Thursday, September 29, 2011

Lower Leg Pain and Minimalist Shoes


I began a transition to a minimal shoe in January 2011, starting with the Nike Free Run+, and very quickly moved to Vibram Five Fingers (VFFs). The VFFs challenged my calves and various parts of my feet continuously. Despite this I was determined to wear them, and reasoned that this was pain I would just work through to get to a better place.

Calf Pain

Calves were the first body part to yell loudly.  It happened at the end of a good 3 mile run, and I decided to turn on the jets for the last 300 yards.  I stepped off a curb and it felt like knife was thrown into the belly of the soleus.   Thus began a series of calf injuries that prevented me from running with any consistency for months. 

Each series of injuries led me to try different attempts at recovery.  I tried Chinese Salves (QiVantage products which gave me a nasty rash and smelled like Indian food), calf stretches, The Stick, walking barefoot on gravel (?!), Advil, cross training on the stationary bike, Chiropractic and Acupuncture.  While none of these impeded recovery, I doubt any had substantially added to recovery either.  By happenstance I had a long weekend of outdoor yardwork and spent the whole time in a classic work boot with a heel (think Timberline).  I noticed that most of the calf pain had gone away, and reasoned that it was the conventional shoe combined with non-repetitious activity that allowed my calf to return to the operating range it had grown comfortable with for 40 years.  That allowed it to relax and get flushed and nourished by blood flow from the constant movement.   Getting my mind off of recovery by doing something else helped a lot too.

I have since tried this a few more times with similar success, and recommended it to others with reasonable success as well.  I now prefer a conventional Merrell hiking shoe with a padded heel and conventional lift.  (For you barefoot purists out there, this is therapeutic use – VFFs for hiking is the only way to fly.) 

Deep stretching a severely injured calf muscle doesn’t work, so don’t bother.  It will aggravate it and impede recovery.  Instead, try to keep everything above the knee free and loose.  I spend a lot of time doing hip stretches, glute stretches, hamstring stretches and keeping the IT band loose.  When doing hamstring stretches you have to do it with a slightly bent knee to keep the calf from getting stretched in the process.   Many calf and foot discomforts seem related to muscle and tendon issues further up the leg for some reason. 

Top of Foot Pain (Metatarsal Pain)

It’s not uncommon to hear of Top of Foot Pain (TOFP) from VFF wearers.   I had mild bouts of it when I first started wearing them, but nothing serious until I pulled a 12 miler.  I swear I had a stress fracture, the pain was unbelievable.  I limped on both feet for a week.  This pretty much suspended my VFF running attempts until after my scheduled fall marathon event.    Even with a minimal shoe, I still get TOFP flare-ups, mostly in the metatarsals.

The Podiatrist I saw for TOFP (who is also a Sports Injury Therapist) was incapable of making a recommendation short of an orthotic.  I didn’t want to go that route, so I worked with my Chiropractor who is also a physiologist of a sort.  He noticed that at the points of pain between my metatarsals there was a grainy, almost ball-like spot that he reasoned were adhesions that had to be broken up.  By taking his knuckle and massaging it for 3-5 minutes (the pain of this is unbelievable – you cannot do it yourself) the adhesions would begin to break down, pain subside and thus allow the recovery process to start. 

At night I would grab some massage oil and first work down between the metatarsals, from the cuboid to the great toe, massaging between the bones, and focusing on those grainy areas.  Then I would grab both sides of the foot just behind the balls of the foot and rock the muscle/tissue areas between the metatarsals.  I start with the great toe metatarsal while holding the other 4, I rock the foot length-wise.  Then holding the great toe and the index toe in one hand and the other 3 metatarsals in the other hand, I would rock again.   I would continue down until I’m holding just the 5th metatarsal in one hand while rocking the rest with my other hand.  This is good therapy in general for a runner.  In total I spend about 5 minutes per foot each night. 

I still have metatarsal pain, but it doesn’t impede me from running in Nike Free Run+’s.  It’s the shoes with a solid sole that aggravate it, whether running shoe or street shoe.  The Nike Free’s have a segmented sole that give flexibility in all the places needed so there’s minimal stress on the metatarsals.  The VFFs seem to aggravate it for some reason (Bikilas or Treks), but barefoot does not.   

Conclusion

Adapting to minimal shoes or VFF’s can be challenging for some, and I’m sure a person’s age and the style of shoe worn for most of their life has a lot to do with the transition success/failure rate.   For the most part I run in Nike Free Run+ shoes (for now) which some would scoff at as not a true minimalist shoe.  However, it’s keeping me running which for now is what I need. 

My sights are set on going naked foot after my fall marathon – I enjoy the VFF feeling but still struggle with TOFP they bring.  Stay tuned.

3 comments:

  1. Since this is a popular post of mine, I will provide a couple of updates. First, it doesn't seem to matter what I run in anymore, my TOFP is persistent. It never goes away, there are just degrees of tolerance. The only time I don't feel it is while running, so I'm starting to think it's my other shoes that are causing the problem as my foot tries to adjust. Note thought that I still have issues when "walking" around in Five Fingers.

    Secondly, during the adjustment to flat heel, it's important to give your calves a break as I originally wrote in this post. However, once you've made the transition, now there's a dilemma - what DO YOU WEAR??? I've found that any heel lift at all is beginning to irritate my knees. I posted to this blog recently my thoughts on Minimalist Dress Shoes (http://learning-runner.blogspot.com/2011/12/thoughts-on-minimalist-dress-shoes.html)

    The Journey continues, but running barefoot (like, skin on road barefoot) seems to be good therapy. I have another post on why I love & hate VFFs (http://learning-runner.blogspot.com/2011/11/torrid-lovehate-affair.html), and it was my goal to stop using them. However, now my feet hurt just as much or more using Nike Free Runs as the VFFs. Perhaps avoiding "Too Much, Too Soon" is the best advice. Listen to your body, and when it hurts, rest it. But pay attention to WHEN you have pain, and WHEN you don't, and the conditions you're operating under. Then make a small adjustment and give it some time.

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  2. How are you doing now? The cause of my calf pain was my running shoes. Although I am now calf pain free due (thanks to stem cell treatment and my surgeon, Dr Grossman), I am still worried about my calves each time I run. I mean, calf pain could be really painful and irritating, and I never want it to happen to me again. My Nike shoes is about to give up on me and soon I will be searching for another pair again. I might be searching online for recommended pairs for runners...

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  3. Kirsten, I was sidelined from any serious running most of 2012 while I experimented with a variety of shoes. I miss the VFFs, but won't touch them now. Currently running in the minimal Mizuno Cursoris, and while my feet are sore at the end of the day (mostly heel pain), they are allowing running with consistency. I foresee issues with the long run with this shoe, however, and will probably try Newton Gravity for the 10+ milers. Along the way I've tried Brooks, NewBal Minimus, Nike Free (too narrow now), Vivobarefoot, and test run others. I haven't fine-tuned the heel rise yet, but I think 4mm will work best long term. Just too many years and too much adjustment to ask of my body to go flat.

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