Tuesday, November 10, 2015

My Right (@#$%*) Foot

Last night (Monday) I got home from work at about 6:15 pm.  Cooked dinner for the posse (chili and tacos).  Then, feeling motivated and empowered, decided to go for a run, since I hadn’t gone out since last week.  I ended up completing 3 miles, but I’m not going to lie, it was mostly walking.  My right foot is becoming a serious issue. 

Fast forward several hours later. Last night at about 2 am, my dog bounded into the bedroom and did a small bark to wake me up.  She’d had “digestive issues” earlier in the day, so, freaked that we could have an explosive digestive mess, I bounced out of bed and let her out back.  Turns out she was on a mission to chase something.  Intruder? Raccoon?  Wildebeast?  I don’t know. In any case, I was awake and not falling back to sleep. So (in what was probably a stupid move because I’m insanely tired now), I got on the internet and looked into my foot issues. 

After 2 hours of surfing the internet in the middle of the night, I’m now a “foot expert” and thus have determined what my problem is: A plantar plate sprain. All joking aside, the symptoms of this type of injury uncannily match my symptoms. The bad news is it’s kind of a pain to get healed if it’s really what I have.

Before I dive into the particulars, I’d like to take a moment to note that it is EXTREMELY dangerous to search for medical information on the internet. No, I'm not talking about the possibility of misdiagnosing oneself. It's WAY worse: the photos will curdle your blood!  There are some people out there with some seriously messed up feet!  I mean, really.  I’m not a hypochondriac and I rarely go to the doctor unless it’s a major issue. But by all that's holy in this world, how do people let their feet get to the state of decrepitude I saw in some of those photos last night without seeing a doctor????  It scared the bejeezus out of me, I can tell you. I'm not even going to post any of the really scary ones. You're welcome.

Me, looking at gross feet photos last night.
There are some things you can't un-see.
And now back to our regularly scheduled blog post.

A plantar plate injury refers to damage to the strong supporting ligament of a toe, located on ball of foot. 

Symptoms:  Runners will typically describe intense pain near their 2nd through 4th toes in the ball of the foot that gets worse while walking or running. (This is me!) If you have pain beneath your 2nd, 3rd or 4th metatarsal, and it gets worse with walking, jumping or running, you may have a Plantar Plate Sprain. 

See that?  That's pretty much where my foot hurts, except on the right foot.

“During walking or running, your toes naturally flex upward. At the same time, your body weight – all of it – is supported by the bones in this part of the foot and the plantar plate. The plantar ligament is a relatively small structure, so you can see how easily it might be damaged. Injury to the plantar plate is usually caused by overuse, such as from running; obesity, which puts too much body weight on the ligament; or wearing high heeled shoes too often which locks the forefoot into a flexed position and requires the plantar plate to carry all of your body weight.” Text taken from this site.

Another site says:  “Most commonly experienced by middle aged women whose feet have a tendency to overpronate or roll in, a plantar plate tear is often a cause of persistent pain and swelling in the ball of the foot. It is also commonly associated with a bunion and a hammer toe.”

So you are at risk if you are a chubby, middle-aged woman runner who lands on your midfoot when running and who already has a bunion. That’s pretty much me. I don’t have a severe bunion, but ever since my mid-20s when I wore high heels, I have had some minor discomfort in the joint of big toe on my right foot when I run and walk (never been bad enough to freak me out). I don’t appear to over-pronate (which means landing on the inside of your foot), but otherwise this is me. What I noticed in my run last night was that because of the pain in my bunion toe, I tend to land more on the ball of my foot to relive the pain in my big-toe joint. I think this may be what has caused my problem in the past month or two. 

My feet.  Thanks to Grandma Pogue, they're wide.  They kind of look like hobbit feet,
don't you think?  But without all the hair / fur????  But note that my right foot doesn't
look deformed or swollen or bruised.  Deceptively normal, in fact.  Oh, and forgive
the pathetic pedicure.  I paint my toes myself, and I was in a hurry this morning.  

This, on the other hand, is the right foot of a woman with a seriously unfortunate bunion.
See, my feet don't look so bad now, do they??
The various stages of this injury are:
  • Grade 1 Sprain is a ligament that was overstretched which results in microtears and ligament laxity.
  • Grade 2 Sprain is defined by partial tearing of the ligament resulting in more severe pain and possibly, partial joint deformity.
  • Grade 3 Sprain is a complete tear of the ligament and results in intense pain with obvious joint deformity.
From what I can tell, I have a Grade 1 Sprain. It hurts when I run and walk, and sometimes at work when I’m wearing my low heels or stupidly rest with all the weight on the balls of my feet. I don’t appear to have any freakish deformities (yet).

At any rate, this may be something I ultimately need to see a doctor about, but from all of my reading (on maybe a dozen web pages, including the Running Institute of San Diego, which had a lot of good info), it appears that in the early stages of the injury it can be treated using "conservative" methods.  They say you’ll know if the injury has progressed if your pain gets worse or you develop a limp following activity.  (from http://www.sdri.net/running-injuries/plantar-plate-sprains/).

Note:  I’m nowhere near a limp.  I’m just at the whining stage right now.

So what do they mean by conservative methods? Basically "conservative" means "not surgery". And the following:
  • Icing the injured area
  • Anti inflammatory medications like Aleve or Advil to reduce pain and inflammation
  • Strapping the toe into a downward position to align it in order to help the tendon heal
  • Custom orthotics
  • Off-loading body weight via felt padding in shoes
  • Footwear modifications like purchasing new running shoes that are stiff and provide a LOT of cushion beneath the ball of the foot
  • If your case is severe, a special boot or shoe to keep weight completely off the ball of your foot
In the cases of severe tears, they advise stopping running.  For like 3 months. Sometimes longer. However, my case appears to be minor. I’ve identified the problem early.

So, my plan for now? 
  • Treat the injury myself and only go to the doc if it isn’t getting better.
  • Stock up on ibuprofen and start taking it on a regular basis for the inflammation.  This sounds simple, but I’m notorious for not remembering to take medicine (or vitamins) on a prescribed time-table.  Will probably need to implement an alarm on my phone to remind me.
  • Get some sports medicine tape and tape the toe as shown in various YouTube videos (I told you I was an expert - look out world!)
  • Get some new running shoes that are stiff and padded.  I may go for Hoka One One’s.  They’re renowned for being uber-padded.  They’re also renowned for being uber-expensive.  But my birthday is next week and I already have some gift money (thanks parents!) that I can use toward the cause. In any case, my plan is to hit the local running store (1stPlace Sports) and have the experts advise me.
  • Get some arch supports and something to support the ball of my feet.  I’m pretty sure 1st Place Sports can help me out there, as well. 
Right now I’m NOT going to stop running.  I want to see if I can help things with the above interventions first.  If after a few weeks, I honestly don’t see an improvement, then I solemnly swear I’ll stop running.  And if it still doesn’t seem better, then I’ll take the step to see a doc about it.

Stupid middle-aged foot.