The Scene Begins

This post is not really intended to be a celebration of overcoming an injury, because I’m not completely out of the woods yet, but more of a checklist of things I have tried and some additional information that will hopefully help any fellow runners out.

First, a description of the injury. This is both the most simple, and most complex issue I have dealt with. It is simply a sharp pain about the size of a dime, directly on the back of the heel. Despite x-rays, an MRI, along with visits to podiatrists and ortopedic specialists, I have not gotten a 100% conclusive diagnosis.

It could be any one or a combination of:

Retro-calcaneal bursitis – inflammation of the bursa that is nearest the achilles attachment

Insertional Achilles tendonitis – inflammation and damage to the achilles tendon where it attaches to the heel

Achilles tendonosis – degeneration of the achilles tendon

Equinus – basically super tight calves

Haglund’s deformity – the calcaneus (heel bone) has an extra bump on the rear that increases the distance to the achilles attachment

Heel spur – sharp bone growth

My best guess is a bit of the insertional tendonitis + bursitis along with a little bit of Haglund’s. Basically, it hurts when my left foot hits the ground running (although I am not really a heel-striker), and it REALLY hurts when I push off. That motion of planting my foot and then using it to propel myself forward lights it up. Having chronically tight calves has really made things worse as everything tugs at that one spot. Climbing hills aggravates it as that increases the distance along the back of the lower leg that the achilles has to stretch.

It all started at the Pueblo Half Marathon (Rock Canyon) in December of 2008. I didn’t notice anything during the race, or immediately after. When I got home after driving for two hours I couldn’t hardly walk. I had to use a severe limp to get around. I went through the normal routine of resting for a week or so, ice, etc. It improved very slightly, I started running again, and have been on a huge roller coaster of progress and setbacks ever since.

I have taken ~4-6 week rest periods three different times. I was on track for making a good comeback last year when I reinjured the spot at the Salida Marathon (8 mile climb right off the bat) in March. Doing speedwork is also a sure way to tirgger a relapse. The longer stride and harder push off put a lot of strain on that area.

So I became a shuffler. No, not really to that extreme, but I have had to limit my faster running and scale it back to something just above a jog a lot of times. No fun.

Here are the remedies I’ve tried:

Multiple rest periods

Ice

Heat

Compression

Elevation

Night splint

Strassburg Sock

3x/week physical therapy for 6 weeks

Iontophonesis

Anti-inflammitories (ibuprofen/naproxen)

Heel sleeve/brace

Heel lifts in shoes

Salonpas medicated pads

Extra padding inside shoe or sock

Surgically-altered shoes (cut out heel counter with razor knife)

Slant board

4 different foam rollers

3 variations of the ‘stick’

Stretches

Eccentric calf exercises

Homeopathic medicine (ruta-grav, arnica)

Massage

Barefoot/VFF running

Kinesio tape

Trigger Point tools

and endless Google and letsrun.com searches

Long list…

Out of that list, what has helped?

All of it, to some degree. And any one of those pursued longer, and with the addition of more rest, would probably result in good progress. However, some things have been more effective than others.

I think the root of the problem is still with my overly-tight calves. While a lot of things on the list treat the symptom, I believe the real cure lies in working on the calf issue. I can’t just do a few wall stretches and make it all go away, though. I come from a cycling background and have strong calves and quads, but when it came to weight-bearing stuff like running I was very weak. I am becoming a big believer in mixing in a bit of barefoot running into my routine. I just need to be careful with that and find the right balance. I had severe flare-ups last summer where I would have to stop in the middle of a run and limp back, but I could take my shoes off and run on the grass with hardly any pain at all.

While heel lifts are often prescribed for achilles injuries, I have actually had better results in dropping the height of the heel in my shoes. I have gotten myself into a little trouble with pain in the 2nd metatarsal on both feet after spending too much of my running time in low profile shoes on hard surfaces.

I think the eccentric calf exercises are worth doing (starting from a raised position and lowering the heel – rather than doing the traditional calf raise that promotes a contraction of the muscle). The eccentric motion focuses on strengthening the muscle while it is being lengthened.

Searching letsrun.com from their site is a pain, but letting Google do the work can have some good results (i.e. use the following syntax in your google search – site:letsrun.com “insertional achilles” ). There can be a lot of crap to wade through, and some generous doses of misinformation, along with occasional humor. I have found some good ideas that way, and if anything it is somewhat comforting to at least find other people that are dealing with similar issues.

I had pretty good luck with the Salonpas medicated patches. Much better than swallowing handfulls of pills and seemed to be effective at treating just the spot of the injury while leaving everything else alone. I just bought them at Safeway.

My best purchase has been the TriggerPoint brand of products. While I do like the grid roller they came out with a while back, the ‘quadballer’ and ‘footballer’ are by far the most effective things I’ve used.

Setting the ‘footballer’ up on the foam block and then rolling your calf on that is very good. While a normal foam roller will have some benefit, this thing is amazing. I love how I can go extremely slow and changing position by just a millimeter or two can make a huge difference. When I find a good spot I really take my time and work it over.

So, things are looking better. I am able to walk somewhat normally when I first get out of bed these days. In the past, I would have to shuffle 4-5 inches at a time until things started to loosen up. I am back into regular training. Still not as much as I would like, or as hard as I would like to push on some days, but building some good consistency while mixing in some decent days on the bike as well.

If you are suffering from anything like this… good luck!  It has been a tough couple of years.  I have had some great experiences and decent results (running Boston, Leadville big buckle, etc.) while dealing with this, but there is always a huge feeling of being held back.  I have to alter my stride to compensate for the pain and that has led to various other injuries.  I am rarely able to truly just run free.  For now, I’m being patient and taking what I can get while building towards the future.