If the shoe fits.....

I've been in physical therapy for two weeks now and it's been tough. There has been sweat inducing pain, discussions about stability and at least  three "shoe" tests.

First, the numbers. Apparently the posterior tendon has a flex range of about 8% over and above what is typical. My tendon was rotating about 14% given my defunct heels (genetic shape and slant that I can do nothing about) and the partial droop of my arch. My physical therapist said she'd never seen that much "play" and was really surprised that I hadn't experienced a rupture. Me too given those stats.

Though I can do nothing about my genetics, there is much I can do to improve my flexibility, give my feet more support and in general create better foot mechanics. One way to do this is with custom orthotics. The process started with these paper mache looking strips that were wrapped around my feet. They hardened pretty quickly and immediately I was able to see the nature of my deficiency. One of the casts actually ROCKED back and forth a considerable amount. Sigh. This is what my foot is doing thousands of times per hour every time I run. No wonder my tendons are pissed off! The outcome of this exercise is to create a piece of plastic that will compensate for these deficiencies. The photo negative of the rocking cast. Seems like we'd have better technology this day and age. Something space age that could be inserted just under the skin and magically balance both feet. But alas, no. The human body is complicated.

The next step was to do a stability test pre-orthotics in all of my favorite running shoes. First up, the shoes I thought for sure would pass - the natural running, forefront gliding Newton's. NO SUCH LUCK. In fact, for my particular feet, the Newton's were the absolute worst possible shoe. According to my physical therapist, these shoes are where all of the trouble likely began.

In my particular case, the Newton's cause my feet to roll around even more than they do already! Plus, they are too wide. Newton does not make a narrow shoe - trust me I've complained. Unfortunately, I have very narrow feet! For a $175 running shoe, you should be able to have a narrow shoe in a decent color, that comes complete with matching socks, a cape and a super hero decal, but I digress. So the combination of the pitch of my body and feet forward, the resultant stress on the posterior tendon combined with the lack of stability, wobble and low profile heel, made the Newton's a disaster for my poor feet! Sad in some ways, but not really. These shoes are incredibly expensive and if I can fare better in less expensive kicks then I'm in!

Next up, the New Balance Miniumus series. The physical therapist tested me in the trail and regular running versions. The winner? The trail or most minimal version of that shoe was the absolute, most stable. The non-trail version was not far behind and she thinks once I get the orthotics, they should be ok too. A surprise of a different sort were the Brooks stability running shoes. I ran a marathon in shoes like these. The verdict? No go. They were almost as unstable as the Newton's. Crazy what you can learn in physical therapy.

The next card in this house of tendons was my back and core stability. Apparently I am unstable in general terms and not just in my running shoes. My core stabilizing muscles have apparently been on holiday and haven't returned. To draw them back and "wake them up" I have homework: Lie on the floor on my back with my thighs perpendicular to the floor. I have to push my thigh slightly forward creating a litte bit of resistence. First on one leg and then the other and finally with both. Hands flat on thighs, light resistance, don't shake. Check! This is supposed to help my back as well. A back, by the way, that I thought was in pretty good shape. No so much but that's a topic for another blog.

As far as the posterior tendon goes, I am almost ready to run again (with the orthotics, of course). In the meantime and ongoing there is "homework":

Wall Stretches: Stand with toes about 1-3 inches from the wall (knee/foot flexion dependent). Keep a neutral position and drop the knee forward to touch the wall. The stretch is felt in the heel and calf. Really, really felt!

Arch Lifts: Standing, roll feet upward toward the ceiling so the arches are as parallel to the floor as possible. Do this 20 times. Minimal roll to the outside of the foot or lightly supinated. Don't roll up onto the ball of the feet.

Arch Lifts part deux: Standing lift calves and heels up and roll onto the balls of the feet. Not like a standard calf raise where the calves do the heavy lifting but more like a supination of the feet with a finish on the balls of the feet.

I've learned in physical therapy that the posterior tendon is both delicate and tough. It is the central theme in the foot and lower leg and any irritation or weakness will severely disrupt your ability to walk let alone run. Looking back over my years of running and running shoes, I never really encountered so severe an issue until I started using more high tech shoes. Nothing against Newton, I think they have a fine concept for a lot of people but for those of us who are mechanically deficient, their shoes may be a disasterous choice. The devil is in the details as they say.

For me, it's back to basics. I will give the natural New Balance shoes a try and see what happens. At least I know they are stable and won't likely exacerbate my existing injury. I may need to size up to be able to accommodate the orthotic but that's ok. What I want more than anything is to run again pain free. I am willing to do whatever it takes to make that happen.

Homework, sure. New shoes, fine. Until you can't walk or run without pain, you don't realize how much you take your basic mobility for granted and what you are willing to do to get it back. I want to hike the Grand Canyon Rim to Rim to Rim. I want to hike, period and be able to walk three miles for dinner. I want to be able to run more than fifty steps before my ankle hurts. I want to be mindful now that being able to do any of this without pain and effort is a blessing and not a right. Thank heavens for physical therapists and their dedication to making us all more mechanically correct. But the real effort lies in maintaining that investment throughout the journey.

Good Mourning?

This past weekend I got to see a really good friend of mine that I don't get to see often. We met for coffee and chatted about life. She marveled at the boot and the fact that this is round two. We both talked about what the Universe might be trying to get across, what I could learn from all of this and the precise date when the boot would come off. 

"You can still bike, right?" she asks. "Yeah but I haven't done much of that either." I  sort of mumbled. She smiled and said, "Yeah, you have to grieve the loss of running first. Then you'll figure out that there is more to life that dashing through the streets on two feet." And as she said this I could feel her words resonate somewhere deep within me. She was right. 


Since the boot went on, I've been largely uninspired to do much training at all. Typically, I'd bike 2-3 times per week with at least one of those rides being a hard tempo ride and the other specific to pedal stroke training. I have sort of shrugged them both off for the past couple of weeks. I do ride on the weekends now but only one day and half the time I used to. I had been marveling at my lackluster attitude and almost non-existent motivation to ride until I heard her utter those words. 


Running is such a part of me that I am indeed grieving at the loss of it in my life. It is the stick by which I measure my athleticism. I am a runner first, I always have been. Running has delivered me from some of the worst moments of my life and delivered into some of the best. Running is moving meditation, a chance to compete and a way to push myself to the edge physically. Running is the metaphor for my life and I miss having that means of expression.


Today was the most perfect running day!  I shuffled to the mailbox dragging the boot behind and sighed. By the time I am "healed", it will be spring. Summer running is not my thing - especially fat which I have a good chance of being given the weeks ahead. All this Fall running will slip right past and leave me with another season of wondering what might have been.


I think for the first time in my life, I am actually sort of depressed. Maybe because for once in my life it seems like my running life could well come to a close. That is something that is very painful for me. If I have to give up running, I will have to give up such a big part of who I think I am.


 I have been lucky enough in my life not to have had to mourn much. Mourning is useful. It gives our pain a voice, our loss a purpose. It allows us the opportunity to reflect and determine how we will move forward, adapt and become stronger in the broken places. Despite whatever becomes of my running life, I will never be the same runner I was before I got injured. I wasn't the same runner after the last injury. I will always be different. I will have to adapt. If I can't run, I will have to determine what's next. 


But I am new to mourning so I am not sure how it works. Should I be going through all the traditional  "grieving" steps? Or will I just sort of feel unmotivated and uninterested for awhile? I am trying to give whatever this is the proper air time. My usual way is to just fix it and move on. Make it better and be off to the next thing. This time I just don't have the energy to do that. I suppose the teacher appears when the student is ready. I'll try to be open to the possibilities. 


Nothing is confirmed. There is no unfortunate prognosis.  I keep wearing the boot like some sort of storm trooper religion and awaiting that miraculous day in physical therapy when I can be pronounced mechanically sufficient. 


Looking on the bright side, the swelling is gone, I can flex my foot to the inside a little bit more than I could before. The pain is also largely gone though the stiffness is still there.


I had a dream a couple of nights ago that I was running barefoot with no pain. I wonder if it's a prophetic dream or if it's just my psyche's way of expressing its longing. Life is about defining and refining. I suppose that's the lesson in this. For now, I am still a runner. An injured runner but a runner until all avenues are exhausted. 

Day 7, in captivity

Today marks one full week that I've worn Das Boot, the lovely Aircast meant to sheild my pissed off tendon from even minimal movement. It works, my tendon cannot and does not move. Tightly sequestered in the cast, my foot is cocooned in cushy foam, two side airbags and two harness-like straps. My foot looks like it belongs to a storm trooper child, boot size 6.

The boot, though effective, presents some curious challenges. The most vexing is the heel height of the other shoe. Every day I have to evaluate which shoe matches my outfit AND is just the right height so that I don't teeter precipitiously one direction or the other. My hips are tired. Not being able to flex my foot in a normal walking fashion causes me to throw my hip forward in a Frankenstein sort of way. Then there is the sheer ugliness of the thing. Das boot is just hideous in terms of fashion. And of course, it leads to an explanation as to what's wrong almost every day from someone new. SIGH. At least people care.

But am I better? That's the real question. Is the tendon better off now than it was a week ago? I think so but I can't really tell. The swelling has definitely gone down. My foot looks almost normal again. I can press on that little triangle area just below my ankle and it hurts a lot less than it did before, but it's still tender. My foot is stiff. I can't turn it in toward my body very easily and can only turn it so far before I feel that familar soreness. I can put weight on it without pain. I haven't tried to stand up on my toes or stretch the tendon in any significant way because I am afraid I'll set myself back in terms of healing. Such a precarious situation!

I have two weeks left in the boot before physical therapy begins. I am both excited and depressed. Today was a gorgeous day after what seems like weeks of rain. I saw runners everywhere on the way home from work (my commute is all of two miles) and felt sad. I knew I was going home to prop up my foot and eat a yogurt instead of donning my running gear and bounding out the door to watch the sun set over the Eastport Bridge as I surged the hill, rounded the corner and headed for the back part of my running loop. Again, the thought settled in on me. What if I won't ever again be one of those runners? I felt even more sad. WHY? Why is my tendon forsaking me? I don't have flat feet. I wear the most expensive running shoes my budget will allow. I get massages, I try to stretch though I know I could do a better job. Still, it seems so unfair. I guess all will be revealed in physical therapy. BIGGER SIGH.

That I have found a really, really good physical therapy practice makes me excited. If there is a chance for me to recover without surgery it's physical therapy. Fortunately or unfortunately, I have a friend whose husband has the same condition so she helped guide me toward this particular practice. They've helped him a lot and helped her rehabilitate her knee after a skiing accident. This practice is busy! The particular therapist my friend recommended has a three month wait list! I decided on a slightly less busy therapist who is good with "feet". A good sign to be sure. There is a big difference between rehabilitative therapy and therapy for someone with aches and pains.

My orthopedic surgeon called me mechanically deficient. NICE. I've been called a lot of things but so far this is the worst because for me it means that I must drop from the running ranks. I am on injured reserve. I am booted. Like a car for having too many parking tickets. I am sidelined from some of the best running of the season and it makes me feel depressed. Even with the glimmer of hope, it's hard not to focus on what I don't have: my outlet for keeping my sanity, my "me" time and my moving meditation.

Will I ever run again? I don't know. For now, I have hope because the power of the body to adapt and recover is incredible. The body wants health. It wants to maintain that state that best sustains it for longevity. It's amazing. So for now, even if it turns out my hope was false, I am holding on to it. I am going try stay focused on what I do have. An amazing partner, incredible friends, a good job that's exciting and fun, a short commute and a generally healthy body (save one particular tendon).

There are scant few accounts of others who have endured this same injury and run off into the sunset. I've seen scary "I can't get rid of it" posts on forums and happy post surgery posts. I have yet to see a post that covers even the partial journey of tendonitis in such a critical area. I hope that my journey can be that "post" and maybe help other runners (and just regular folks) who are sidelined by this same condition. And so the journey begins.

De Ja Boot

So here I sit a little over two years to the day staring down at a familiar sight. Das Boot. My nickname for the Aircast I will wear for the next 2-3 weeks to allow my very inflammed posterior tibial tendon to return to some semblance of its normal size. I feel depressed but oddly accepting for my Type A nature. There is nothing I can do, really but wait. Nevermind that the very best running weather of the year is here now; that my participation in the Championship Series (I was number 2 overall) is over and that I can't even remember my last long run. The fleeting thought that it may have been my last makes me feel like crying.

The orthopedist seemed concerned but not overly so and everything I've read online indicates that I am catching this in enough time to "fix" it. But didn't I "fix" it last time? Why is it back? "Good question", says my orthopedist, "My guess would be you have a mechanical deficiency. We can address that in physical therapy but first we have to get past the inflammation first." Understood. Sigh.

The posterior tibial tendon is an important one. My orthopedist told me that it supports the bones on the inside of the foot including the ankle and holds the foot's arch up. If it "fails" as she put it, the treatment options are extremely limited. Foot reconstruction is about the only treatment option left and even that generally involves some sort of joint "fusion". That would mean that not only could I not run, walking without gait issues would be a serious challenge.

The good news is I can bike and swim. Having recently returned from Jamaica, I have my swimming chops back so I could certainly slog it out in the swim center pool lap after lap like some sort of hamster on a liquid wheel. Not excited about the prospect of this to be sure but it's an option. Biking season is coming to a close. I am a whimp when it comes to biking in the cold wind and usually opt for the indoor trainer in the basement. I use those long, gray biking hours to catch up on back episodes of shows I've missed while biking beneath the summer skies. These basement spins are usually offset by the promise of a long run - scooting through the woods, wind in my hair, fresh air in my lungs and plenty of time to just be. Unfortunately, I am many, many weeks away from even a one mile run let alone a long one.

How did I get here, I wonder? Apparently I didn't do something mechanically correct that ended up landing me in the same place. I am sure I did not stretch enough. I hate yoga and all the pretense that goes with it but I suppose I could have used some of those techniques to loosen up my aging tendons. Louise Hay, a very well respected medical intuitive and author of many books on healing your body by healing your thoughts, suggests that problems with the feet indicate an unwillingness to be flexible. I ponder this. I could certainly see the literal and figurative truth in that statement when applied to me.

But in what domain? I can't be "inflexible" in every domain of my life, can I? One thing that did occur to me this morning as I woke up from a dream about work (anxiety about things I haven't finished) was that for the past several years, I have been training to catch up. Catch up to my old running speed, low body fat, ability to fit in the skinny jeans or come in first in my age group. All of my exercise has been about getting somewhere. Whether it's the next win, next race, next half mile per hour faster on the bike, I am always working toward something. Where is the joy? There is no being in the present when you are constantly striving. Could it be that this physical manifestation of inflexibility is simply a way for the Universe to say "If it ain't joyous, you ain't doing it."? I don't know. But the fact that I am oddly calm leads me to believe that I must see the lesson in this for me once and for all. Or I'm in denial or both.

I am prone to inflexibility. It's in my "j" ness as a friend of mine refers to my high Meyers-Briggs "judgment" score. "J"ness is what gets things done. It keeps things moving in a positive direction with goals and deadlines and details. But I suppose there is a dark side as there is with anything. The "j"ness can rob you of the joy of the moment because it doesn't allow you to savor the smaller victory sometimes. There are also some other things that all of the "chasing" has kept me from. Painting, repairing and putting my house on the market so I can move on with the next phase of my life; going back to school for the same reason and doing something more with my evenings than training. Maybe if I don't have any concrete training goals, I can focus on exercise as a release instead on another "have to". Who knows. But as I log my journey through triathlon, training and life, there is something to be learned from this injury to be sure.

I am sad but open. Depressed but hopeful. Willing and compliant - at least so far.

Ok, Universe, I am listening. Really, I promise this time.