time:    5:34:44.
Swim Time:             26:01
T1:                             5:14
Bike Time:            2:37:39
T2:                             2:18
Run Time:             2:23:34

The Breakdown:

Swim per 100 yds: 1:18 min/100yds
Bike mph:  21.4 mph
Run min per mile: 10.9 min/mile

Overall Thoughts:
Very happy with the swim, and the bike.  Not so much the run.  But then I would not have a need for this documentation blog if I was happy with my run.  My goal was sub 6 hours, which I made easily.  Unfortunately I was on pace for sub 5 hours, which was my new goal calculated during the ride portion of the race.