Metatarsalgia--A Pain in the Foot

I ended the last post with the protocol for an 18-mile run. I hypothesized that...if I could run 18 miles 3 weeks without getting injured before Rock n' Roll marathon, I would be ready for the race. The results were exactly what I hypothesized. Right down the injury part.

The 18-mile run went swimmingly, actually. I finished the run without incident, ate, took an ice bath and requisite nap. Tuesday, however, I went for a "recovery" run in San Elijo Lagoon. 7 miles of hilly, sandy trail. Not really ideal for a recovery run but I couldn't resist. It's my favorite trail, and I was in the neighborhood. Unfortunately, I also brought the run pair of running shoes, the ones without my orthotics. Looking back, I'm not even really sure I know why. All that damn "barefoot runing" talk. The hype had leaked into my brain, causing me to wonder, "Hmmm. What would happen if I ran without my orthotics? Do I really need them?"

I didn't mean to run 7 miles. I was only going to do 3 or 4 max. Besides, my legs were still trashed from the 18-miler 2 days ago. But after 2 or 3 miles, I started to feel better. And better. I decided to just do the whole trail. I allowed myself to run slowly, enjoying the view. I glanced at the GPS. Oops. Almost immediately after I hit 6.5, the ball of my left hurt started to burn. The burning sensation increased. It felt like my foot was on fire. To be on the safe side, I walked the final 1/2 mile back to the car. I must have bruised my foot, I reasoned. I figured it just a few days of RICE (rest, ice, compression, elevation) max.

Despite 2 ibuprofen, ice and a good night's rest, I couldn't walk without limping the next morning. Walking hurt. I tried stretching my calves and plantar fascia. Nope. Wasn't that. The ball of my foot hurt, right under my toes. Great. I probably have a stress fracture. A few days later, when I was limping around the Atlanta airport on an emergency trip to visit my ailing grandmother like Frankenstein's assistant, I started freaking out. I made a trip to the podiatrist and sat and fretted for the next 10 days waiting for the appointment, wringing my hands with my foot in an ice bucket.

The doc poked, prodded and X-rayed. "Not a stress fracture," he told me. I wanted to kiss him. He informed me I had Capsulitis, gave me 2 cortisone shots between the first 4 metatarsals (toe bones), and assured me I'd be running safely again in 2 days. A little bit overconfident, but, nonetheless, I was relieved.

What is "capsulitis"? It's inflammation of the joint capsule, and can occur anywhere in the body. This was specifically "capsulitis of the metatarsals", better known as "Metatarsalgia". It can be caused by wearing the wrong shoes, running, high-impact sports, or any pounding activity of the feet can cause it. The pain is on the ball of the foot, near the toes and is aggravated by pushing on this region or moving the toes (specifically during the push-off). The pain is very sharp and burning.

My symptoms were textbook. The doc gave me the cortisone shots to shut off the inflammation and gave me some new orthotics. He said to continue the ice and ibuprofen. I guess metatarsal pads would be another thing I could try.

The final result? One week later, my foot is 60% improved. It no longer hurts when I walk, a huge relief. However, the ball under my pinky toe still hurts while I run, although on a scale of 1-10, the pain has been reduced from a 9.5 to a 5. But I don't want to run a marathon with that kind of pain, mainly because it means my foot is still injured. I see the doc for visit #2 Thursday but I will most likely have to sit this one out. Which is a real bummer. This race was critical in training for Cuyamaca 3 Peaks 50K in July. If I can't run San Diego Rock 'n Roll Marathon Sunday, there's no way I should run a 50K a month later.

I'm most likely going to have to be conservative and start over...again. Building the mileage up slowly brick by brick. Perhaps I can have a late season come-back (Noble Canyon 50K is in the fall). Needless to say, I've been biking, swimming and doing weights a ton. Thankfully, I still have 2 other sports! Gotta love triathlon!



http://www.mayoclinic.com/health/metatarsalgia/DS00496
http://www.webmd.com/a-to-z-guides/metatarsalgia
http://www.foot.com/info/cond_metatarsalgia.jsp
http://orthopedics.about.com/od/footankle/a/metatarsalgia.htm

Protocol for 18-Mile Run

Note: This is the 2nd post I've had to re-create after the fatal Blogger crash a few weeks ago. I plan on getting everyone caught up this week. Enjoy and stay tuned.

5/8/11

Purpose: To prepare for the Rock 'n Roll Marathon on 6/5/11.

Hypothesis: If Rachel can run 18 miles without injury or illness, she will be able to do the Rock 'n Roll Marathon.

Rationale: After racing RAGNAR SoCal and the Painted Rocks Half Marathon the same weekend, my body was pretty wrecked. I ended up with a nasty virus/sinus infection that required antibiotics, 2 weeks of rest, and missing a key race (Wildflower Long Course). Nervous about the upcoming marathon, I decided to jump back into training and see if I could nail the previously scheduled long run on my plan, 18 miles. In hindsight this was make-or-break-me attitude was pretty stupid but you know what they say about hindsight...

Materials:

• Running clothes and shoes (duh)


• Fuelbelt with 4x8 ounce bottles of water or water+sports drink (diluted INfinit). (I refilled these bottles 2x, consuming a total of 94 ounces of liquid).


• 2 packs of Cliffblocks (1 pack of orange (caffeinated) and 1 pack lemon (non-caffeinated). Total calories, not including sports drink (400).


• Baggie with salt tabs, tums, ibuprofen and Immodium (Just in case. Luckily, meds not needed on this run!)


• Group of fun friends to run with


• Perfect upper-60s running weather and lots of great trails


• A pre-planned place for massive amounts of greasy food and friends afterwards


• 16 pounds of ice+cold water in a bath tub for afterwards (Brrrr!)


• A heaping pinch of fear to motivate me to get it done

Procedure:

1. Meet a group of friends to run the first 9 miles with on the beach. They agree that my 9:30 pace is perfect and assure me I will have lots of company.


2. Breathlessly let them run ahead after struggling to answer their conversational questions beteween sharp gasps for the first 2 miles.


3. Hang on behind them as an extra challenge for another 2 miles. Glance down and realize an 8:50 pace for 18 miles after a lay-off probably isn't the best idea.


4. Admire the pelicans lazily flying their everyday 7:30 am "breakfast patrol route" in a v-formation overhead.


5. Zig-zag around a flock of fearless seagulls.


6. Zone out and curse as a wave sneaks up and attacks, soaking your shoes.


7. Curse again as you leap over one puddle only to land in another one up to your ankle. So much for the extra 20 minutes spent wrapping up your blisters left over from RAGNAR this morning.


8. Realize as you slog through deep sand and sink in soft wet sand mile after mile that 9 miles of sand running is hard no matter how you slice it.


9. Refill your bottles and head up the 101 in Solana Beach for the 2nd 9 miles in San Elijo Lagoon.


10. Become completely enchanted by the fireworks display of wildflowers exploding along the trail, surrounding me like a tunnel of soft greens, lilacs, sunburst yellows, crimsons and oragnes.


11. Exchange wide smiles as I side-step several families enjoying the trail on a gorgeous Mother's Day in San Diego.


12. Stare admiringly at several different species of water fowl as I run past, including ducks, coots, loons, snowy egrets, and a few great blue herons.


13. The miles fly by quickly and I'm running faster now, a horse running eagerly back to the barn.


14. Realize my foot is kind of itchy and block out the pain, knowing I'm developing fresh blisters.


15. Also realize that San Elijo Lagoon is not that flat and also very sandy.


16. Reach the finish in tribulation, hobbling back to the truck.


17. My lower back, hips and feet hurt. I will definitely need an ice bath.


18. Enjoy a hearty breakfast with my new ultra-running team for Vegas (October).


19. Also fill up on lots of fluids: water, coffee, and a mimosa.


20. Discover bloody socks and a giant hole in my foot after removing my shoes.


21. Enjoy a 15-minute ice bath followed by a well-earned nap.


22. Another successful long run!

My foot, immediately after the run.

24 hours later, after swelling has begun.

Painted Rocks Half Marathon Race Report

http://www.dirtdevilracing.com/races/painted-rocks-half-marathon
4/17/11

Weary from finishing RAGNAR less than 24 hours the day before, I dragged myself to the inaugural Painted Rocks Half Marathon on Sunday morning. Everyone thought I was nuts for doing both races but I was like a kid in a candy shop. It's rare to find half marathons entirely on trails; I just couldn't resist. For some reason, Lake Hodges seemed an eternity away. I was pleasantly surprised to discover it was a short drive from my house. Bonus! New trails to train on!

At the start, I quickly bonded with other weary RAGNAR races, easily recognizable by our race shirts, proudly earned the day before. We exchanged furtive, shy smiles, embarrassed to admit that we were running junkies, yet secretly relieved to discover another fellow addict. The race was loosely organized with an approximate start time, no timing chips, no finish line, and a small number of entrants. I especially appreciated the race cap being set low, particularly for single-track trail. I loved the grass-roots feel and intimate atmosphere. It's rare to find a race with such a laid-back, relaxed feel nowadays; however, this attitude is particularly attractive to me.

The racers lined up, loosely staggered according to approximate pace (fast, medium, and slow). The whistle blew, and we were off! My quads were shredded from RAGNAR. I could barely pick up my legs. I resisted the urge to help my legs along by physically picking them up with each step by my arms. Instead, I shuffled along painfully, unable to hide the grimace on my face.

Soon, we were filing onto the single track trail. My focus blissfully shifted from the blinding pain in my legs to side-stepping other runners and avoiding a nasty fall from surprise rocks on the trail. The trail hugged the bank of the lake so closely that I nervously stepped over some precariously placed holes where the trail had eroded. I had a nasty vision of falling headfirst into the dark water below.

The trail briefly ended, and we spread out onto the road and over a fun suspension bridge spanning the lake. Surprisingly, my the pain had completely dissipated from my legs. I had fallen into an ambitious pace. Smiling, I decided to just go with it. I couldn't believe how good I felt considering what my body had endured the previous 24 hours. I passed a large number of runners before filing back onto the trail.

The trail was extremely rocky, and I winced, dancing my feet lightly over the sharp shards, which felt like glass piercing through my shoes. Soon, the trail evened out again, and I was surrounded by trees, grass, and flowers, a striking contrast from most of the dusty, dry scenery in southern California. I felt like I was back in Virginia, surrounded by greenery.

Near the halfway point, the trail narrowed, and I carefully avoided several runners racing back in the other direction. Many beamed grins from ear to ear as they passed. I returned their smiles. Soon, I too, was headed back. Had it been 6.5 miles already? Hard to believe. I felt so wonderful.

The weather was cool and foggy, warmed by the morning sun, peeking through the clouds. I was thoroughly enjoying the trail as well, particularly since my feet had never touched this soil before. Surprisingly, unlike most of the trails in San Diego, the route was forgiving and mostly flat. I was able to maintain my "blistering" pace, much faster than anticipated on tired legs.

Before I knew it, I was heading towards the finish. Spectators cheered me on. "Go RAGNAR girl!" one woman shouted. I couldn't mask the smile on my face. I reached the finish and threw my arms in the air. The post-race ceremony was the best, held a few hours later at a quaint microbrewery in Mira Mesa, Hess Brewery (http://www.hessbrewing.com/). The beer was delicious (although very potent)! One weekend, two short little days, two amazing races. I do not regret biting off more than I could chew. Race on everyone, race on.

Blogger Sux!

Okay, I spent about 4 hours yesterday working on two blog posts: The Painted Rocks Half Marathon Race Report and a Protocol for my 18-mile run. Photos and all. Blogger pooped out and now the posts are GONE!!! Ugh. Stay tuned....

Spring is Here!

Phew! Clearly since I'm back in training now, I'm going to have to return to more frequent updates. Spring is late in the season here in sunny San Diego. I've been soaking up the sunshine before "May Gray" sets in (or my version...Tourist Season). Everything is in full bloom (flowers and allergies, included), and the sky has been busy with circles of swallows making dizzying sweeps chasing insects in the sky. Anyway, A lot has been happening!

First off, congrats to everyone racing these past few weeks. The Boston Marathon was two weeks ago. Last weekend, Spring Sprint officially kicked off the season in San Diego in Mission Bay (if you don't count CA 70.3 and Superseal). Congrats to everyone who raced Wildflower as well. I'm envious of you guys. I was forced to sit this one out due to illness. Grrr. Finally, good luck to everyone doing Ironman Utah this weekend. It was my favorite Ironman. Don't let them scare you. The course is actually not that bad (snickering). No matter what, enjoy the course. It's absolutely stunning.

(Anyone interested in my Ironman Utah race report can find it here: http://amateurtrigirl.blogspot.com/2010/05/ironman-st-george-third-times-charm.html)

On a personal note, I'm finally getting back into training after a 2-week layoff due to illness. Sound familiar? I found out, again, that I'm not Superwoman. (What? I'm not?) Apparently, I can't race RAGNAR and a half marathon the same weekend without paying the consequences. Although I had a great time at both races, I woke up Tuesday morning with an extremely sore throat. The ice 2 baths I had subjected myself to in the name of "recovery" had done a fantastic job in quelling the aching in my quads. However, it had done nada for my immune system. As a scientist, I had read the research revealing that a person is more susceptible to common colds 72-hours after a long run. (Part of me suspects the random water bottle I picked up by a public restroom in Spanish Landing Park during the 3rd leg of RAGNAR). Anecdotally, I can attest that this research is true.

The old me would have raced Wildflower anyway, irrespective of a full-blown sinus infection and antibiotics. But what would have been the point? I've done this before. I raced CA 70.3 in 2007 (my first half IM) with a bad cold and ended up with a sinus infection so severe that it took 8 weeks of antibiotics, prednisone, and misery to overcome it. I learned my lesson. It's better to lose the battle and live to fight another day. I have Rock 'n Roll Marathon and some 50Ks on the docket this season. Those are my A races this season. I decided to bow out of Wildflower (the race director gave me event credit for next year with a doctor's note). It was a very difficult decision for me. However, what would be the point of all my previous illnessess if I didn't learn from them? So, begrudgingly, I cancelled my plans and stayed in bed.

It took 2 weeks to fully recover but I feel 100% this week, and workouts are back in full swing. I'm working on my training plan. I've been flying without a net this season and feel sort of lost without my ole' trusty training plan. I can safely say that the Prep period is over. I'm ready for training. Rock 'n Roll Marathon is in a month (gulp). I have an 18-mile run Sunday. It will be the test of truth. Wish me luck.

Killing it on the bike at Superseal in March.

Having fun on the run at Superseal.

Team DNR after finishing RAGNAR SoCal.

Running the Painted Rocks Half Marathon at Lake Hodges 2 weeks ago the day after Ragnar SoCal.

And finally, a sample of one of my sketches from the Shelter Dog Project I'm working on.

"Stray Boxer" N681
copyright 2011 Rachel's Animal Art
(http://www.rachelsanimalart.blogspot.com/)
This sweet Boxer is one of the many great dogs available at the North County Animal Shelter in San Diego.