Monday, October 5, 2009

Stress Fracture

So as I mentioned last time I believe I have a stress fracture. It happened on a Vibram Five Finger run on the road about four days prior to the Vermont 50K. I started to feel pain which then quickly progressed to where I had to hobble home. Initially I was hopeful that it was along the lines of a mechanical metatarsal issue (see the post Dropped Metatarsal.) I had my friend and colleague Garret Llewlyn, D.C. work on it several times, which alleviated some of the pain, but the remaining pain was on top of the 4th metatarsal and persisted. Pain on the top is quite often indicative of a stress fracture (while pain on the bottom is usually mechanical in nature.)

I haven't gotten an X-ray yet as stress fractures are notorious for not showing up initially. Out of the dozen or so stress fractures we saw this past summer I can only think of 1-2 that actually showed up on the first X-ray (by the way most of these occured wearing conventional shoes.) I'll proabably get one in a week or so just to confirm, and what you would typically see more than a fracture line is the fluffy white evidence of new bone being layed down.

I want to thank everyone for their best wishes. I didn't feel like I was doing anything outlandish with my running, so therefore just have to accept it and move on (what else can you do?) I'll treat this as a learning experience. Fortunately it's not so bad that I can't do some biking so I'm not going completely nuts. (Running up a hill with a cyclocross bike on my shoulder did prove unwise. I'm trying to picture the look I would give to someone in my situation who did that. Physician, heal thyself.)

Anyways the intent of this post was to provide a cautionary tale to those interested in the whole minimalist movement. I still believe whole-heartedly that ultimately that is the way to go. However I can pick out some mistakes I made that led to this, that might help others avoid a similar fate:

1. First and foremost, I realize that a Tarahumara Indian I am not! Meaning that just because I integrated barefoot and Vibram running into my training throughout the summer, I spent most of the rest of my time (not to mention life) in shoes. It takes time for most of us Westerners to adapt the foot and calf strength, and apparently bone density, required to do this safely. When someone suffers a stress fracture, I often use the phrase, "Too much, too soon." This applies here as well.

2. Be extra cautious on the road. This wouldn't have happened had I stayed on the grass. I honestly have never felt better than the barefoot runs I did on grass this summer. There were times where my form felt perfect and I felt like I could have run forever.

3. Additionally, be cautious of using Vibrams on the road. Vibrams take away the skin sensitivity factor of running barefoot, allowing you to open up your stride more, which is something I initially liked about them. On the other hand, they don't really provide any more cushioning that being barefoot. The net effect is that there can be more impact to your foot in Vibrams than when barefoot. I noticed this phenomenon leading up to the injury. Running on a mostly soft surface such as Pineland, Vibrams were perfect, to minimize the ouch of stepping on small rocks, acorns, etc. However on a nice smooth road free of debris my feet were actually more comfortable when barefoot, once I had built up enough calluses.

(This same effect has been observed in conventional, cushioned running shoes. Most of the feedback from your foot is dampened, which can lead to alterations in your gait, such as heel striking, that can actually produce more force than if you were barefoot.)

4. Lastly, I don't think that it was random that it happened where it did. Having Dr. Llewlyn work on the foot right after it happened made me realize the joints nearby were fairly locked-up, which placed more stress on the spot that fractured. Also, I had been sick for about a week leading up to this, and had done a lot of laying around trying to recover. I could feel my gait was off, and in particular that my left foot wasn't springing off the ground like my right (which I associate with the tibialis posterior muscle, which supports the arch.) This is something I had noticed before but had improved as my calves had gotten stronger. I think being sick, and also being barefoot less overall due to colder weather had weakened my left calf just enough to contribute to the injury.

We've all heard stories about people having near-death experiences realizing the preciousness of life. Not to over-dramatize, but it's really hit home for me over the past two weeks what a gift it is to be able to run.