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Monday, April 29, 2019

Bone Injury Problem: Email Advice

Dr. Blake,

I saw your blog and was very impressed with your ability to break down
foot issues in a way a layperson can understand. I’m writing to seek
advice about my current situation.

I recently had an injury caused by running. In December, I ran on
mostly concrete a handful of times with trail runners (New Balance MT
10v1), since I was visiting family and did not bring my normal running
shoes. This was a big mistake. At the end of the month I started
feeling a severe pain in my left foot. For 2 weeks I was minimizing my
walking, and mostly limping around. After 2-3 weeks my left foot felt
better, but I had a lingering pain when applying pressure just below
my big toe, to the right on the side of the foot. I did not feel this
while walking, my foot/toes had full range of motion, and otherwise
would not notice unless I put pressure on that spot specifically.

I went to my general physician 6 weeks after the original injury, and
he recommended seeing a podiatrist if it didn’t get better within 2-3
weeks, since it didn’t appear that I had broken any bones. I saw a
podiatrist soon after, and after an X-ray showed there were no broken
bones they determined it was sesamoiditis. They recommended I wear
dancers’ pads for some time, and to come back if the discomfort did
not subside in 3 weeks. I went back, and got an MRI that time. Not
only did I have sesamoiditis, but I had a stress fracture in the 3rd
metatarsal bone along with the bone behind it. There was evidence of a
previous stress fracture as well, one that only partially recovered. I
was given a CAM/walking boot to wear for at least 4 weeks, and they
were to provide custom orthotic inserts to put in my shoes after. In
both visits my podiatrist also noted I have very flat feet, and that
treatment afterwards will need to keep this in mind. I am now entering
my third week wearing the CAM boot, and have started planning ahead
for my recovery once I'm out of the boot.

Before my injury I have been a regular weightlifter for 7 years, and I
never had any injuries related to that. However, I have done very
little cardiovascular exercise, practically never running before late
last year. Despite that, I walked a lot, often averaging 8-10 miles a
day on weekends. I would wear various types of shoes, ranging from
ordinary sneakers, athletic shoes similar to the Adidas Ultra boost,
and minimalist boots (Vivobarefoot Gobi II). Even though the
minimalist boots had nearly no support, I found walking with them
quite comfortable even for long distances. I find either minimalist
shoes (due to the wideness at the front, giving my toes a lot of
space) or Ultra boosts the most comfortable for long distances.
Ordinary sneakers generally felt a bit tight after a while.

After this injury though, I am re-evaluating what footwear is best for
me. Since my shoe selection may have been a cause of my injury, I want
to ensure I don't make the same mistakes.

In my anecdotal experience, walking in minimalist footwear was fine,
but running was definitely not. Is this a result of the surface I ran
on with minimalist shoes?
Dr. Blake's comment: First of all, I am sorry it has taken me weeks to answer your question, for I was
on a great vacation and three weeks later still not caught up. It is all about accumulative stresses to our bones and soft tissues. I always look at 3 causes of an overuse injury, and the most common ones at that, since it is never one thing. In your case, what could possibly stress out the bones enough to cause sesamoiditis and stress fractures. The most common in order are:

  1. Increased running without enough recovery time (typically 48 hours if you do not have a good running base).
  2. Less bone protection with more minimalist shoes, especially when you were not used to them, while running.
  3. Overall bio mechanics of your running form (no info here)
  4. Overall bone health (could there be Vitamin D Deficiency) since you are picking on bones that need Calcium and Vitamin D among other things
  5. Type of training (hills and speed work harder on the sesamoids), downhill with a tremendous increase in bone stress (up 3 times flat ground running)

It’s almost certain my running form could
use some work as an inexperienced runner. As someone with a flat foot,
is it possible to walk with more minimalist footwear but run in well
supported shoes?
Dr. Blake's comment: Yes, so many of my runners only wear more protection for their running, and some just for their longer distances, and the minimalist shoes for speed work and walking of course. 
Or should I wear shoes with a lot of support
regardless of whether I am running or walking?
Dr. Blake's comment: No need unless your biomechanics is so bad you need both orthotic support and shoe support all the time. That is rare. I like to patients to have variety in shoes, orthotics, training. I also need my runners to have good bone health, and to be strong from foot to their cores. I hope this helps you some.
 I have seen conflicting
information online and would love your thoughts on this.


1 comment:

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.