Following my MRI and visit with the orthopedic surgeon, the final diagnosis is better than I had feared. It is not a ligament rupture; it is a plain stress fracture of the Navicular and possibly also the cuboid, two of the chunky bones on the top of your foot at the ankle. It appears the main culprit was running down hills, something I will have to be very careful with in the future. I was surprised that I had cracked the chunky bone rather than the long thin metatarsals, but there are big ligaments that attach to the chunky ones and pull hard enough to fracture them when pulled over and over and over and over.
So for the next 6 weeks (hopefully not extended to 8) I am sporting this lovely fashion statement.
Now that I have the Boot, I am realizing what good company I am in. Hardly a day goes by that I don’t see someone else hobbling around the base in a matching appliance, and I am on a really small base. The hills here are steep and brutal luring many runners to injury.
In Virginia, the only hills I had were those on the Noland Trail. One trip around the loop had a gain of over 2,000 ft. over the 5+ miles. I ran that trail 3 times in a row right before I left, (a total of a mile each of ascent and decent), so I thought I was ready for hills, but it consisted of dozens of small hills instead of long continuous ones, and it was a dirt trail which is way less stressful on your body than asphalt or concrete. In addition, I was exhausted with jetlag and stressed from the move, I added hills to every run while maintaining my mileage and pace, I was running on sidewalks instead of the road most of the time, and running both up and DOWN hills. And, of course, I’m an over 40 woman. By adding hills to every workout and not backing off on mileage or intensity, I totally exceeded the 10% rule!
I was asked on my regular running forum, how I thought barefoot running plays into injuries like this my answer was: In the early stages of barefoot running, being actually barefoot (not in a minimal or "barefoot" shoe) protects you from TMTS (too much, too soon), but once your feet are conditioned for the miles, it is just as easy to overdo it in bare feet as in shoes. I think if I had tried to add speed work to every work out, the bottoms of me feet would have let me know before I got hurt, but hills did not add a challenge for the soles of my feet so I didn't have that warning. Plus I have learned to run on very old rough roads and the roads here on Osan Air Base are pristine. I could probably run a full marathon on them without my feet being tender or blistered. Being barefoot neither protected me from, nor caused my stress fractures. I simply exceeded my limits.
I was also not listening to my body. I've always been opposed to running streaks because people will run no matter how horrible they feel, not wanting to break their streak. I see now that mileage goals are no better. My goal of 1,000 miles for the year is what blinded me to what I was doing to myself. I didn't want to fall behind on my mileage when I had already lost some ground in the previous week due to the move. Physically, I could easily have cut back on miles and still been gaining conditioning because of the hills, but I was so determined to keep my numbers pumped up that I ignored my better sense and kept going.
I have never thought much about stress fractures, they were something that happened to other people who weren’t paying attention and pushing too hard. I’ve never broken a bone and always been strong so it simply was not something I was looking for and I had no warning. I did not feel tired on that run, I did not feel like my form was off. I had no soreness anywhere. Nothing physically told me I as over doing it. When I felt the pop in my foot, it felt like a spring "sprung," it really wasn't painful at all, just very strange. At that moment I stopped running and my foot began to feel a bit tender, but on a scale of 1-10 it was only a 2. After a minute or so of walking, I tried running again and it didn't feel any worse so I just slowly finished the last couple of minutes back to my hotel. The next day my foot was sore, but after another couple of days it was no longer tender to walk on and I could jog in circles around my house without pain so I went for a short run. Everything was fine for about 15 minutes and then it suddenly became VERY sore. It actually hurt worse to walk than to run so I turned around and ran back to my car. After that the level of soreness did not waiver. I could not walk, let alone run, so I knew I had really done something this time and went to see a doctor.
I have been questioned about whether or not my rheumatoid arthritis was a factor in the fracture, but I am confident that if RA was to blame for my stress fracture it would have happened while I was marathon training, in the marathon, or for sure at the 24-Hour Relay. I cannot blame it on anything but my own lack of judgment. I have used some cortical steroids to treat RA, but rarely and not in high doses or for long periods of time. My bones do not show thinning and I have put them to the test before. This is not an RA related injury and in my life the benefits of running still vastly outweigh the risk of injury.
What I'm hoping to really push is the fact that hills are much more stressful than running on flats so if someone moves from a flat to a hilly area, or goes on vacation from their flat city to the mountains, this is something they really need to watch out for. I knew hills were more stressful, but I hadn't really connected the dots on HOW much more strain they were putting on my body. If I had treated them with the 10% rule and considered 10% as no more than 10% of the running time up or down a hill and no more than 10% of my weekly time totals, instead of just thinking of them as not that much of the total distance, I would probably not be in a boot. I had never heard of anyone getting a stress fracture from running hills and thought I was taking it easy enough by doing some of my running in flat areas. Sometimes these things sneak up on us, but now everyone that has read this blog will hopefully tuck away this grain of information so that if they are ever faced with more hills than usual, it will pop up and remind them that somewhere they read about someone getting a stress fracture from running hills.
The other lesson I want to stress here is: When something in your foot pops, STOP and do not proceed until you have seen a doctor that has experience diagnosing stress fractures. The general practitioner I saw at first was great, but he didn't know how to manipulate the foot to determine a stress fracture so I was walking around on a broken foot for 2 more weeks (yep, a total of a month walking around on a stress fracture, OUCH!)
The good news is, I'm cleared for cardio in the gym as long as I can do it with the boot and AND it doesn’t hurt. Since it did hurt my foot to do spin class before, I have been holding back and not going to class, just sticking to the stationary bikes in the cardio room at the gym, but I did sneak in between classes and give it a whirl. I could stand to pedal with the boot on, but I think I need to at least give my foot a couple of weeks of peace before I push it that hard so I will wait a bit to resume spin class. Additionally, I have added to my supplements. I am not usually one to pop pills for nutrition, but some things we just can’t get enough of. I was already taking loads of Vit D, but I have now added calcium and magnesium to make sure I'm getting plenty to build new bone. I see the orthopedic surgeon again later next month and I will sign up for physical therapy to get started on a good and healthy track. The boot isn't so bad, it makes it much easier to walk (it has a rocker on the bottom like all the new power walking shoes, LOL) and keeps my foot from hurting. I am maintaining my goal of at least 5 hour of cardio a week plus some weights and I have actually lost weight, (although my pants are a bit more snug so I know I am losing muscle, not the fat I would like to lose). It is rather disconcerting to see that my right calf is already significantly smaller than my left, but I am definitely not the first person to have to rebuild a muscle after casting so I know it will be back to normal eventually.
It is killing me to look out from my window and see hills that I know are full of hiking trails (Koreans are very into fitness) and not be able to run them while the weather is beautiful. Of course, I have already found a “Return to Running after Injury” training plan and cannot wait to get to it! Patience, patience, patience! Just 4 ½ more weeks…
