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3936 Views 24 Replies Latest reply: Jun 7, 2011 7:36 PM by JamesJohnsonLMT RSS Go to original post 1 2 Previous Next
  • Designeer Pro 125 posts since
    Jan 28, 2010
    Currently Being Moderated
    15. Jun 5, 2011 1:23 PM (in response to SlowRunner50)
    Re: Achilles Tendon Pain

    It is truly a horror when your family and extended family not onlly leave you to die, but they literally trip you up as much as they can because they hate education and if you have a masters degree in an art related profession (architecture), they feel justified in calling a death sentence out onto you and ostracize you because making money is job #1 they tell you, that your happiness and health mean nothing to us.....you have humilated us by not becoming wealthy.........(capitalism gone mad.....)  I have gone 30 years without knowing what a family Christmas or any family holiday is like, prior to that I was too young to know what was going on beneath the surface and ready to sprout.............

     

    Running and activity have kept me alive all these years.......I have literally run myself into the ground....but there was no other way.........playing chess did not help............

     

    My prolo treatments are closer to 400 and not 700, I am sorry for the unintended exaggeration there, it just seems like a constant stream of needles go into me (I've lost count) so that I can undo the sickness the world has poured into me just to get back to a pain free day of existence.  Its not good to be born too sensitive or too weak.

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    16. Jun 6, 2011 6:45 PM (in response to SlowRunner50)
    Re: Achilles Tendon Pain

    People often buy a drill, when what they really need is a hole. I've  always felt this "Sales 101" analogy, classically used to draw attention  to benefits vs. features, is doubly important in health care. People  are always getting talked into wanting what they don't necessarily need,  as if the virtues of the product were the only important consideration.  Many of us are, after all, drill salesmen, whose product is often more  important to us than the purpose for which it is intended. With focus  comes competence and success, but the human body is anything but  focused. We are arguably the most general appliance to have ever walked  the earth, so a more flexible approach to our care seems appropriate to  me.

     

    Most therapies are performed, and therapeutic devices  manufactured, by people who specialize in their craft. We have often  looked to doctors to navigate us through this sea of therapeutic  interventions, but the alternatives are too numerous for anyone to  maintain up-to-date familiarity with all at once. Doctors themselves  have had to specialize to stay in business. This fact, and the presence  of a business model in general, makes me say "Caveat Emptor."

     

    As Abraham Maslow  put it, "It is tempting, if the only tool you have is a hammer, to  treat everything as if it were a nail." Knowing one thing very well is  likely to make you feel confident about using it over and over again,  whether it works in every case or not. In general health care, the Law  of the Instrument has been expressed by drugs and surgery, and in sports  med by ice and stretching. There are a few mainstream interventions and  lots of alternative ones, with insurance companies narrowing the focus  by what they will pay for. Whichever strategy has enough money behind it  to pay for the most studies becomes "evidence based."

     

    That  off my chest, I can tell from the above posts that we have just gotten  started. I am really curious about what it may be that has led you to  these particular injuries. You didn't mention that you were running 100+  miles a week or anything else in excess, rather that your regimen  sounds quite reasonable for your age. You mentioned injuries in college,  but not due to competition. You did mention running on road shoulders,  but also that you once had Achilles problems in both legs.

     

    My guess from your earliest posts was the possible effect of overuse on the Tib  Posterior, which might be consistent with running on either the left or  right side of the road, left/right gradients being the usual. If the Tib P were wound too tight from supinating  your foot to match the terrain on the left side of the road, it might  become dysfunctional tissue in its normal job of tensioning the arch. On  the other hand (or foot, so to speak), running to the right might  produce an eccentric contraction as this muscle fights the forced pronation  to match the road canter, with a similar result for the exhausted  muscle tissue. Put the two together, the arch and the road surface, and  it seems like we have a clue, but not so fast...

     

    What  happened in college? were you running track, cross country, or just  staying fit running the roads? If the road scenario is the same, the  hypothesis is worth exploring. If you were running the flats, Achilles  problems in both legs, begs more questions. Did you run too many miles,  or run them too fast? If neither, then all of us should be so afflicted.  Why you? Is there something about the way your back, hips, knees, legs,  ankles, or feet are constructed that make you more vulnerable to this  injury? Regarding Morton's Neuroma (if that's the diagnosis), was there  something about your shoe or foot that crowded the nerves enough to  cause the suspected encapsulation?

     

    I ask these  questions of course to help, but I should disclose that I work with the  human body for a living, and material from my work helps me handle  questions here. By the same token, issues from the Med Tent forum inform  me in my practice. It is in the spirit of solving problems like yours,  or asking questions that may help others to solve them, that I proceed. I  understand that ultimately, the onus of the solution you seek falls on  those who are getting paid to provide it. Having been in that role, I  can tell you that a lot of time can produce little knowledge, but a  little knowledge often saves a lot of time!

     

    I should  also disclose that I am also a runner, have competed in several  marathons, have sustained a number of injuries, and have had a few  experiences similar to yours (no bunions to date). More importantly, I  have applied what I have learned over the years to my own body with (so  far) great success, overcoming both Achilles problems and years of neuroma  sensitivity. The burning sensation was like a flame in the middle of my  foot (I compared it to crucifixion), and it ruined a few marathons. The  Achilles problem was so bad that I could not run for 6 months. I am  also in my late fifties, but typically run longer than the marathon  distance a few times a year. So, I've been there.. and emerged  victorious. I truly believe you can, too!

     

    The more  specifics you can come up with about your running surface, mileage,  equipment, anatomy, etc., the sooner we can help to get you back on the  road (literally) to recovery. You've already supplied a lot of helpful  information, but there's room for more. Take your time.. we haven't hit  the turnaround yet!

  • Designeer Pro 125 posts since
    Jan 28, 2010
    Currently Being Moderated
    17. Jun 6, 2011 8:06 PM (in response to JamesJohnsonLMT)
    Re: Achilles Tendon Pain

    You seem to be a good soul James, I appreciate your good heart.  I will try to share what may be useful.

     

    Because I have a slightly bent second toe on each foot and was vain, I did not wear open toe shoes or flip flops much, I hid my feet in shoes.  I liked the styling shoes that were pointy, same with cowboy boots.  The shoe salesman always said you will stretch them out, its leather.....hence compression and little toe boxes all my life........

     

    In my 30's I instinctively stomped my feet when dancing to feel like I was making a statement or resolve of some kind because I was timid otherwise.......overcompensation.......

     

    somehow I shamed my parents into helping me finish architectural school in my 40's by announcing my plans to the relatives and making them feel obligated to help despite their resolve to abandom any concern for us past 21 years old.  By now I was running both morning and night, hardly taking a day off, about 1.5 to 2 miles each time (4 miles a day), I was packing on muscle and weight, I was always around 200 lbs, I never stretched, I ran with legs that were becoming pile drivers, thoughts become things, I knew I had to finsih school to save my life, it was my last chance to do it, I built a body that resembled an offensive lineman.  I pile drove my feet into the ground as I ran, I wanted to feel like a frieght train, so nobody could stop me..........

     

    I clashed with many retro professors, I woas an unwelcome innovative, think out of the box designer in a backwards traditional school.  I fought hard, I ran like a maniac in my forties, I ran up the football stadium steps for two years, my legs became huge, I took up mountain biking, I climbed the steepest hills, the pressure I put on the pedals in those bear claw cages and skinny running shoes crunched my feet, I was fighting for my education, I used every bit of my will to climb and become unstoppable, I must have torn my feet apart there each weekend at that park.

     

    One year before graduation, I came home to rest for a few days and I was physically assaulted by my folks for putting them in a position of having to help me go to school, it interupted their parties and European vacations, etc........plus they hated us........good ridance is what they expressed to us...........I got on my bicycle and rode about 50 miles into an exhaustion that is just as bad as being intoxicated and I found myself flying over the handlbars at speed and surprisingly not wanting to put my feet out to save myself, instead I stupidly asked God to take me....which he did not.........so much for religion...........i felt my knee smash into the ground, a nice roll and my shoulder smash into a concrete telephone pole..............the pole did not move at all by the way........there was no mercy from God despite what I have been through all my life......no cutting back on any cruelty.............you crash, well you crash..........eat it up now........

     

    Fast forward one year of having a knee that would not heal and I refused to bear full weight on..........by now I was on the brink of insanity, I kid not......it actually went through my head that if my left foot were injured a bit temporarily, then I would be forced to bear weight on the right foot and the knee would strengthen...........I was not in my right mind, I was desperate..next thing I knew I had kicked a brick wall with the ball of my foot.................I believe that was the final straw...............my foot became a loose bag of bones.and I kept running like that for the next 3 years till today, finding prolotherapy 2 years ago and tightening my foot constantly, all while running still, the nerve slowly healing and shrinking............having a relapse lately on the stair climbing machine..........I had my joint capsules shot up and another round of prolo and it is feeling better today............starting jogging again................I have never run a marathon, I have run to save myself from mocking, violence, betrayal, loneliness............my poor feet.........I did not know how much I needed them.......I abused them........now I love them.ugly or not.they have done so much for me.........how ignorant I was........thank you

     

     

    Again, today I still receive prolo on my shoulder but have military pressed 225 .......4 times because of prolo, my knee is over 90% healed and still improving by prolo, my left foot is alot tighter, the nerve it not squashed, so has a chance to heal in between my running..........my soul is slowly healing because I meet good people who for some reason feel called to heal me............and now I believe in good people and not God.........its more palpable.........and ........safer.trust me

     

    THANK YOU TO ALL THE GOOD PEOPLE IN THE WORLD, I wish I had collected you as dear friends from a young age and never took a single one of you for granted...........ever......you are the gems of the earth..........and probably the only thing that is truly real

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    18. Jun 6, 2011 8:25 PM (in response to Designeer)
    Re: Achilles Tendon Pain

    Well, there's another reason for running, as if there weren't already enough. Your story is certainly compelling.  Before this thread goes too far out on a tangent, though, I must say  your situation and that of the original poster (GGG) appear to be very  different. We always learn, however, when contrasting different  etiologies with similar outcomes. I'd say in your case you were asking  much more of your feet than the average person would, to the point of  anatomical failure. In GGG's case, we may find it was not the task but  the tools found wanting. I want to keep an open mind about it, but have  my suspicions. In any case, I can see that running is very important to  both of you, if for different reasons, and there is great hope for all.

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    20. Jun 7, 2011 3:04 PM (in response to SlowRunner50)
    Re: Achilles Tendon Pain

    I'll make a wager with you GGG, about a condition I have often written about here in the Med Tent forum, a condition that affects approximately 1 in four of us (including myself), and is particularly vexing for runners. An almost guaranteed source of chronic pain from head to toe, it would explain the problems with your ankles, achilles, and bunions, as well as multiple visits to the podiatrist over the years. The angle (Proximal Articular Set Angle) of your great toe is an important clue, along with the instability of your ankles, and other issues you mentioned.

     

    If your pod has not mentioned the relative length of your metatarsals, it may be because an irregular pattern in these is quite common among foot and ankle pain sufferers, enough so that a less stable foot structure may appear to be "normal" in the practice of podiatry. Understanding that all your body weight plus the G-forces of running must be distributed and partially absorbed among these bones, it is easy to see how small variations in structure could lead to accumulated damage over a lifetime. Basically, running with a second metatarsal head that projects beyond the first metatarsal head (regardless of toe length) is like running on ice skates as the foot moves forward. The first through fifth of these metatarsal heads must be in a straight line for the most stable foot plant, triangulating with the heel. Anything else requires more work from the leg muscles, producing adaptations from the toes (as you have seen) all the way up through the hips and back, sometimes felt to the jaw and beyond, including the pain of chronic headaches.

     

    One adaptation of concern to you is rotation and crowding of the metatarsals in order to provide stability, leading to the grinding of your nerves between the metatarsals and the resulting "neuroma," which is usually not a real neuroma, but a thickening of the tissue around the nerve in defense. It typically occurs between the middle metatarsals and can include multiples, although one is usually painful enough to immobilize the sufferer, preventing the excess motion that would create more. While shoes are often blamed, it is the structure of the foot, or sometimes hypermobility, that causes crowding of the metatarsals. Similarly, bunions, another adaptation, have been found in aboriginal tribes that wear no shoes.

     

    At this stage in your life there may be no highly effective work-around, even though your orthotics are obviously meant for this purpose. Few orthotics are made to adjust the abnormal proprioceptive feedback created by this foot structure, and even the athletic versions typically do not simulate the optimum bone length. Orthotics are typically made to cradle the foot in order to minimize excess motion, but not to make it unnecessary. The necessity is based on the way the brain perceives the movement of each bone as your foot moves forward. No changes to the way these bones move, means no change to the result, even if temporary relief is granted by restricting movement. It's simple engineering. While there are some expensive orthotics modified for this purpose, I corrected my short first metatarsal by placing a thin pad under the head (ball of foot). That was enough to simulate a longer metatarsal and stop the progression of my neuroma pain.

     

    Forgive me for the information overload, but this issue comes up over and over again, even though for reasons stated above it often eludes diagnosis. If you were anyone else, you might have a sore back or hips. As a life-long athlete however, your experience with pain has been equally intense. I hope the foregoing helps stimulate discussion during your next appointment. Your situation is not unique, but unusual enough to escape the most appropriate solution. Congratulations on your years of athletic endeavor, and for staying out there. I believe your perseverance deserves more than treatment of your symptoms, and I sincerely hope that's what you get.

  • Designeer Pro 125 posts since
    Jan 28, 2010
    Currently Being Moderated
    21. Jun 7, 2011 3:52 PM (in response to SlowRunner50)
    Re: Achilles Tendon Pain

    Even 4 prolotherapy treatments with the strong solution of sodium morhuatte would do wonders for Golden Girl..............but it must be one of the best prolotherapists.........

  • Designeer Pro 125 posts since
    Jan 28, 2010
    Currently Being Moderated
    23. Jun 7, 2011 7:09 PM (in response to SlowRunner50)
    Re: Achilles Tendon Pain

    As impossible as it may seem, I was walking/running on the far outside edge of my left foot for about 20 years, after the accident and susequent prolo, I now plant the foot perfectly flat believe it or not because of all the work he did on my ankle.  I already notice a more even wear on my shoes.

     

    There are prolo doctors in every state.

     

    www.getprolo.com

     

    I know I seem like a marketing person but I'm not......I just want people to know this exists for them in lieu of the knife.........

     

    I will accept and respect your decision not to go with prolo.........

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    24. Jun 7, 2011 7:36 PM (in response to SlowRunner50)
    Re: Achilles Tendon Pain

    lol, that's a good attitude for a runner, I guess! I'm still suspicious of your Tib P. because it can become quite lax in failure, which is suspected when the ankle gives way. Being unresponsive is the normal operation of this muscle when overworked, even if the nerves are intact, if that gives you hope. You have to palpate it deeply when the Soleus/Gastroc on top are soft enough to penetrate. That alone may cause it to respond.

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