Monday, October 26, 2009

Swimsuit Season?

My visit to the podiatrist last week went approximately how I'd expected it to, but I'm glad I went anyway. First of all, he was at least familiar with the Pose method and barefoot running and all of that -- so I appreciated being able to have a discussion of the topic with a real live person with some knowledge of the issue (as compared to the orthopedic surgeon that originally diagnosed my plantar fasciitis, who had never heard of the forefoot running approach and could only tell me that a heel strike is the "most stable" for the skeletal structure).

After a lengthy discussion, it came down to this:
(1) Barefoot running is a useful training tool when done on grass for short distances.
(2) The biomechanical effects of the very slight overpronation in my right foot can best be fixed by a proper orthotic.
(3) The arch strengthening exercises and PF stretches/exercises I've been doing are good for any runner to do (more strength in the feet and ankles is better), but will not change the static strength of my foot.

and...this is my favorite part...
(4) The Pose method (forefoot strike) is appropriate for faster running (ie 7 min. miles or faster), but not for slower running, when a heel strike is "more natural."

It took considerable effort for me to understand this final point that he was making, as it didn't make any sense to me. Once I was finally able to get my head around it, I restated it to be sure I was getting it right. He confirmed that, yes, I was understanding him correctly. But no, it still doesn't make any sense to me.

Round and Round We Go
Pod: When we sprint, we all run on our forefoot. (No argument.) That's the natural technique for running fast, he says.  But when we slow down, our natural stride changes, and we don't run well on our forefeet. Thus we adopt a more "natural" technique - a heel strike.
Me: A more natural technique - but more natural in shoes, you mean.
Pod: Yes, of course, you'll never land on your heel barefoot, because your body instinctively knows that will hurt.
Me: Right, so how is it that my body will run naturally, that is, correctly, if I run fast barefoot, but will start running incorrectly suddenly when I slow down?
Pod: Because when you slow down, a forefoot strike produces poor form, and doesn't allow you to run naturally.
Me: But aren't I running naturally if I'm running barefoot?
Pod: Only if you're running fast. 

It is just me or does this sound rather circular? If it doesn't sound circular to you, please, educate me! Of all the things I expected to hear, this was definitely something new. He suggested I do a video gait analysis so he can show me "how unnatural it looks" when a person runs forefoot at low speeds versus high. I told him I don't care how it looks if it's what is good for my body! Are we comparing how it looks against the current prevailing image of what running "is supposed to" look like? Because that seems unlikely to be useful. But perhaps I'm just being a contrarian.

And perhaps I'm oversimplifying his point and the gait analysis will show me something useful. I'm always willing to admit that I don't know what I don't know. Besides, I've already met my insurance deductible this year, and I'm willing to get a little more information from "the establishment" to weigh against the massive amount of information I've been gathering on minimalist running.

All that aside, he couldn't confirm the tendonitis I thought I was experiencing. He couldn't put pressure anywhere on the foot that would indicate that the posterior tibialis tendon is irritated. That said, I realized this weekend that the spot I pointed to when he asked where it hurts was off the mark. The day I went in, the ankle wasn't sore (as the ankle isn't generally sore unless I run too far on it). But over the weekend I went for a bike ride, and that irritated the same bit of my ankle that gets irritated when I run. So I realized that I'd pointed him to the wrong spot, but I'm still guessing its a tendon or ligament in there somewhere.

After the long discussion with the podiatrist, I asked what to do next. Essentially, we spent so much time discussing the background of my PF, barefooting, and related issues, that I need to make another appointment for him to get a better handle on what specifically is hurting me now (with the gait analysis and some other tests) to move forward. Understandable. But since there's no appointment available for all that stuff to happen at the same time until November 13, I'm left pretty much deciding my own course for the next couple of weeks. (He did suggest that I go out and get a new pair of Brooks in the meantime, since I told him that's what I used to run in. But, um. No thanks. He's got a remarkably long way to go to convince me that that's the right course of action.)

Rest/Protection Mode for This Week

That said, the podiatrist outlined the importance of looking at injuries in three stages (1) rest/protection, (2) rehab/recovery, and (3) return to activity. This was not new information, but a good reminder for the importance of not rushing stage 1. So regardless of what this current ankle business is, it makes sense to me that right now (at one week since the serious Green Lake ouch) I'm still in rest/protection mode. I felt today like I might've been able to go out and try to see how a little run might feel. But I've already decided I'm going to wait a second whole week before I try any running at all. I'm also going to stay off the bike, since that seems to aggravate the same part of the ankle. So if I'm going to exercise this week, it's going to be time to buy a new bathing suit (this summer I finally threw away the horribly saggy one I bought in 1989. Yes, seriously). Or maybe I'll just stick to weight training and/or yoga for the week. We shall see.


  1. Your podiatrist is silly.

    You should pursue your interest in minimalist shoes and barefoot running. ("Barefoot" doesn't have to mean bare feet. The Vibram FiveFingers allow you to run with a barefoot-style gait, with protection from the road.)

    Those two key phrases in Google will unearth a wealth of information for you (you've probably already started to figure this out). You'll also discover lots of people like yourself who have resolved their running problems with cheaper shoes or Vibram FiveFingers. I'm one of them.

    Sneakers are profoundly unnatural, and promote an unnatural method of running. I took up the barefoot-style running method in June full-force, have worn sneakers twice since then, and am not going back.

    And if you'd like a video gait analysis, here's one, from a doctor who gets it:

    You'll notice with no sneakers, no heel strike. Naturally!

  2. I'm going to have to disagree with Tuck.

    1. You are not barefoot in Vibram's. They are shoes. Better than "running" shoes, certainly, but they are still shoes. Language is important.

    2. It's not just about the heel. It's about being able to feel the ground so you can learn how to run barefoot. You can still land incredibly hard on your feet when wearing Vibram's and still experience no pain (in the feet; other stuff will hurt later). Without the signals from the ground to your feet, it's very hard to learn how to run.

    But I certainly do agree with Tuck on one point: your podiatrist is silly.

    Good luck with your ankle; rest up. The only way to avoid occasional aches and pains is to do everything perfectly. Not being perfect myself, I expect things to not work out from time to time...