Too Much Too Soon Syndrome FAQ: A Look at Inside Ankle Pain

The most frequent question that barefoot runners ask me is, “Why does the top of my foot hurt?” Second, “Why do the insides of my ankles hurt?”  I will go a bit backward with my posts, because I’ve gotten two inside ankle pain questions in the past two weeks. I will try to address top of the foot pain in my next one.  First of all, what is Too Much Too Soon Syndrome (TMTS)?  TMTS is very common among us newly converted barefoot or minimalist runners.  Many of us have tried for years to run in traditional shoes and failed to run injury free, or failed to meet our goals, or just failed to run happy!  Running happy is the most important thing of all.  So, that being said, when we start running barefoot or even in Vibrams, something funny happens to us.  The first time, it’s a little weird, and we may even vow to never do it again.  All it takes is that second time.  Two barefoot runs, and you may find yourself addicted.  THIS IS FUN!! WHEEE!!!  All of the sudden, running is fun again, and it feels like play.  Sensation is on overload, your awareness is heightened, and you think to yourself, this is great!  I’m going to run my usual five mile route!  Now it’s very difficult for a barefoot runner to do their normal five mile route because their soles will force them to turn around, but this is where many Vibram Five Finger runners get in trouble.  We have a false sense of security from the rubber on the shoe, and we do not pick up the feedback that’s telling us to stop for the day. And that’s when I get an email, or a message on Facebook…

They usually go something like this: Leigh, I tried those stupid shoes (and yes I ignored you when you said to go barefoot first) and I started really slow by walking in them, and then I ran 4 miles.  Or 6 miles.  Or 8 miles.  Now, I can’t walk!  The top of my foot hurts, or my calves are dying a slow death, or the insides of my ankles hurt, or my whole body hates you Leigh, and I can’t even sit on the toilet correctly.  I broke myself.  These are all things that I’ve heard!  And guess what?  I’ve experienced all these things, because I too, am an impatient runner and ignore my own advice.  It’s true, PTs make the worst patients!

Anyway, what am I talking about? Right, TMTS.  So as new barefoot runners, we truly need to appreciate the amount of time it takes to build strength in the lower legs.  Not only that, but the mobility of our foot must be enough to accommodate our new running style which is decidedly different than say, running in a shoe with an 1.5 inch heel.  It is known that it takes about 8 weeks to gain strength and mass in a muscle.  While we may feel stronger after only a few sessions of weight training or barefoot running, this is only due to neurological factors, i.e. the signal from the brain to the muscle to tell it to contract is getting faster.  This is the common phenomenon that may happen when you’re trying to bench press for the first time.  The first time you try it in the gym, the bar wobbles around like a noodle, and everyone laughs.  Yes, it’s happened to me.  But after a few days of persistence, that bar is steady and you get to show off your mad skills.  Are you stronger?  Well, in a way.  You have better control.  But you won’t be maxing out on the bench press with the big boys and girls until you practice for a long time.  And so, there is the parallel to barefoot running. Just because you’ve been a runner, doesn’t mean that you can max out (run 5 miles barefoot) the second time you try.  We are learning to turn on muscles that have been off for a long, long time.

In the past couple of weeks, I’ve gotten questions from two different people about inside ankle pain after ramping up mileage in Vibram Five Fingers.  In both scenarios, the individual ramped up mileage very quickly. Because they were both runners before, they likely assumed they could do this.  Let me start out by saying that if you’re experiencing persistent pain after trying minimalist or barefoot running, please see a physical therapist who specializes in running.  If possible, seek an open minded, knowledgeable PT who has experience in minimalist running.  Physical therapists are movement and musculoskeletal experts, and they can evaluate and treat the specific problem.  While primary care doctors are a good starting point to get a referral to see a PT, they might not necessarily know exactly what’s going on or be open minded to a form of running that’s still considered to be “alternative” or “different.”

So let’s get back to inside ankle pain.  Inside ankle pain is not uncommon because the muscles that support the arch and muscles of the lower leg are usually atrophied from wearing regular shoes or running shoes with an arch support.  The arches including the intrinsic muscles of the feet need to learn to come alive again, but until then, sometimes certain muscles will try to do all the work to hold up and support the arch.  One such muscle that may become overworked while trying to control the arch, is a muscle called the posterior tibialis.  This muscle originates deep in the calf area and its tendon wraps underneath the inside ankle bone (medial malleolus) and connects to a small bone in the arch called navicular, and then attaches by fibrous expansion to many other small bones in the foot.  When this muscle is overworked, one could develop posterior tibialis tendonitis.  The action of that muscle inverts or brings the foot in towards the midline, plantarflexes the foot (points it like a ballerina)  supinates the foot (helps it roll out during running) and helps to control pronation (arch rolling in during running.)

Good Picture of Posterior Tibialis

So what can you do for this ailment? Well, for starters, RICE.  Rest, ice, compression, elevation.  Yes, it works!  Then, it will be necessary to restore normal mobility and strength in the feet and lower legs.  This is important for anyone who is considering barefoot/minimalist running!  So the question is, is there anything that could cause inside ankle pain other than the posterior tibialis tendon?  Of course! That’s why it’s important to talk to your PT.  But, these exercises below will be beneficial to ANYONE who is considering minimalist running, so you really can’t go wrong with them.

Stretch!

1. Gastroc/Soleus Stretch: Please perform this with knee straight and then bent to stretch both gastroc and soles muscles.  Soleus (knee bent) is of utmost importance as you will be eccentrically loading this guy with your barefoot running.  I like to hold this one for up to 1-2 minutes and repeat 3 times to really change the tissue and increase the dorsiflexion range of motion. Additionally, I like to use a slant board to obtain even more of a stretch. It is necessary for barefoot runners to have lots of dorsiflexion range of motion!

2.Ballerina Stretch: This will ensure the top of the foot has sufficient range of motion so that the muscles/tendons in back of the leg are not overworking. 

3. Roll Out!  Roll your calves out on a foam roller.  Get in there!  Also, roll out the arch of your foot on a golf ball.  Get in there! This should be a “good hurt” and the area should feel looser and freer afterward, not damaged and painful. The muscles/tendons need to be free of adhesions, rolling out can help bring circulation to the area.  Increased circulation means increased blood flow and oxygen, which brings the good stuff we need to repair tissue.

Strengthen!

1. Direct Isolated Posterior Tibialis Eccentric Strengthening: Tendonitis and eccentrics are enemies.  This one is a great addition to your toolbox! 

2. Short Foot Exercise: Janda’s genius idea.  This one is fantastic for intrinsic strength, so that posterior tibialis does not have to compensate for intrinsic weakness. Sanatan calls this the invisible arch support exercise:

3. Calf Raises with Eccentric Lower: Great strength exercise for minimalist runners, as we must have eccentric control via the muscles of the lower leg and foot to decelerate upon landing on the forefoot.  Please be sure that your weight is focused over the big toe.  In other words, do not allow the foot to roll out when lowering down. I use this daily! 

4. Calf Raise 100’s: Love this! 

5. Functional Posterior Tib Exercises: During the second video, you can stop watching at about 3:30, unless you want to know about the navicular drop test.  

These exercises are just a few things to put in your toolbox for minimalist barefoot running.  The most important thing to remember is that patience is key to success in your transition, and the reward in the end is well worth your time.  Run happy and run strong!

Have you experienced any TMTS injuries? What are/were they?  

My Journey to Becoming a Barefoot Runner, Part 3: The How to Begin

When I started this journey, I’m pretty sure I started a little backwards.  I ended up with the best possible outcome, but that’s not to say I didn’t encounter some major speedbumps.  So, I believe a cautionary tale is in order:  If you think that you can go out and run the same distance barefoot or in minimalist shoes as you do in your conventional running shoes right away, you better check yourself before you wreck yourself  For real!   Thanks, Ice Cube, for that throwback to the early 90’s.

First, (after I sprained my ankle again) I went out and bought a pair of Vibram Treksports.  Here’s a picture of my muddy feet in them:

  When I first bought them, I didn’t try to run in them right away.  I’d been wearing cushioned shoes for so long, that I couldn’t even stand barefoot in my bathroom to get ready for work without pain, so I knew running in these was pretty much a death wish.  I walked around most of the day in them and realized, oh, I have a pinky toe!!  Apparently that appendage is actually a separate entity from the rest of the foot.  It blended in for so long, I was surprised to hear it screaming at me from the ground.  OUCH! You’re stretching me out!  But I was excited to see that I could walk around pretty well in them despite recovering from an ankle sprain.

A couple of days later, I finally got up the nerve to go for a quick run in them.  I strapped them on, and stepped onto the sidewalk feeling like an alien.  Awkwardly, I began slowly running down the sidewalk.  I imagine I looked something like one of these guys, this absolutely cracks me up: 

That day, I ran 2 minutes in one direction away from my house, then 2 minutes the other direction away from my house, so I was never far from home in case of a disaster.  I ran for a total of 4 minutes, and oddly enough, my ankle didn’t hurt.  A few hours later, the calf soreness set in…

The next day, walking was a chore.  I was having trouble with stairs, and thought about borrowing a cane from a patient.  Over the course of the next couple of months, I slowly built up to running 3 miles, then 5 miles.  My first 5 mile day, I was ecstatic.  My this time, alien running was really feeling good.  I was light, energetic, and best of all, no ankle pain.  I felt so good, that the next day I went out and did it again, the same 5 mile route despite the lingering soreness in my calves.  This is where the problem resurfaced, the problem of being both a runner and a PT.  There’s that deranged runner on one shoulder shrieking, “WHEEEE!!!  This is fun, do it again, again!!”  And then the sensible PT on the other shoulder saying, “Come on, you know better than to do this, you’re not ready!”  It seems that the runner always wins the first round.

The next day, walking was not even an option.  I had successfully acquired my first too much too soon injury from minimalist running, also known as TMTS in running lingo.  Retrocalcaneal bursitis, welcome to your new home in my ankle for the next few weeks.  Oops, I got a little too excited and and ran two back to back 5 mile days.  You see, the reason for most injuries resulting from minimalist running are due to user error.  It’s not the shoe’s fault.  Or your foot’s fault.  It’s your own damn fault, you deranged runner.  🙂  I spent plenty of time icing the golf ball on my heel over the next couple of weeks and realized that I needed to listen to my body.  Afterall, this was something brand new, and you have to respect that.

The easiest way to avoid the TMTS injuries is to take the shoes off.  That’s right, nudey foot time.  Strip down to your bare soles.  Even if the Vibrams or other “barefoot shoes” feel like nothing on your feet compared to what you’re acquainted with, they still disguise the precious feedback coming in from the sensory nerves in your feet.  Have you ever tried to find something in your purse or your pocket when you’re wearing thin liner gloves?  It’s like being blind!  I always end up getting frustrated and taking the things off to find my chapstick.

That being said, when we first introduce our bare feet to the ground, it’s like waking up and seeing the sun for the first time.  Holy hell, that thing is bright!!  We will be using muscles that have been sleeping for years in your shoes, heck I’d be sleeping too if I didn’t have anything else to do.  A good rule of thumb that I’ve used when we begin running this way is this:  If it hurts, acknowledge the pain and where it is.  Continue running for another 10 seconds or so, and if it still hurts, head home.  Preferably, stay close enough to home so that you can get there easily.  More importantly, Michael Sandler, author of one of my favorite books Barefoot Running, says, “Stop barefoot running when you stop having fun.”

If we begin barefoot, we won’t get  far because our soles won’t be tough enough to get the job done.  If we begin in minimalist shoes, we have more chance of being injured because we will not get the sensory communication from our feet, leading to overdoing early on.  Beginning barefoot for short distances allows our skin on the bottom of our feet to toughen up, while simultaneously strengthening the muscles and tendons.  Strengthening the muscles and tendons gradually will facilitate the gentle tugging on the bones they are connected to, in turn strengthening those bones and preparing them for the increased weightbearing load that they were originally designed to hold.  Have you ever heard that resistance training (lifting weights) can help to prevent osteoporosis?  Bingo!  The bones respond to the gentle tugging from the muscles and tendons by building stronger bones, resulting in a stronger overall body and increased bone density.

Now don’t misunderstand, we can begin this journey in minimalist shoes instead of totally barefoot, but know that injury/soreness is more likely, and we have to learn to rein in our deranged runner tendencies.  Heck, I did it, but I’m a physical therapist who still was dumb enough to go through 2 separate but short episodes of retrocalcaneal bursitis (“WHEEEE!!!”) and some killer top of the foot pain for a week or two.  While these brief discomforts were nothing compared to the chain of injuries I had before, they were still discouraging.  But in my case, I really didn’t have the option to go back to shoes, so I stuck with the alien running.  Lucky for me, because I’ve been totally injury free for a year and a half.  All of my TMTS injuries (3)  were in the first 5 months of running inVibrams and lasted 2 or 3 weeks at most.  All my fault, I might add.  1. Back to back 5 mile runs in the first month or so.  2. Half marathon followed by launching into full blown marathon training the next week (top of foot pain coupled with retrocalcaneal bursitis on the other foot)

In the case of minimalist running, it’s no secret that there is a new crop of injured runners experiencing ugly things like stress fractures and the above injuries.  But on the bright side, this is easy to prevent as long as we educate ourselves and retrain our bodies to run properly by giving ourselves enough time to build strength in the muscles that have been napping for a while in our cushy shoes.  In my next post, I would like to go into preparation, form, and progression of barefoot/minimalist running.  In the meantime, a great book to read is Michael Sandler’s Barefoot Running.  The book along with the DVD, which I also highly recommend, can be found on his website, http://www.runbare.com/.  Here is a picture of my copy of the DVD!  It’s filled with great philosophies and instructions on form as well as preparation exercises.  Also, visit Minimalist Mondays You Tube channel which is a program hosted by local PT, Sanatan Golden and local podiatrist,  Dr. Ray McClanahan.  They are doing a fantastic service for the community, and I will certainly reference several of their exercises next time when I talk about preparation.

In closing, here is a funny video about us barefooters:

RUN LIKE HELL, Portland’s Freaky Halloween Race 2012

Ah, Halloween, one of my all time favorite holidays.  I’ve come to appreciate Halloween even more now that I live in one of the freakiest cities in the United States.  I have no data on that, but it has to be true.  Afterall, people walk around in costume daily  here; you can’t even begin to imagine what people come up with when they’re actually going to a costume party.  Even better, how about a Halloween race?  Runners are mostly a bunch of weirdos anyway, so the costumes were just the icing on the cake at Run Like Hell, 2012.

Run Like Hell supports one of my favorite charities, the ALS Association.  I’ve had a handful of patients with ALS over the years, and am treating one now.  ALS, aka Lou Gehrig’s disease, is a devastating, progressive disease leading to weakness and eventually paralysis.  The ALS Association is a lifeline for these individuals, providing support for the entire family as well as medical equipment when needed.  My first question to my patients is always, “Are you hooked in with the ALS Association?”  These people are real live angels walking this earth.

Run Like Hell features three distances, the 5K, 10K and half marathon as well as a kids race.  This year, the theme was “Super Heroes” which was nothing short of hysterical.  Last year, the theme was zombies and Mike and I made the mistake of going downtown to breakfast that morning only to realize that we would be eating with the living dead.  The sweaty living dead I might add, considering they had just run a race!  Mike and I decided we needed to go along with the theme, so he was The Riddler and I was Cat Woman from The Dark Knight.  It would probably help if I had actually seen The Dark Knight, but you do what you can.  Here are some pictures of our costumes:

My costume came with ears, but they kept falling apart so I decided to go without.  I think people still got the idea!

When we got downtown for the start of the race, it was POURING!  And cold, in the lower 40’s when we arrived.  We huddled with some other heroes underneath the precious canopy of Starbuck’s in the middle of Pioneer Square.  Mike was getting quite a bit of attention, especially from the ladies, which isn’t unusual 🙂  The start of the half marathon was delayed by 15 minutes, so the higher ups decided that all races would be delayed by 15 minutes.  Mike ran the 10K and I ran the 5K, which would now be starting at 8:35 and 9:25 respectively.

The Joker was the race announcer, and the 10K started off with a bang.  I watched Mike tear by in his Riddler costume, people shouting “Riddle me THIS!!” after him.  Around the middle of the pack, I saw a pack of barefooters happily running along with Barefootrunners.org painted on their backs.  One guy was wearing a loin cloth with painted toe nails and another guy was a Hawaiian in a grass skirt.  I made a mental note to find them later and pick their brains.

Meanwhile, I had plenty of time to kill, so I wandered around for a while and met some Ninja Turtles, The Hulk and Wonderwoman, and The Ambiguously Gay Duo to name a few.  The Ambiguously Gay Duo was made up of two of the funniest guys since SNL, and they were not so ambiguous.  During the Best Couple costume contest later on, they dutifully shoved whole bananas in their mouths as the announcer introduced them.  I was on the ground laughing!

I knew my race was supposed to start at 9:25, so I decided to head to the porta potty around 9:10.  Have you ever tried to go to the bathroom when you’re wearing a full body suit?  Take off gloves, take off backpack, take off jacket, take off belt, unzip body suit, take off sweatpants, hover (hello, this was a porta potty!)  By the time I made my way out of there, I was sweating like hell despite the cold weather.  How’s that for a warm up?  I headed over to clothing check and checked my bag quickly and began to jog over to the starting line.  By this time it was about 9:16 or 17, so I figured I had plenty of time to take a little warm up jog, because there were still plenty of 5Kers milling around in Pioneer Square.  It’s a good thing I took the back way to the starting line, because when I showed up at around 9:17, the announcer was saying, “Ok folks, we’ve got about 30 seconds to the start!  The countdown begins!”

WHAT?  I guess they decided to start early!  I fumbled around with my Garmin watch and it began searching for satellites.  Not an easy feat when you’re smack in the middle of downtown with skyscrapers around.  There wasn’t a chance that thing was going to pick up a satellite in the next 20 seconds.  I desperately held my arm up in the air as if that might help and even tried a few white-girl jumps to get my arm closer to the invisible satellites orbitting above.  Failed.  The race started and off we went.  WHEEEE!!  I love race starts, they  never get old.

My Garmin continued to search for satellites for what turned out to be the first 1.5 miles, until all of the sudden, there was the dreaded “DING DING DING” of a train barricade coming down.  “STOP RUNNERS!” shouted the officers as they formed their own little barricade across the tracks as if to prevent any renegade runners from darting across at the last moment.  Although I had no idea how fast I was going, I was disappointed by the train’s appearance because I had a feeling I was going to get a PR if I kept up my pace.  I really have no concept of pace unless I have a watch to monitor it, so all I knew was that I was near the front of the pack and I felt like maybe I was going faster than usual.  Miraculously, my watch decided to find a satellite as the train slowly chugged by, so I was back in the know.  Except since there were no mile markers that I saw, I really had no clue how much further I had to run. 

All of the sudden, I saw a marker for mile 6 for the 10K course, as the 10K and 5K courses came together at some point.  What?  That means there was only .2 mile left to get to the finish line.  I looked ahead, and sure enough, there was the balloon arch signifying the end.  I was totally confused, and prepared to turn off somewhere to finish the 5K because there was just no way I could be done already!  Then I saw a sign for mile 13 for the half marathon, indicating there was only .1 mile left.  I think it was then that I realized I was almost done, and I sprinted for the finish.  Success!  It turns out that after you run a marathon, a 5K seems incredibly, wonderfully short.  I’ll take it!

I still had no idea of my time, but quickly found Mike waiting for me at the finish line.  We then headed over to the post race celebration in Pioneer Square in search for the brews from Lagunitas.  One of the best parts about racing in Portland is that you almost always get a couple of post race beers with your race number.  While standing in the clothing check line, Mike continued to get lots of attention in his costume with the standout being his neon green contacts in his eyes.  One girl wearing some sort of  leather dominatrix outfit (so not Superhero) asked him, “Are those contacts?” 

Mike, always the jokester, replied, “Oh no, these are real!”

Ms. Dominatrix replied, “Yeah right, so are these!” and shook her ta tas around in a way that was not so kid friendly.  Did she just shake her boobs at my husband?  Time for a beer!

Beers in hand, we made friends with some friendly costumed people in front of the stage, where a bluegrass band played.  They were awesome, I wish I got the name of the band so I could go see them around town.  I got to talk with the barefooters too, they were great!  I totally wussed out today because I was thinking about running the race barefoot, but my feet were so numb at the start due to my inadequate warm up that I wore my VFF SeeYas.  I talked to a great guy named Mike with barefootrunners.org, and it turns out theres a Portland chapter that meets for group runs.  Their Facebook page apparently is the place to get all the info for their get togethers.  I joined today and I’m excited to go forward!  I really wish I had remembered to get a picture with them.

Eventually, we heard a rumor that the results were in, so we made our way up to the results tent.  On our way, we ran into a Giant Banana.  This wasn’t just any Giant Banana though, it was our friend Dennis Le!  Dennis is a personal trainer who coached me before my wedding.  Thanks to his expertise, I pushed myself harder than I ever have in the gym.  I gained physical strength, but the mental strength that I found within truly made it all worthwhile.  Several months have passed since I last saw Dennis, and I have to say, he looked great!  Then, I glanced down at his feet and saw that he had crossed over.  Yes, he was wearing Vibram Five Fingers, what looked to be the KSO model for men.  I always wore them when he trained me, and he asked me about them a few times, but you could tell that he really thought I was nuts back then.  It turns out that Dennis developed plantar fasciitis some time ago, and decided to make the switch to minimalist footwear.  Guess what?  Plantar fasciitis gone.  This is what happens when you strengthen your feet and allow your body to move naturally!  I really regret not getting a picture with Dennis either, see what happens when you drink beer after races?  Dennis said, “Thank you, thank you guys,” and continued telling us how much better he’s doing.  Talk about pulling at the ol’ heart strings!  This is just one of the reasons why I’m so passionate about minimalist running, it’s truly a gamechanger and a lifesaver.  Made my month.  I salute you, Giant Banana.  You can find Dennis Le training at Boom Fitness in Tanasbourne. 

We finally arrived at the results tent, and found our results.  I’m terrible at remembering times, so I went somewhere around 21:30ish for the 5K (2nd in my age group, I got a ribbon yay!) and Mike went 39:30ish for the 10K.  He’s fast.  Ridic.  He was hoping to break 40 minutes in the 10K and he did it!  Look at that, hit by a car in April and setting new PR’s in October.  I’m so proud! 

Meanwhile, the announcer on stage was saying something about Best Villain costume, and so Mike took off running for the stage.  As soon as he hopped on stage, he was playing the part, egging on the crowd and acting like a crazy mofo.  Here’s a pic to prove it.   

Of course, Mike won first place for Best Villain!  He won a great prize too, $30 off entry fee for any Terrapin Event in 2013.

After the race, we headed to Morning Star Cafe for breakfast, costumes and all, in memory of last years zombie breakfast.  All in all, it was a great day for a great charity.  We both got new PR’s in our respective races despite a train, and the weather cleared up just in time for the start of the races.  The sun even came out!  Racing is truly a great way to improve your level of fitness and get out there and meet new people, even if we’re all a bunch of freaks here in Portland.  Just cover your kids’ eyes when Mrs. Dominatrix comes around.

My Journey to Becoming a Barefoot Runner, Part 2: The Why

I had the distinct pleasure of flying to Hilton Head, SC last weekend to watch one of my best girls, Andrea, marry her prince charming.  Ah, the beach, with its perpetual sand, sun, water and fresh air is a perfect recipe for a vacation to relax and reconnect with the earth.  In fact, 72% of Americans prefer a beach vacation according to a poll by ABC news, and that number increased to 83% when families had children under the age of 18. 

So why is this?  Well, there’s the obvious benefits to going to the beach including epic sandcastle construction, finding the best seashells, burying people in the sand, surfing and splashing in the water.  But did you ever stop to think that maybe this is the only time that you’re barefoot outside for any length of time?  “Toes in sand.”  Google that phrase and over 16 million results pop up.  Say it to a co-worker and they’ll have a thirty second escape, daydreaming about the warmth of the sand on their naked feet.  It’s no coincidence that Americans’ favorite spot to revive themselves is with their bare feet on the ground.

Why Bare is Better:

  1. Anatomy of d’ feet.  Your feet are totally awesome, in case you didn’t know.  You have 28 bones, 107 ligaments, and 19 muscles and tendons which provide a springy effect that stores and returns energy with each step.  Commonly, when you have a foot, knee, or hip problem, someone may recommend to you that you need arch supports, custom orthotics, or super stability shoes to control the overpronation of your foot.  Overpronation is common when we don’t strengthen our feet and we confine our feet to modern shoes.  Let’s consider this for a moment:  When you break your arm and wear a cast for 6-8 weeks, the muscles in your arm are nearly non-existent when you remove that cast.  They have atrophied, and it takes a significant amount of time to rebuild your strength and your muscle mass via physical therapy and exercise.  Now, apply that same principle of muscle atrophy to the foot.  If you support your arch in the foot with an arch support or custom orthotic, the muscles in the foot no longer have to do their job because they are held up by that support.  They will begin to atrophy even more, leading to weaker feet, increased overpronation without the artificial support, and increased injuries.  If any other muscle was atrophied in the body, we would strengthen the thing, right?  So why then, in the case of a wimpy, weak foot do we tend to rely on an artificial support instead of utilizing the powerhouse foot to its full potential?
  2. Shape of the Foot.  Dr. Ray McClanahan is a local podiatrist in Portland, OR as well as one of my personal heroes.  “Dr. Ray,” as I’ve heard his patients affectionately call him, is a proponent of restoring natural movement in the lower extremities by encouraging proper footwear and the usage of his rad creation, Correct Toes. 
    Correct Toes

      

These images can be seen on the NW Foot & Ankle website.  One of my favorite items that Dr. Ray discusses is the shape of a newborn baby’s foot.  We were all born with beautiful feet, feet which are widest at the toes!  By taking a glimpse at modern footwear, you would never know this with the narrow toe boxes and curve to the shoe.  And guess what?  Our feet become deformed as we stuff them into these narrow shoes, causing our big toe and pinky toe to turn inward leading to bunions, crooked toes and an endless array of other foot impairments.  We can just call them by my favorite umbrella term “Toeliosis,” a nod to an awesome clinical instructor in Waitsfield, VT.  Dr. Ray discusses the shape of the foot and encourages natural movement in this video

When the feet become deformed by the use of modern footwear, we run into the problem of “overpronation” as well.  In one of my favorite Dr. Ray videos, he demonstrates how when the normal foot shape is restored by bringing the big toe back out into proper alignment, “overpronation” is virtually impossible.  This is incredibly fascinating, as so many of us are wearing improper shoes and suffering from the results in the form of foot, ankle, knee, hip and low back pain.  When barefoot or in proper footwear that closely resembles the shape of the foot, this allows for normal functioning of foot mechanics. Therefore, the foot becomes stronger and the rest of the kinetic chain is much happier.  Dr. Ray’s website also has articles by Dr. William Rossi, another podiatrist that discusses the benefits of being bare.  Here is a link to those articles.

3.  Schumann Resonance.  Wha?  Natural healing through the earth’s transfer of energy right through the soles of our feet.  Sound screwy?  It’s for real!  I will admit this is a bit over my head, but I will attempt to sum it up here.  The earth has a frequency of approximately 7.83-ish Hz.  This frequency is important to us, as humans, because our brainwaves also vibrate at 7.83-ish Hz.  So that means that our human vibrations are perfectly paired up with our Earth mother’s, connecting us at a level that many of us haven’t ever thought about.  So here we humans are, buzzin’ along, directly in sync with the Earth, as long as we are connected to it by the soles of our feet.  The trouble begins when we separate ourselves from our Earth mama by driving cars with big ol’ rubber tires, wearing big ol’ rubber soled shoes, and living in our suburban houses set high off the ground.  The benefits of being connected to the ground are many, but as a wannabe athlete, the one I like best has to do with inflammation.  This paragraph from one of my favorite books by Michael Sandler, Barefoot Running, sums it up perfectly:

“Second, when you reconnect to the negatively charged electrons on the surface of the earth, the build-up of positively charged free radicals in your body that leads to inflammation is neutralized.  Chronic inflammation has been implicated in all types of serious health issues including diabetes, Alzheimer’s, cancer, leukemia, heart disease and autoimmune disorders such as rheumatoid arthritis, multiple sclerosis, and many others.  When research subjects were connected to the earth, medical thermal images showed decreased inflammation in only minutes.”

Obviously, the easiest way to connect to the earth is just by stripping off your shoes.  There are other devices called grounding pads or earthing pads that exist to mimic the connection to the earth, and they are being used by athletes and us regular folks with chronic pain to increase energy and speed healing time.  Needless to say, I totally want one!  Afterall, I have more energy after a barefoot run than I do all day driving around in the car.

Another pseudo fact is that the NASA space program was using a device called a Schumann Resonator attached to their ships when they send their astronauts out into space.  I say “pseudo fact” because I have yet to confirm this with NASA, it seems they are too busy to answer my silly questions… they must be doing something more worthwhile I suppose.  Or doing nothing at all, since my husband just reminded me that NASA is no more.  Rumor has it that the astronauts that were going up into space were becoming quite sick when away from Earth’s precious frequency and only returned to their normal state when reconnected to the ground.  The solution was to send this device that emits the Earth’s frequency with the astronauts on the ships, and this seemed to solve this problem altogether.  Great!

So, could it be that we feel rejuvenated after a beach vacation because we’ve had our happy feet stuck in the sand and reconnected ourselves to Earth mama?  One full week of Earth’s healing effects to try to propel us through the next work week.  Perhaps that’s why we feel the post-vacation buzz linger for a while after we get home.  Now imagine connecting to the Earth daily via a barefoot run or walk, and consider the lifelong benefits.

4.  Heelstrikin’ (Or lack thereof).  When we run in giant marshmallow shoes with a high heel, aka traditional running shoes since the time of Nike’s takeover, our foot lands way out in front of our body smacking the ground with our sweet little heels.  Poor things, they certainly weren’t designed to absorb all that shock.  Check out this picture:

I apologize, I’ve had this picture for so long that I’m not sure of its origin.  Anyway, when we attach a cushioned heel to our shoe, it takes away our profound ability to feel the ground like when we’re barefoot.  In search of feeling the ground, we land harder to try to feel the surface with the eyes (nerve endings) of our feet.  One of my favorite studies that was featured in the book, Born to Run, was the gymnast study out of McGill University headed by Dr. Steve Robbins and Dr. Edward Waked.  They found that the thicker the mat, the harder the gymnasts landed, theoretically in search of the stability of the ground.  This could be directly related to the thickness of our running shoes!  The thicker the heel and foot cushion, the harder we land, seeking out the stability of the firm ground.

When heel striking, we disengage the natural marvel of the foot’s mechanics during running.  When hitting midfoot/forefoot, we activate the springy effect of our bones, muscles, and tendons which absorb the shock from the ground, store that energy and release it with power to propel us forward.  When hitting at the heel, we absorb the shock up through the bony heel, which has no way to dissipate that shock.  Therefore, the shock travels from the heel to the knee joint to the hip joint to the back and on up.  This is the very reason why my injuries became more frequent when my shoes became thicker and more cushioned, with a price tag to boot.  I always liked that saying, “to boot.”  What does that mean, anyway?

Take a look at the two pictures above again and you may notice how the heel striker would be the less efficient runner as his heel is acting as a braking force, impeding forward propulsion.  On the other hand, the forefoot striker will continue to glide along easily, as the foot is hitting underneath his center of gravity and his body will continue to propel forward.  This results in a smooth, easy ride and the storing of energy for use later on during a long race, just when you need it most.  The heel striker may tire out quicker with all the stopping and starting, leading to the infamous bonk.

5. The Pelvis.  For me, the position of my pelvis is one of the most important aspects of running injury-free.  When I was in physical therapy school, we learned in our neurology class how the position of the foot can impact the position of the knee and therefore the pelvis.  If we put our foot into plantarflexion, (pointed toe like a ballerina) even slightly like in a high heel or traditional running shoe, this creates a knee extension moment.  In otherwords, when your foot is in a high heeled running shoe, the knee will have a tendency to be locked out straight.  This also results in anterior rotation of the pelvis.  Translation: Your booty sticks out and the curve in your low back increases.  You seen them booty runners?  It’s ok to laugh a little, it’s funny.  I’m allowed to laugh because I used to be one. 

This rotation at the pelvis creates total disconnect between your upper and lower body because the core musculature is imbalanced and can’t hold everything together.  This is a disaster, because much of our power, balance and forward propulsion should be coming from strong stomach, back and hip muscles where our center of gravity lives. Additionally, your quads and hamstrings which are attached to your femur and your pelvis, are wildly trying to recruit and activate at a bad angle resulting in injuries all the way down the chain due to shortened quads and overstrained hamstrings.  Hello hip and knee injuries!  The Dr. Rossi article has a nice picture of what happens to the pelvis in high heels in Fig. 1.

Contrarily, when the foot is in dorsiflexion, (bringing the toes up towards the nose) this creates a knee flexion moment, or bent knees.  Have you ever seen someone walking around in ski boots?  To my knowledge, there aren’t any running shoes on the market that put your foot in dorsiflexion, but there are some walking shoes.  But this video is just pure entertainment, and you can see how this would not be a favorable running position either.

When barefoot, and with a little postural reeducation for those of us who’ve been sticking our booties out for a long time, the pelvis can be restored to its neutral position.  The pelvis can truly be the center of power for your stride and I never even realized this until I began running bare.  I will talk about how to properly position your pelvis in my next post, which will be the “how to” section.

In closing this post, I want to reiterate that running barefoot not only reconnects us to our Earth mama, but we begin to feel the connection between us and others as well.  Thinking back to the races I’ve done over the years, I only really began noticing other people when I took away the inch or so of rubber beneath my feet.  When you’re closer to the ground, the energy that you feel not only comes from Earth, but also from the people surrounding you as you all vibrate along at the same frequency.  I can honestly say that I never had much of a desire to run with other people before, but now that I am the way I am, you can bet that if you ask me about running, I will invite you to run with me.  My running buddy, Christy, and I were talking last night about the effortless conversation that flowed between us the day that we met, which also happens to be the day we did a 19.5 mile trail run together.  My husband and I have run for miles through the woods together without saying a word, appreciating the quiet solitude yet connecting to each other through the ground that we tread upon.  So whether or not you have a beach vacation planned, take off your shoes and get your feet on the ground!

Through running and reconnecting to the ground, we can improve our overall health and wellbeing.  I’ll leave you with links to a couple more articles:  How Humans Ran Comfortably and Safely Before the Invention of Shoes and Running Shoes May Cause Damage to Knees , Hips and Ankles.

My Journey to Becoming a Barefoot Runner, Part 1

Tonight, I had one of the top ten best runs of my life.  No, top five, for sure.  Fall weather has finally descended upon us here in Oregon, unpredictable and wild.  I got home from Pilates feeling energized and decided to go for a barefoot run.  Let me be clear: When I say barefoot, I mean naked feet, not running in Vibram Five Fingers or VFF’s for short.  Although I do run in VFF’s often, I’ve been venturing out more and more in my nudey feet.  The streets were wet, but it was only misting outside and the temperature was a perfect 60 degrees. 

Off I went, taking in the fresh evening air.  About half a  mile in, the rain came, exploding  from the sky with such focused energy that it literally startled me.  My first thought was, “Crap!”  My second thought was, “Sweet!! LET’S DO THIS!”  It took less than one second for my mind to switch gears and begin to feed off the strength of the rain that was quickly flooding the streets.  My feet were on sensory overload with the wet leaves, twigs and giant puddles that crossed my path and I took in all in with gratitude.  As the rains raged on in the darkness, I was running faster and faster, my clothes plastered to my body and smiling the whole way.  As I ran past the McDonald’s drive-thru, a lady sitting in her car stared at me like I was a total lunatic as I fist pumped my way through the monsoon.  I even got up the courage to wave to her to come join me, but she acted as if she was more interested in her Big Mac than joining me for a barefoot romp in the slanted rain.  Weird.  For five glorious miles, the rain poured and I was soaked and full of joy.  So how did I go from an injury ridden cushioned shoe heel striker to the loony neighborhood barefooter?  Great, I’m glad you asked.  Let me tell you:

In October, 2009 I encountered one of the nastiest injuries I’ve had to date.  I was running in St. Augustine, FL on the flattest beach you have ever seen.  I had just returned from an internship in Vermont, where I spent my weekends running a few miles on the beautiful paths of the Appalachian Trail, so I was feeling pretty confident of my footing on the beach.  I should note that I was also sporting custom orthotics, a heel lift in my left shoe, and the best stability shoes on the market with a huge built up heel and medial support.  All of the sudden, a giant sea shell rose up from beneath the sand and attacked my foot.  I didn’t really feel it with all that stuff under my soles, but the next thing I knew, I heard my ankle make a sickening SNAP and I fell flat on my face.  NOT GOOD.  Tried to get up.  Fell again.  NOT GOOD.  Finally, I made it to my feet and tried to “walk it off.”  It was terribly painful.

Being a physical therapist and a runner is a funny thing, really.  You see, the physical therapist sits on one shoulder and tells you, “Do the right thing and stop running because you’re obviously flat on your face and injured.”  The runner sits on the other shoulder and has no common sense at all, because she tells you, “Keep running you worthless turd, you’re fine!  Walk it off!”  Unfortunately, I listened to the runner on this occasion, and ran the two miles home.  I didn’t really see any other choice, I needed to get home!  My ankle was a pretty, purple softball when I got home.

As it turns out, I had a partially torn calcaneo-fibular ligament (CFL) and a completely torn anterior talo-fibular ligament (ATFL), two ligaments that are commonly involved in a lateral ankle sprain.  The podiatrist used ultrasound imaging to confirm this, although he said there may be a single string left in my ATFL.  If there was, it sure didn’t look or feel like it.  I was terrified to walk on my foot for fear it would give out again at any moment, so I resorted to wearing a beautiful orthopedic boot for a while.  I developed a complication with the healing process called Anterior Impingement Syndrome, which was likely my anterior capsule of the tibiotalar joint getting pinched every time I dorsiflexed or brought my toes up towards my nose.  This happened with every step as well as when trying to stretch my Achille’s tendon, which was painfully tight due to wearing the boot.

Over the next year, this improved slowly, but I was still battling chronic ankle pain on a daily basis.  My running was not going well, and I was only up to about 4-5 miles at a time with my huge shoes and equipment inside.  By this time, it was October, 2010 and I was living in Portland, OR working as a P.T.  Almost a year to the day of my first ankle sprain, I went out for a run on a rainy October evening.  I made it about 2 minutes down the road before I was flat on my face in the middle of the sidewalk. “NOOOO!!!” I shrieked to no one in particular, and followed that with a slew of profanities.  I had sprained the same ankle again on an unknown piece of uneven sidewalk that I never saw or felt coming.  A scared, elderly gentleman was in the nearby storage center and kindly asked if I needed an ambulance.  I told him I would survive (although I wasn’t sure) and hobbled back to my apartment where I knew my husband, Mike, was working out in the gym.  I burst into the gym soaking wet and panicked and asked Mike (also a physical therapist) to test my ankle and determine the damage.  The test confirmed my greatest fear, that my ligaments were totally incapable of supporting my ankle.  I had a full blown MELTDOWN.  It’s a good thing I have such a wonderful husband because he stood by while I rolled around on the floor like a wounded animal and decided that I would never run again. 

The next few weeks was filled with icing my ankle and brainstorming.  Let’s face it, I was a lousy runner.  I’d had nearly every running injury possible and hadn’t even come close to my longterm goal of running a marathon.  Sometime over the next month or two, I was on Facebook, when my friend Ryan (also a physical therapist) posted something about running in Vibrams.  That’s right, those goofy shoes with 5 toes.  Gorilla shoes.  I was intrigued.  Coincidentally, Ryan was also the person who showed me an article about barefoot running while we were in school that always stayed with me.  At the time, I thought I could never run barefoot, and anyone who did had probably lost their mind.  I also remembered the seed that Steve Vighetti, PT had planted in my brain when rehabbing the first ankle sprain.  He was convinced I didn’t need all the junk in my shoes, and maybe I should go back to the basics.

Then, a funny thing happened.  I started using my brain and thinking about all the knowledge I had acquired over the past few years.  I finally stopped listening to the people who told me for all those years that I needed support, custom orthotics, and a giant marshmallow shoe.  I donated my new cushy running shoes, and I went out and bought my first pair of Vibram Five Fingers, the Trek Sport model.  My friend Ryan had successfully inspired me to buy them along with my very own copy of the now famous book Born to Run, by Christopher McDougall.  I devoured Born to Run and breathed new life into my legs and feet by beginning to run and walk for very short distances in my TrekSports.  Much more about this in the next post, along with how to properly increase your running distance in your bare feet or minimalist shoes.  I will also provide much more insight into why bare is better and point you to some fascinating research studies that have confirmed this. 

In the meantime, if you see a crazy person running barefoot in a monsoon, I would love some company.  You don’t know what you’re missing!

How to Recover From Your Running Disease(s)

I haven’t always been this way.  I haven’t always been vegetarian, and although I grew up as a pseudo on-again-off-again runner, I didn’t always stick with it.  What I can tell you is that I grew up with two active parents who have always quietly inspired me.  I say quietly because they never asked me to be a runner and they never asked me to be more active.  They simply lived by example, they walked the walk. 

When I was eight years old, my mother ran the Boston marathon.  It was April 18, which also happens to be my birthday, and I also happened to be a stinky, miserable mess because I had some unknown GI tract disease that I was sure was going to be my demise.  I have never been so pissed at my mom for not being with me at that very moment in all my misery.  I remember speaking with her on the phone, and she said to me, “Leigh, I want you to remember this day because you’re going to be proud of your mom one day for running the Boston marathon.”  I had no idea at the time precisely what that meant, but now that I’m adult, of course, she was right.  I’m not sure if it was that day, but somewhere along the way, my mom and dad must have planted a seed, because I now have a new disease:  The Running Disease.  It’s very serious.

Growing up, I ran a few 5k road races here and there, sporting some traditional, supportive, motion control running shoes.  Even at a young age I was told by running shoe gurus, docs, and the orthotist that I had another type of disease:  I was an Overpronator.  It turns out that this is also a very serious disease, because my shoes got more expensive and I had to wear something called custom orthotics, even in my soccer cleats!

Let’s jump ahead to my college years. I always owned a pair of running shoes, but they were quickly gathering dust in the corner.  The orthotics were moldy, I’m sure of it. I’d forgotten about running for a while and was known as the girl who brought a 6-pack of Bud heavy tallboys to the party along with a BBQ chicken calzone from Oscar’s in Knoxville, TN.  In case you were wondering, I finished all that.  By myself.  Also, in case you were wondering, a calzone consisted of a large pizza crust folded on top of itself to create the calzone.  More or less, (probably more) I was basically eating a large pizza to myself on any average Tuesday evening.  Real talk:  I was overweight.  I still remember the day that I caught a glimpse of myself in the mirror as I was walking across my room in baggy gray sweatpants and bra.  My skin looked old, my hair was stringy looking, but most importantly, the face looked unhappy and swollen.  WHO THE HELL WAS THAT??  I suddenly saw myself going down a bad road.  Why didn’t I see it before? 

That day, I decided I was going to make a change.  I hadn’t been on a scale in years, so I hopped on my roommate’s scale to get an idea of the damage.  This was bad.  Really bad.  The next day, my beautiful roommate, Katie,  took me to the local Bally’s where she belonged and we did 25 minutes of running followed by 20 minutes on the elliptical trainer.  THOUGHT I WAS GOING TO DIE.  After the workout, I was shaking like a leaf and starving, so I rewarded myself with a cheese pizza.  Afterall, I deserved it right?  I’d burned off all the calories, right?

Over the next 5 years after the gray sweatpants incident, I would lose a significant amount of weight through diet and exercise, but usually gained it back because I was doing the Lean Cuisine deal, the Lean Pockets (diet cheeseburger Hot Pocket anyone? Check out the sodium in those!!) Slim Fast, you name it and I probably tried it. 

I also attempted running again and was pretty decent at the shorter distances, so I began running 5k races again.  One day, when I was 21, I decided I was going to try to run a marathon.  I had some aches and pains, but I figured that comes with running.  Everyone gets hurt running right?  I went for my first 10 mile run without too much excitement except for some mean chafing between my thighs. Otherwise I thought I’d escaped unscathed.  The next day, THOUGHT I WAS GOING TO DIE.  I had a new disease, the My Hip is Going to Fall Off Disease.  More about this in future posts. 

To make a long story short, I spent the next 5 years fighting different ailments that I associated with running such as Runner’s Knee, ITB syndrome, Leg Length Discrepancy, Possible Torn Labrum of the Hip, Iliopsoas Tendonitis, Tendonosis, Rectus Femoris Tendonitis, Lateral Ankle Sprain, SI Joint Pain, Low Back Pain, just to name a few.  Sound familiar to anyone?  :)  So what was the treatment?  There were many suggestions:

  1. Surgery to fix the torn labrum in the hip and torn ligaments in the ankle
  2. More expensive, supportive running shoes
  3. Custom orthotics because you are an Overpronator (which by the way, when combined with the most expensive stability shoes on the market may directly contribute to a lateral ankle sprain)
  4. Grow your left leg to be as long as your right (I still haven’t figured that one out yet)
  5. Stop Running

I gave number 2 and 3 a valiant attempt, leading to more and more injuries.

Then, there was one suggestion I had not considered before.  Steve Vighetti, a physical therapist at the University of St. Augustine, was assisting in my treatment for my lateral ankle sprain.  He was someone that I greatly respected, as he was a FAST runner, and the go to guy for running injuries.  In fact, I was calling out splits at our school’s 5k sporting my sweet boot for my sprained ankle when he ran by.  Or at least I think he ran by.  All I know is, someone flew by with a cute little boy in jog stroller, his hair blown back, cheeks flapping in the wind, giggling uncontollably.  I’m pretty sure the guy pushing the stroller was in first place at that point.   My sweet friend, Melissa said, “that little boy probably thinks he’s in a wind tunnel!”

Anyway, Steve kidnapped my expensive running shoes one day and pulled out my custom orthotics, my medial wedge for my Overpronation, and my heel lift, and threw them on the floor like abandoned children.  “What are you doing?” I asked him, terrified. “I NEED THOSE!” 

“Do you ever think that all this junk may in fact be your problem?”  He asked me matter of factly.  I’d never thought about that before.  However, that day, Steve successfully planted another seed.  Fast forward another 3 years, and I now have another disease: The Barefoot Running Disease.  This is by far, the best disease of all…

So you see, I haven’t always been a barefoot runner, and I certainly haven’t always been vegetarian.  What I know now is that my lifestyle choices today allow me to feel more alive and more excited about running and eating than ever before.  The journey to today has not been an easy one, and this is why I need to share my story.  I’ve had as many or more running injuries as the average runner, and I’ve struggled with eating for most of my life.  Today I feel like my body is strong and lean, and ready for the upcoming Portland Marathon with the support of plant foods, my Vibram Five Finger See Yas http://www.vibramfivefingers.com/products/Five-Fingers-Seeya-Womans.htm, and my loving husband, Mike.  This will be my second full marathon and I hope to follow it with a 50 miler next year.  So here we go, come along with me.  Happy Reading!