Thursday, July 19, 2012

Final Injury Update-Extensor Tendonitis

*Here is a link to my first Injury Update, which explains more about the injury itself, and is the basis for which I formulated this post.

It's been a little over 2 months since I began feeling pain in my foot from switching to barefoot running.  I am no longer running barefoot, but I am running quite well with a pair of minimalist shoes (Saucony Kinvara 3).  I've logged around 100 miles over the past 5 weeks in these shoes and my foot is feeling completely better.  I figure that since my injury is completely behind me...knock on wood...I should post an update to the treatments I used.

Ice:  This continued to be a lifesaver for me.  I continued to ice my foot, as described in my previous post, throughout my healing process.  I also began a routine of applying heat, friction massage, then ice which I'll describe later.

Compression:  I continued to wear an elastic bandage throughout the day, especially if I knew I would be walking a lot.  This helped for the first few weeks, but around week 3-4 it started to feel like it made things worse.  I discontinued wearing the wrap after that.  I think the discomfort was caused by the added pressure from the wrap on the top of my foot where the inflamed tendons travel along my foot.  Initially it provided comfort, perhaps by adding stability and cushioning to my fore-foot.

Wear Running Shoes:  I continued to do this throughout the entire recovery process.  I started out with my old Mizuno Wave Rider shoes (This link will take you to the current model, but mine are 12's).  The WR's had been through a marathon and much more, so they were pretty shot.  I switched to a pair of Kinvara 3's about 3 weeks post injury.  My Kinvara 3's felt better than any other pair of shoes I own so I wore them everywhere until about 7 weeks after injuring myself.

Forefoot Padding:  I actually quit using this after about 3 weeks or so.  After switching to wearing the K-3's all of the time, there was no need for additional padding.  The extra padding did seem to help initially though, so it may be worth trying.  As a side note, I read several internet posts about people placing cotton balls between their toes to relieve stress from inflamed tendons in their foot; however, this didn't seem to provide any relief from discomfort for me.

Stretching:  Stretching continued to be a great help for me, especially calf stretching.  Once my foot was feeling a bit better (about 3-4 weeks post injury) I started doing a stretch on the top of my foot where I would sit in a chair, place the ankle of my injured foot on my opposite thigh, and use my hand to gently bend my toes downward.  I would have to apply counter pressure with my thumb on the bottom of my foot near my arch.  I would recommend any leg stretches that don't seem to aggravate the injury while doing them.

Friction Massage:  I stumbled across friction massage several weeks into my recovery and this seemed to help tremendously.  It's not entirely comfortable, but it really helped to pinpoint the injured area and also seemed to alleviate pain for hours afterwards.  Here is how to perform friction massage.  I highly recommend this!

Toe Raises:  I actually quit doing these shortly after my original post.  I quickly decided that strengthening exercises weren't helpful early on in recovery.  I would recommend these for injury prevention, but not for treatment.

Running:  I definitely don't recommend running while injured.  I went on a few light runs, but decided that it was actually making the problem worse.  I could feel pain in my foot while running, but since it wasn't severe I thought I could just run through it.  I did; however, find that after about 2-3 weeks of rest I could walk/hike relatively pain-free.  I started walking as much as my foot would allow.  I tried to just listen to my body.  If my foot started getting sore, I toned down the walking.  If I felt good I kept going.  I actually did several 5-10 mile hikes with my 1-year-old son in our Baby Carrier Backpack.  This may not work for you if you're injured, but I think it really helped me recover.  I think that stimulating the tendons, without causing pain, is very beneficial to recovery.

Rest:  I ended up taking another 2 weeks off from running completely, with the exception of a few light "test" runs, for a total of 4 weeks off.  In order to keep my sanity I started walking and hiking quite a bit to at least stay somewhat active.

Now that I've revisited all of the previous treatment methods I mentioned before, I'd like to mention the heat, friction massage, ice routine that, in my opinion, was more helpful than anything else.  First thing in the morning I would apply a heat pad by wrapping it around my foot and securing it in place with the elastic bandage I used use to wrap my foot.  I would leave the heat on for about 20 minutes, making sure that the heat was concentrated on the top of my foot between my toes and ankle.  Next I would conduct a friction massage for about 10 minutes as described in the link.  During the massage I would start rubbing very gently and as time went on I was able to increase the pressure.  By the end of each massage my thumbs would be very tired from applying so much pressure.  By the end of the massage I could feel the pain centralize to a very specific point on the tendon, maybe the size of my fingertip.  After the massage I would apply ice for 20 minutes.  This felt SO good, as the massage isn't exactly pleasant.  By the time I finished this ~50 minute process my foot felt absolutely wonderful, and it only got better the more that I did it.  Occasionally I would end up applying ice again later in the day if my foot was really bothering me.

I hope this helps someone make it through a tendon injury.

Happy Running!