What? When my podiatrist told me the above last week, I was very surprised, to say the least.
When I did the Camp Pendleton Sprint Triathlon three weeks ago, I re-injured my foot during the run from the surf to transition. It felt just like my incident last October, only half as painful. After promising myself I'd quit if it got worse, I completed the race anyway. Being unable to push with my right foot, my left leg was cramping by the time I finished the 5K run, but my run was only 90 seconds slower than my goal!
I saw my primary physician two days later, and when nothing showed on the X-Rays (again), he gave me a podiatry referral. Since there aren't many podiatrists in my system, I had to wait two weeks for an appointment.
One thing about my X-Rays: I was not surprised that my injury last October did not show up on my X-Rays, because stress fractures often don't. But with a repeat injury at the same location, both my primary physician and I were puzzled to see no bone thickening associated with the healing of the prior stress fracture. And the reduced pain level of the new injury did not fit with any kind bone fracture diagnosis. Hence the podiatrist.
The podiatrist instantly saw I had never had any significant trauma to the bones of my foot, and he then proceeded to lecture me on the fine anatomy of the foot (unsurprisingly, it seemed to be a well-practiced topic for him). Basically, the foot is criss-crossed by a large maze of muscles, tendons and ligaments. And unlike most other parts of the body, where a single degree of motion involves only a single primary tendon and/or ligament, the foot has multiple layers of interlocking support.
The thing that confused me is that tendon and ligament damage I've had in other parts of my body still generally hurt after the load was removed: For my foot, both times the pain was completely eliminated when I simply lifted my foot from the ground. I also have had a long history of ankle sprains, so I though I knew what a sprain felt like.
Not so, said my podiatrist: When a tendon or ligament is dislodged from its place in the maze, intense pain is often the immediate result. And since the tendon or ligament itself may have experienced minor or no damage, there will be little or no pain after the load is removed. And so long as activity is limited, there will often be no visible swelling.
That diagnosis perfectly fit my symptoms. It also explained why the re-injury hurt less than the original. And, not surprisingly, the time needed to completely heal a sprain is about the same as to heal a stress fracture.
It also explains one other thing that puzzled me during my healing process: My foot always felt better in snugly laced shoes than it did in sandals, slippers or barefoot. While compression is not generally helpful in healing fractures, it is often helpful in healing sprains (by limiting incidental loads).
And since my foot was more comfortable shod, I had been strictly limiting my barefoot activities to the absolute minimum. Which meant my foot became easier to injure while unshod, which is exactly what happened during my swim exit at the triathlon!
What does that mean for my future in running? First, to help my current healing process, I will continue to limit my barefoot time. But the moment my foot is healed, I plan to gradually increase my time spent out of shoes (in sandals and/or barefoot).
My current injury was primarily caused by the spreading of my unshod foot while under load, combined with the twisting associated with exaggerated barefoot pronation, plus running on an irregular surface. My initial injury last October was more due to the pronation alone while wearing flimsy racing flats. Over time, I need my foot to become better accustomed to and more tolerant of these motions, and greater activity without shoes is the only way to do so.
Toward the end of my visit with the podiatrist, I asked him: "Which ligaments or tendons were affected?" His answer? "I haven't a clue. There are way too many of them to know for sure!" (I think he did know, but didn't want to take the time to explain, since he had a bunch of appointments stacked up after mine.)
The identity of the culprits doesn't really matter: The recovery process will be the same.
I've been doing lots of research on foot sprains, and I'll summarize what I'm learning in a future post.