Wednesday, January 25, 2012

This Is Not My Foot

Last year, I read Running on Empty by Marshall Ulrich. Ulrich is a legendary ultra-runner whose exploits include such things as the "Badwater Quad"--running the uber-difficult Badwater 146-mile race in Death Valley, then running it backwards, then forward again, then backwards again. (He still holds the course record for the 146-mile course, even though these days, it has been shortened to a much more reasonable 135 miles.) On another occasion, he ran Badwater without a crew, choosing instead to drag a wagon behind him that weighed over 200 pounds. Check him out:

On yet another occassion, Ulrich finished the Pike's Peak marathon, jumped in a car, and hightailed it to Leadville in time to be at the start of the Leadville 100. In Running on Empty, he focused on his failed attempt to break the Trans-America running record. Although he broke the Master's and Grandmaster's record--he was 57 years old at the time--his mark of 52.5 days was only good enough to be the third-fastest crossing of the continent. That's all: third-fastest, at age 57. Amazing.

Throughout the book, Ulrich told all sorts of stories about experiences he had along the way. He was nearly hit by a car. He listened to the same songs over and over again. His sex drive was kicked into overdrive. His hair and nails stopped growing. He didn't drink any water during the entire trip (because he must take in calories constantly). He managed issues with his crew and his sponsors. And, of course, he dealt with injuries. His most dogged problem was plantar fasciitis, which inspired him to divorce his foot from the rest of his body. "This is not my foot," he declared. Right now, I know how he felt.

For the last three weeks or so, I have been dealing with pain in my left foot. Although it evidently orginates from the ball of my foot, it manifests itself in a tight, sore feeling under my medial ankle. I initially thought it was some sort of achilles issue, but my actual achilles wasn't hurting. And in fact, I'm not sure what the injury is. One doctor posited tendinitis in my flexor digitorum longus and flexor hallucis longus.

See how the flexor hallicus longus goes right under the ankle, out of the foot, and into the calf? That's exactly where it hurts. Thus, tendinitis in these two tendons made sense. In addition, since those two tendons were the site of the SEVERE hot spots I developed in Ironman Cozumel, I figured that perhaps I irritated them during the race and then didn't give them enough time to recover before starting to run again. After all, as I wrote in my race report, my feet were undoubtedly the most uncomfortable thing on my body during the run. However, an experienced doctor this week told me that if it was in fact tendinitis of one or both of those tendons, it would be the first time that he had ever heard of such a case. [Sigh.]

Whether it was the cause of my foot issue or not, I knew that I needed to address the hot spots on the bike, so I went to my bike fitter a couple of weeks ago. He found that my fit was fine, but my heel down pedaling was putting too much strain on the nerves and tendons that come out of my calves and into my feet (such as the flexors--more evidence that they were the root cause of the injury). This was magnified by the ultra-thin insole that comes in my otherwise totally sweet Sidi shoes. Thus, we modified my pedaling, we put in new insoles, and since then, I have had no problems with hot spots on my bike. Woot! At least I'm not making things worse now.

My foot was feeling good enough this past Saturday to try running again, so I went out for an eight-mile run on soft, flat trails. While my foot didn't hurt much during the run, it got steadily more painful in the hours after the run. Thus, I have decided with my Coach to take all running off my schedule until February 19. Missing scheduled runs was frustrating, but trying to run when I wasn't fully healed was only prolonging the injury. This certainly compromises some of my secondary events, but all of my major training plans are still intact. As I told my coach, I don't want to still be dealing with this issue in April, so we're better off missing some miles now and getting it entirely better. I have a very deep running background, so I'll be fine.

In the meantime, I'll continue to swim and bike, but I'll also continue to be aggressive with my foot rehab. So far, I've done graston, electric stimulation, ice, ultrasound, cold laser, shockwave therapy, chiropractic, massage, and ART. Right now, there is kinesio tape on my foot and lower leg. I'm thinking of getting a prescription for dry needling. As my wife calls it, I'm taking the "dartboard approach," and seeing what sticks. Each treatment has had some measure of success. One of them--shockwave--deserves special mention. Shockwave therapy was undoubtedly the most painful therpy I've ever done, including the therapy I had to undergo after my shoulder was pieced back together in 2009. In shockwave therapy, the doctor takes a weapon--yes, I called it a weapon--that looks like this:

He runs the tip over the inflamed area, and a piston inside the weapon pounds away at the spot. The therapy causes micro-injuries to the area and triggers the brain's natural anti-inflammatory response. The same thing could be accomplished by hitting my ankle with a hammer, and this is exactly what it felt like. I had visions of battlefield surgeries during the Civil War; on a couple of occassions, I had to check and make sure that he wasn't hacking off my foot with a chisel. Throughout the torture, er, therapy, I was asking myself, "Why am I doing this??" I had more doubt about myself as an athlete in those ten minutes than I have ever had in any race, including the last six miles of the Ironman. The doctor told me later that it's possible to use a lower, less-painful setting, so if you have to get this done, I recommend that you ask him to start gently. And it is effective, at least in the short term; even though I repeatedly thought, "This is not worth it," my foot felt much better that night.

So until my foot gets back with the program, I am going to take Marshall's advice and kick it out of my big Ironman party. While the rest of us are getting fit, I'm going to force that little jerk to be submerged in ice, roasted with lasers, and shocked with electricity. I'm hoping that this will bring it back into line and we can get on with the business of swimming, biking, AND running.


  1. Foot--you are allowed back in the family when you will behave.

  2. This guy is certainly an inspiration! Putting your body through all of that for sport is amazing! I would love to do something amazing one day (not to that degree but something that I can achieve), but I have always suffered with a dull aching pain in my foot. This article has helped me to understand how my foot works more, and I feel that with the right treatment in private health in Surrey I can get my foot back to working again!

  3. Shock wave therapies are beneficial in these types of pain. Many people avail shock wave treatment for getting quick relief from the pain and that too in very less time. Doctors also prefer this therapy for their patients to give them instant relief.

    Shockwave Canada Inc.