Foot pain - outside edge.

Discussion in 'Health, Nutrition, Injuries & Medical Conditions' started by skicoach, Aug 6, 2011.

  1. skicoach Barefooters

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    My training is grounding to a halt due to pain on the outside edge of my neleft foot. It's near the middle of the foot and slightly underneath. I'm not sure if it is caused by competitive road cycling or barefoot running, but both are becoming impossible. I can still run but only with cushioned soles - though maintaining a forefoot landing. There seems to be a direct link to pressure directly on that spot. I thought it might be peroneus tendinitis buy I'm noy so sure. I'm alergic to doctors and alternative medical experts so no question of hobbling down that route. Any ideas based on experience would be welcome. Rest and inactivity is not an option that I can consider.
  2. Barefoot TJ Administrator
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    Rest and inactivity may be

    Rest and inactivity may be your only option. Please feel free to post in the Ask the Docs forum. They'll be checking it later, maybe today, and responding to questions there.

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  3. skicoach Barefooters

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    I'd rather hear from

    I'd rather hear from non-doctors who have experience.

    It would be interesting to know a little more about the injured area just if it would help to find a way to avoid resting.

    I'm in a 127km bike race tomorrow morning with 10,500ft of climbing and will get to the end of it regardless - guaranteed - even if I end up pedalling with one leg only on the climbs. I've gone the opposite from "barefoot" and packed the cycling shoes with hiking footbeds that have a thick soft pad on the outside edge and quite a strong inside arch support. I've also moved the cleats inwards so that pedal pressure is more towards the inside of the foot. I can loosen the shoes also so that there is less pressure from constriction. All of this should help to generate less pressure over the injured area.

    I don't yet know whether the problem is caused by barefoot running or cycling or in fact the combination of both together. It would be nice to be able to indentify exactly what the problem is though. There must be other examples of problems precisely in this spot. It seems from everything I read that it's tendinitis - but it's not exacerbated though mechanical action - only though direct pressure - which makes me doubtful about the tendinitis. People often get numbness on the outside of the foot when cycling and my new shoes and cleats may have been a fator. My problem became more serious after a 130 mile bike race with 15,400 ft of climbing in the cold (2°C), wind and wet, which was followed next day by a 17km barefoot run. The foot was slightly sore to start with but became progressively worse during the barefoot run until it was excruciating to let any weight onto the outside edge of the foot.

    I used ice and massage but there is practically no pain if there is no pressure. The pressure from massage makes it worse. One strong dose of Ibuprofen completely gets rid of the pain for the following day even for walking - but only temporarily.
  4. randicoot Barefooters

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    I've had some soreness in

    I've had some soreness in that spot--around the base of the fifth metatarsal. I also had some TOFP at the same time on the 4th meta, which was worse. Rest and eventually ice is what seemed to really help. I still get a hint of soreness there sometimes so I'm trying not to overdo it. I think ice would help even if the pain is only under pressure.

    Excruciating pain doesn't sound good. Wouldn't that be great to have a magic remedy for excruciating pain? Has anyone heard of such pain to go away with more exercise?

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  5. skicoach Barefooters

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    Hi Randy,Well more of the

    Hi Randy,

    Well more of the same exercise certainly won't help. What I'm trying to do is work around it - whatever it is. I'm running with cushioned low profile Mizuno road running shoes which still allow me to use natural technique (almost) - and that don't give any excruciating pain - or much pain at all if I avoid stepping too heavilly on the outside of the foot. I've also brought the distance back down to about 6k and increased the speed (this does involve a 1000ft climb and descent though). I have had to stop barefoot running though - which is very frustrating. Even walking barefoot in the house hurts - but my running shoes are fine.

    I'll know after the bike race tomorrow if my foot is going to fall off.

    Experience of other injuries - including multiple disc surgery in the lower back and various other thngs for broken bones and dislocations - has taught me that appropriate activity is nearly always the best approach to fixing things. When I broke my upper arm I lost one day skiing only - on doctor's advice that time! No plaster cast either - that's the French way - unless the limb is falling off.

    I suspect that something about this 5th metarsal is inflamed and the cycling has caused it - but the barefoot running has made it worse. I run as advised by the late Gordon Pirie (world record holder - most distances between 1500m and 20k) and land on the outside edge of my forefoot - pronating onto the ball of the foot and then allowing the heel to contact the ground. He ran 1/4 million kilometres doing this without injury - but he didn't ride bikes.

    Skicoach
  6. Barefoot TJ Administrator
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    Ski, does it help for you to

    Ski, does it help for you to know that all three of our docs are barefoot runners? You may not want to hear what you need to hear, but until you find out what is causing your problems, just treating them without getting to the root cause isn't going to get you very far down the long road.

    Good luck on your ride. I guess you will be taking lots of IB then.

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  7. skicoach Barefooters

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    One rule I have is "no

    One rule I have is "no painkillers" when racing!

    I'm sure they would help the foot but they don't give me an honest pain threshold or feedback during the race for everything else. I'm pretty good at messing myself up without that sort of help! It's a form of doping really and the furthest I'll go down that path is strong coffee. (lots of it though!)

    I'm sure you are right about the docs but I'll try everything else first. The docs where I live would have you under the knife for just about anything in an instant - and I've been there all too often - and resisted even more often. I'll now do anything to avoid that whole show. I kind of prefer to follow my instinct now - and that at this moment says "keep active but remove direct pressure from that spot". Searching around on the internet though I can't quite find anyting that corresponds exactly to this problem!

    Strangely enough my girlfriend went mad and decided to go from nothing to running 10k barefoot every day! As you can guess this is a guarantee of trouble and she wouldn't listen to any warning. She ended up with exactly the same symptom in the same foot and the same spot - after the 3rd 10k run. However a week later the pain moved from there to just behind the base of the big toe - the other side of the foot! That didn't happen by itself - she went running again and did some intervals during the run - that's when she had the shift in the pain. This might all be coincidence of course - but it might also be due to her landing on the outside edge of the foot too much as she is trying to develop the same skills as I'm working on (though I've been messing with it for a few more years than her). My injury has stayed put but hers seems to have moved on.

    Need to go to bed now - up very early for the race...
  8. Barefoot TJ Administrator
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    Well, when you get thirsty,

    Well, when you get thirsty, the troft is over there. ;-)

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  9. mokaman Chapter Presidents
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    Hey Ski,Do your shoes still

    Hey Ski,

    Do your shoes still fit the same as before you started barefoot running, your feet might be of a bigger volumne in your bike shoes and the extra tightness could be something to look at.

    Peroneus tendinitis usually shows up just above the ankle but can hurt at the end of the tendon in the middle of the foot at the 5th toe area. This injury is mostly caused by somewhat injured/weak little muscles around the ankles, example ankle sprains etc making that area weak. This kind of thing rears its ugly head when your are forced to balance more than you are used to...barefoot running does really show up these kind of weakness's in the lower leg muscles.

    Massaging the area can help sometimes, digging with your fingers in between the little bones might help...at least it could help point out the problem areas.

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  10. skicoach Barefooters

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    Okay! Survived the race - but

    Okay! Survived the race - but it was an ordeal. Woke up at 5am to torrential rain and storms but decided to go to the race anyway. Everything was screaming at me to NOT go - the weather, my painful foot and a very bad case of d.o.m.s. from running. But as I had nothing else to do I went. The race started at altitude with a 23km 3300ft descent on flodded roads! Very scary!

    Unbelievably the alterations made to the shoe - footbed + moving the cleat position - totally eliminated the pain. My foot was sore to start with so that makes it even more amazing. Even standing on the pedals didn't hurt at all after over 6 hours of racing and close to 11,000 ft of climbing. There was ZERO pain! Walking afterwards though the pain returned about the same as yesterday - but no worse.

    From what I can make out this pain has its origin in cycling and not running and I seem to have isolated the cause and found out how to prevent it - though it may take some time to properly heal. What is really surprising is that a non impact activity such as cycling can damage the foot more easily than barefoot running!!!!!!!!!

    I'm really glad to have done the race now and taken the risk. Despite the horrendous and dangerous conditions (over half the field abandoned) I improved on last years time by 10 minutes - and that was with very slow descents as brakes don't work well in a proper deluge. I'm completely exhausted now but happy about the foot and feel that I can work around this now.

    Anyone know what it is that gets sore at this point in the foot - due to pressure alone? I just can't see it being tendinitis as that would still have hurt me regardless. Can a joint become inflamed or soemthing? Didn't use painkillers on the day but took some ibprofen before sleeping at night to bring inflamation down a bit for the day ahead.

    Skicoach
  11. Barefoot TJ Administrator
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    Anyone know what it is that

    Anyone know what it is that gets sore at this point in the foot - due to pressure alone? ... Can a joint become inflamed or soemthing?

    A Doc would know. ;-)

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  12. Barefoot TJ Administrator
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    So, how did you fare against

    So, how did you fare against the others? How many registered? Half dropped out. How did you do overall, AG, etc.?

    Congrats on a good finish and a safe race.

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  13. skicoach Barefooters

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    It was a very tough race - a

    It was a very tough race - a French national championship for ski instructors - and only the hardiest saw it through with the bad conditions. I came 42nd out of 49 in 6 hours 15 minutes and 10th out of 12 in my age group. I'm normally in the top 25% for all age groups (recent amateur stages of the Tour de France for example) so it shows how good the field was. On shorter distances I can even reach the podium - but endurance is not my strong point. I was just really happy to get though it because it would have been so much easier to call it off and stay in bed instead. I wrote a full blog update here: skiinstruction.blogspot.com

    Something interesting is coming out of this though. I worked out the solution for the foot problem based on feeling - and with spectacular (but unexpected) success. Since the race I've researched the issue and it appears to be peroneus insertion tendinitis - at the 5th metatarsal. It could be a bone issue too but in the same area. Regardless, the solution proposed by professional podiatrists (professors at university) is the exact opposite of what I did. They state that wedging is necessary on the outside edge of the foot to tilt it onto the inside and remove pressure from the outside edge and prevent the tendon from being used. They use a heck of a lot of jargon to say that but it's relatively easy to decipher it. I'd thought about that myself but decided it was wrong. My foot is strong and it felt like it needed something solid underneath the inside edge to simply stand on and directly take the load. That's what I did on the bike and it worked 100%. If I'd taken the standard doctor's advice I'd have done the opposite! That's why I avoid them.

    I'll try the same in my shoes for running next. The other advice is that you must not walk barefoot. I agree with that because it hurts - though I have Merrell Trail Gloves which are designed for "barefoot" technique - and I may try to wedge them the same as I did for the cycling and see how it goes. It would be good to be able to remain effectively "barefoot" and overcome this problem in that way. Meanwhile I'll continue to use ice and ibuprofen at home.
  14. Barefoot TJ Administrator
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    Good that you finished. 

    Good that you finished. Finishing is always the most important part of any race. Everything else is secondary.

    Nice blog. Very professional and clean looking.

    That's the thing about our doctors though. They're not so into repairing what's broken as they are into finding out why it happened in the first place. Read through some of Naked Docs responses in the Ask the Doc forum, and you'll understand what I mean. He tries to correct what it is that is causing the problem. They are not your run-of-the-mill doctors.

    Strange that you mention the wedge thing. I tried some Netwons about three years ago, and they caused some serious pain at my outer fifth metatarsal on my left foot at the tendon. I figured out that it had to do with the extra built up forefoot design they have. You've seen them, right? They call them lugs or something like that.

    [IMG]

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  15. skicoach Barefooters

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    Thanks for the comments on

    Thanks for the comments on the blog - and yes finishing is what counts most! Have you read "Feet in the Clouds" about British fell running - excellent inspiration!



    Interesting about those shoes - it seems that only small changes can make a big difference. I haven't seen those shoes but it would be interesting to know exactly where they were built up - inside edge /outside etc.



    I'm resistant to "expert" advice because it tends to stop you from thinking for yourself - a bit like using GPS instead of learning to navigate. I used to work on ships using GPS and learned that it paid to actually look out of the window sometimes!



    You have probably heard that men over 50 should get a check up for prostate cancer. Treatment is quite aggressive and damaging but necessary for a potential cure. What you don't ever hear is that to locate and cure one real victim they need to "false positive" 47 others (statistic!) and treat everyone. Even when they tell you that you have cancer then there is only a 1 in 50 chance that it's true but you still go though the treatment. I'm not so sure I like this sort of system. Last year in France most people refused the stockpiled flu vaccine when the pig flu "epidemic" that never really happened struck - because they didn't want to be exposed to the hidden additives and heavy metals used in it - in Canada that issue had been dealt with but not over here. It goes on and on and on...



    I remember one Chinese doc telling me that my entire knee joint was deteriorated and that surgery couldn't help it - when I was in real pain with it. He gave me acupuncture and I never went back. I then asked another GP for a reference to a surgeon - but ended up meeting the surgeon's deputy and was told once again that it was referred pain - from a source outside of the immediate area. Not happy with this I asked to see the head surgeon again and was given another appointment. This time he was there - and his first question to me was "What do YOU think is wrong?" Nobody had asked me that up until then. I told him that where I pushed my finger against the patella tendon that it felt torn - right in the front between the tibia and knee cap. He examined me and told me that I was right (though an unusual injury for an adult). He operated successfully one week later.



    Thinking about my current foot pain I made myself stop and go over the issue again from another perspective - instead of just following advice in a blind panic. It occurs to me that there are 26 bones, 33 joints and over 100 muscles in the foot - so this tells me that it should be it should be incredibly adaptable. Most people shut their feet away in shoes and forget them but more than 1/4 of all the bones in the entire body are in the feet. I decided to find out if I could adapt instead. So I have pain on the outside edge of my left foot. Organising my cycling shoes to get all the pressure and support on the inside edge worked beautifully. The nature of cycling is that the feet can't move around too much anyway so that's fine. Medical advice is not to walk barefoot with pain in this area - though it's most likely to be tendinitis it could also be a stress fracture. Instead of adapting a shoe for walking I decided to adapt my foot to walking - barefoot. I can walk on the inside of the foot. By extending the ball of the foot towards the ground - increasing the main arch of the foot I can make a very strong support over the inside of the foot and walk with this apparently normally. Sure enough there is no pain because there is no passive contact and then pressure on the outside edge of the foot. I lose the natural pronation of the foot but as a short term measure to protect from injury it works perfectly. No shoes, wedges or orthotics needed. I walked either barefoot or with minimalist shoes all day today and didn't once hurt the outside edge of my foot because I can control this aspect of my foot easily once I'm aware that I have to do it. Perhaps the main reason I can do this however is because I have spent years doing it as a professional ski teacher inside Alpine ski boots - to improve the active use of my feet - avoid supportive footbeds and strengthen the foot/ankle in general - plus to connect the inside edge of the foot to the inside edge of the ski. I generally make my students lose their footbeds and learn how to use their feet for skiing. Sometimes I use the outside edge of the foot too when skiing so that different leg muscles can be accessed - that's why the ski boot has a long stiff shaft - it's really this that keeps the ski on edge not the ankle and foot - but controlling the foot controls the leg muscles and joints further up the body. In a nutshell - I'm choosing to be barefoot, aware, proactive and physically active to deal with this instead of the standard approach which seems to be the complete opposite of that. If I end up in a hospital bed in a plaster cast then I'll admit that I'm wrong. By the way - France's most successful skier ever was Killy. When asked what made him the best hs answer was "The intelligence of the feet!"
  16. Barefoot TJ Administrator
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    Don't make me sick them over

    Don't make me sick them over here on you. Just teasing! Do whatever works for you. Just know, they're first about finding out why things happen than just blindly trying to make the symptoms go away.

    So, will you get to a point that you actually walk in such a way that is beneficial to you but you DON'T have to consciously think about it? Meaning, you don't want to have to think about how best to step; you would prefer to be able to step that way naturally, right?

    Those Netwons are extremely built-up, have a ginormous heel, and are thickly padded. I saw one cut in half at the shoe store about three years ago, and right where the "lugs" are (the red pads underneath) is right where the tendon pain took place. It's not a subtle change in gait either. It's a complete overhaul. What's worse is the gait is very forced, very unnatural. I would think most people would experience pain and injuries from wearing shoes like that. I know I did. What's good about Newton is (at the time at least; don't know about now) they had a 30-day return policy. Yeah!

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  17. skicoach Barefooters

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    Something seems to be working

    Something seems to be working because my foot appears to be recovering rapidly - but I'm not testing it out just yet and I'm giving the running a break for a short while. Went for another bike ride mid week and it wasn't great but wasn't bad either - didn't seem to do any harm or stop recovery progress.

    What I've realised after 25 years of teaching sport is that people do what they learn to do - not what is "natural". Sometimes what is "natural" is really bad too - just throw someone who can't swim into a pool and watch the "natural" response - or stick them untrained in a boxing ring or on skis. For me "consciousness" is really simple. It's nothing more than a feedback loop that allows us to re-program unconscious behaviour. Most animals aren't very good at that but humans can be. (not all humans!) We can consciously re-program behaviour so that the new patterns or coordination are the new automatic unconscious response. I've been doing that for many years myself in very highly skilled sports (and violin playing - not so skilled!) so altering how to walk temporarily shouldn't be a big issue. The problem is just realising that it should be done - when everywhere people are trying to stuff you into shoes, orthotics and plaster casts and de-responsibilising you (if there is such a word.)

    Some people like to make out that "consciousness" is a mystical property belonging to a "self aware" universe and connected to an eternal soul. Personally I'm pretty confident that it has much more to do with the soles of our feet. Perhaps that's what they mean't all along but it was interpreted incorrectly.

    Those Newtons sound horrible - soulless shoes! I can recommend the Merrell Trail Glove -without socks. I don't really have a good environment for proper barefoot work - lots of thorns, glass, nails, venomous snakes, sharp rocks, steep scree etc. I like the VFF Bikila even off road - and the Merrell Trail Glove is excellent for rough stuff - it's a really good design but you feel a loss of sensitivity and feedback so it's good to alternate and not use them all the time. I'm furstrated at not being out running now but if the foot remains calm I'll try an effort this weekend - on the inside of the foot only - perhaps properly barefoot.
  18. Barefoot TJ Administrator
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    Well, good luck to you Ski. 

    Well, good luck to you Ski. Take it easy. Don't try too hard. Don't go too far. Let us know how you're progressing.

    And yes, I too think there is some deep connection between our souls and our soles. ;-)

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  19. skicoach Barefooters

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    Ran 3km in the VFFs and then

    Ran 3km in the VFFs and then 3km barefoot - about 30 mins - all slowly and concentrating on form. I tried barefoot first but the foot hurt and switching to VFFs the discomfort disappeared. Once warmed up and focussed on good mechanics I went back to barefoot and it was fine after a minute or two to adapt.

    I'd decided that if at any point there was a sharp pain I'd stop immediately. As expected the pain was more evident fully barefoot on the road - but what this did was give me clearer feedback and obliged me to correct my mechanics even better. I found that my natural "protective" response to pain in the foot is to actually land slightly more on the outside edge - perhaps to generate more cushioning effect though greater pronation. This isn't felt with the VFFs so I couldn't spot it until going barefoot. Another tendency I spotted was to bring the foot too far forwards - aslo some sort of protective measure - and for this to cause the foot to land midsole - exactly on the point that is hurting! I stopped "over protecting", made sure that my foot landed underneath me so as to land properly on the forefoot and then everything was fine at a low speed. I used ice on returning home and next morning my foot actually feels better than before the run yesterday (no ibuprofen). Not planning on doing too much of this but if I can manage once or twice a week at the moment then perhaps this approach will be OK.

    I just find it amusing that "sensible" advice is to not even walk barefoot and to immobilise the foot or to at least use orthotics in a shoe. If that was right I should be in a mess after yesterday but I'm not.
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    That's the beauty of our bare

    That's the beauty of our bare feet. They tell us exactly what we can and can't do and what we should and shouldn't do.

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