Extensor Tendonitis (TOFP)

jakeblaser

Barefooters
Jul 15, 2011
19
0
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Today officially marks day 14 since my last run. My first transition attempt into minimalist footwear (Newton) was going so great until about 6 weeks in when I started noticing top-of-foot-pain. I ran through it until I researched that I needed to rest. I rested for about 2 weeks by changing sports to bicycling. I returned to shod running for the first few runs to ensure I was fully healed. I was doing about 5 pain-free miles after a few short test runs.

I later bought a pair of Vibram's and, although I thought I was going slow, I wasn't going slow enough. I got caught up in the moment of efficient and fast back to back days of running and the pain returned. Luckily I began my interest into barefoot running and had started reading Barefoot Running. This prompted me for the first time to listen to my body and stop running immediately.

I'm starting to get impatient and want to run again, but don't want to hinder my recovery. I've been icing daily and recently started taking Ibuprofin for inflammation as well. I have been walking the dog daily in the morning and in the evening barefoot on hard concrete. I am unsure whether this is slowing my healing progress. It seems this is a catch 22 as I understand walking barefoot reduces inflammation; However, this may also put continued stress on my extensor tendons. I tried this with and without shoes and it seems more comfortable barefoot.

My latest revelation was stretching my calves as this is the opposing muscle connected to the tendons on my upper foot. I am also using a heat pad on my calf muscles to loosen them up. Everything I find online says 7-10 days for recovery, but I am still working through a nagging injury. Its barely noticible at this point, but I promised myself I would fully recovery before beginning my completely barefoot journey.

Any suggestions?

Jake
 
Hi Jake,It sounds like you

Hi Jake,

It sounds like you are going through the syndrome that Ken Bob warns about, the barefoot euphoria causing you to transition too fast.

You didn't mention how many miles you were running when you got the injury or if you had higher mileage before you went into minimalist shoes

From experience it will take you up to a year to relearn how to run so forget planning for any up and coming races, or keeping a weekly mile count, slow down. You will need plenty of patience and perseverence. This will be probably one of quite a few setbacks so don't get too stressed about it.

I used my injury time to practice drills and balance skills which are the basic building blocks of understanding how to run. The minimalist footwear is allowing you to train far beyond what your feet are capable of. You should ditch them for now and only go back into them once you have learned the correct technique. The correct technique comes with running with your bare feet on the ground and learning how to minimise the pain.

I wouldn't think walking would be much of a problem but it can wear the pads on your feet away faster, depending on the surface your walking on and the distance.



Regards



Neil
 
Hi Neil. I was running 20-25

Hi Neil. I was running 20-25 miles a week shod. In the Newtons I was already up to 5-mile runs and was at my fastest time ever within a few weeks. That in itself is a huge indication of overuse. I started out only doing like less than 8 mile weeks.

I only ran in the Vibrams a few times at distances under 3 miles. This really felt different than ever. I felt my form was great for the first time ever. At the time I didn't realize how this was putting more stress on atriphiedtendons and muscles. I particularly felt it in my calf muscles. I only felt my tendinitis after it was too late.

I wish I had started barefoot. You are right about the barefoot euphoria.
 
Jake, I'd be concerned

Jake,



I'd be concerned about stress fracture. Is the pain along one of the metatarsals? Does it hurt to jump and land?

You are correct that any change adds a new mechanical stress, even if it is in the right direction.



If it is stress reaction/fracture…”tendonitis” in that region is unlikely

In general for stress fracture recovery once there is healing and callous in place (4-6 wks for metatarsal)) it is optimal to add some mechanical stress with very short running distances. A minute of running and then 5 minutes of walking at first. See how the discomfort is after a half hour. Gradually progess with the minute of running alternate with walking.

Many folks go out and do a mile or two…that is 1000’s of reps. Not good for the first phase of recovery.

Lots of time balancing on one foot also good as long as this does not cause pain.



Dr. Mark
 
It does not hurt to jump or

It does not hurt to jump or land. I pressed pretty hard on the metatarsals at the joint and on the side of the 5th met and there isn't any pain. There hasn't ever been bruising or swelling that I can remember. I'm having a hard time determining specifically where it hurts. It seems like more of a general area than a specific spot. It would have to say the top of the mid foot, more towards the outside. I did notice before minor pain on left foot sitting Indian-Style. Nothing major.

Thank you for your help. I will try the balancing exercises and continue healing with RICE.
 
Here are some things that

Here are some things that helped me get over a 3-4 month episode of serious TOFP last year. (Confirmed extensor tendonitis diagnosed by my podiatrist.)



- Calf massage!!! My calf muscles were excessively tight which were pulling on the extensor tendons preventing the tendonitis from healing. My doctor referred me to an incredible sports massage therapist. Regular visits with a massage therapist specially trained to treat sports injuries made a huge difference for me. I also bought a foam roller and used it daily on my calves. I was literally in tears from the pain the first time I used it because my calf muscles were that tight and knotted. By the 3rd day I could use the roller in relative comfort.



- Calf stretches. Both the doctor and massage therapist recommended several different calf stretches. You can google calf streches and find lots of suggestions. Just be sure that you stretch both the gastrocnemius and the soleus.



- Rest. When I finally went to see the doctor, 3 months after the TOFP started (yes, I'm stubborn), he had me stop running completely for 3 weeks while doing the stretches and massage. The doctor suggested wearing a negative heel shoe (like an Earth shoe), at least for a couple of weeks (he knew I was a barefooter), to help rest the extensors. I happened to own a pair of Earth sandals and I wore them for 2 weeks. It did help with the immediate discomfort. Then I went back to being barefoot (not yet running, just everyday living).



After all of that, I was finally able to get back to running on a fairly regular basis. The problem was that I still had some minor recurring bouts with TOFP through the rest of the year. As soon as I noticed it returning I'd treat it with calf stretches and massage and I'd give myself an extra few days of recovery and it would go away again.



I was sure that my posture and running form must be related to the recurring problem, but I couldn't figure out what I was doing wrong. Then earlier this year I read Esther Gokhale's book about posture, 8 Steps to a Pain-Free Back. I started practicing the posture she teaches in her book and using that posture while running. I haven't had any signs or symptoms of TOFP since then (it's been about 3-4 months now, which is the longest I've gone since the whole thing started). I think she should rename the book, 8 Steps to a Pain-Free Foot. :) I look forward to hearing her presentation at this year's NYC Barefoot Run.



Well, I hope you found something in all of that to help. If nothing else, perhaps it's good to know that there are cases of TOFP that don't heal in just a few days.



Oh, and if you do decide to seek medical help for your foot, it's worth it to call around and find a doctor who is willing to work cooperatively with a barefoot runner. I sent e-mails or made phone calls to nearly every podiatrist / sports medicine office in my area indicating that I was looking for a specialist who was, ideally, supportive of my decision to run barefoot, but at the very least not antagonistic to it and willing to offer me more than some orthotics and advice to stop barefoot running. Many indicated truthfully that they would not be a good match for me. A few said, sure, they'd work with me. One said, "Barefoot running. One of my favorite topics!" That's when I knew I found the right match.



Peace,

Karen
 
Great!  Thanks!

Great! Thanks!
 
Dr. Mark,I did some balance

Dr. Mark,

I did some balance exercises on one leg yesterday. My foot feels more sore today as a result. I'll discontinue these until things are feeling better unless you think this will speed up the recovery process.

The pain is still minor. It seems the tender spot is a tendon or muscle on the top of foot, pretty high up (near the ankle). Not sure whether this is a primary or secondary injury. I feel tenderness when this tendon / muscle is activated during my step. I'll play it safe for now and rest.

Would it be better for recovery to wear regular shoes or a more natural shoe, like Vibram?
 
Jake, Karens advice is spot

Jake,



Karens advice is spot on. if you do need think stress fracture follow those general principles. if patience runs out seek a barefoot friendly podiatrist of sports physician.



Mark
 
I also bought a foam roller

I also bought a foam roller and used it daily on my calves. I was literally in tears from the pain the first time I used it because my calf muscles were that tight and knotted. By the 3rd day I could use the roller in relative comfort.

Karen,

I am really feeling pain in my lower-left calf with the massages. OMG! Ouch! Big issues at soleus and anterior gastrocnemus. There must be a correlation as I have no sensitivity massaging the right leg. Still a little weary of doing calf stretches as that puts stress on the foot. No pain, but I haven't fully ruled out stress fracture. Either way this is something I need to work on. Thanks again. Heating pad seems to help loosen things up before massages.
 
It's now been 7 weeks since

It's now been 7 weeks since my last run so I'm thinking this was a stress fracture after all. I am ready to return but my body is still saying to rest. In the middle of all this I got plantar fasciitis. I have been remedying that well by exercising my feet and then using an insole in my shoe for recovery with RICE.

The pain on my left foot is just lingering and annoying. Its killing me to not be able to run. I don't think o will be fully recovered by the end of next week, which marks 8 weeks of healing. Ugh. The pain is still in a generalized area on the top of my mid foot by the 4th metatarsal.

Any advice or thoughts on what I should be doing differently or how much longer I can expect to rest?
 
Oh, and the deep muscle

Oh, and the deep muscle myofascial release with a tennis ball every 3 days after foot strengthening / balancing exercises has done wonders for PF.

Should you be doint this, this soon? Meaning, shouldn't you have healed more before doing these moves? I would think that if your stress fracture hasn't healed, then you would just be delaying healing by keeping the tissues moving. I don't know. I'm not a doctor. I would also think that wearing a boot to keep the area immobile will help to allow the area to heal. I would think that if you are constantly moving the stress fracture around, that it will take longer to heal.

Did you get PF from walking on your heels while trying to heal from the stress fracture, while trying to avoid putting weight and pressure on the ball of your foot? This happened to me too, in both feet, after I had cryosurgery for Morton's Neuroma, in both feet. Sucks, doesn't it? I'm still dealing with it, although over a year later, it's not nearly as bad as it used to be. I think my being barefoot all the time helps get and keep my feet and arches strong.

Good luck.
 
TJ,I am pretty sure my PF

TJ,

I am pretty sure my PF resulted from overuse, although it really started after I realized my foot pain, which I believe to be a stress fracture. I know the healing may be somewhat delayed as I still have to walk the dog frequently. I do this on the bike sometimes to help relieve weight bearing pressure on my foot. The insoles helped my PF big time. Within about 3 days the PF reduced by 50%. My injuries with stress fracture and PF have conflicting treatment, which leaves me in the middle trying to find the best solution.

The tennis ball is used on the interior of my foot, where my fracture seems to be localized to the anterior part (4th or 5th metatarsal), so I am not feeling pain in that process. Strengthening my feet with balance exercises is great for PF, but not great for stress fracture.

Now the shoes seem to be putting pressure on my foot. I think my feet are getting wider and that causes discomfort while in the shoe. As soon as I take my shoes off there is instant relief of mild discomfort, but walking barefoot aggregates my PF. Ugh.
 
What about some Crocs?  In

What about some Crocs? In winter time, the Crocs have a faux-wool liner which makes them even more comfy for PF, and the footbed and toe box are so wide that you won't feel constricted. Of course, a nice boot would stabilize the stress fracture and help it to heal. Maybe you might have to concentrate on healing the stress fracture first, then work on the PF. Just thinking out loud here.