Jennifer,
Sorry to hear of your painful foot journey! Unfortunately, your story is a fairly common one. When you you sustain an injury on one leg, whether it is foot knee or ankle you will develop weekness in the side hip muscles on the side of the injury. Partially because you are shifting weight to the other side and partially because your brain inhibits the hip abductors when there is pain in that leg. Additionally the muscles in your foot become week because of the immobilization and decreased weight bearing. Wearing orthotics is good for support initially but limits the foot muscles from regaining their previous strength. Most rehab programs fall short of restoring muscular balance in these key areas. It is probably amazing you got as far as you did in the marathon.
So, what to do?
Phase 1 is relative rest – meaning you cross train doing anything you can that is pain free for aerobic fitness and sanity. For your foot you need to focus on stretching (calf muscles (bent and straight knee) and extend and flex each toe individually using your hand, even try the orange trick). Strengthening your foot in this phase is working on simply standing and balancing (shoes off – eyes open and closed) and the hip abductor strengthening (lie on your side with your back and leg against a wall – lift your leg directly sideways (keeping foot close to wall and horizontal) goal is to be able to do 20-30 reps with a 10# ankle weight. Great time to hit the abs as well. Wear the orthotics during this period. Topricin cream may help keep the pain quiet and aid in healing. You may also want to look at your nutrition. Vitamin D3 would be a great supplement (1000units per day).
Phase 2 is progressing to more weight bearing cross training like an elliptical, cycling, roller blading, walking. Continue stretches but increase the foot strengthening to standing on one foot over the edge of a step or stool and repeatedly raise and lower – goal is 20-30 reps with minimal balance assist from your hands. During this phase you also need to begin walking bare foot for 3-10 minutes (not just around the house but a purposeful walk – optimally on a track or grass field). Reduce orthotics to every other day. Keep doing hip abduction shooting for 30 reps with 10#.
Phase Three. Continue stretches. Begin hopping on one foot. At first it may be uncomfortable to do 10 gradually work towards 30, alternating days that you hop. When you can do 30 without any pain you can begin to jog 2-3 days per week and hop on the other days. You still need to walk bare footed. Cross train as much as desired to supplement training. Consider not using the orthotics at all unless the feel comfortable in work shoes. It would be nice at this point to work on your running form. Get friend to video tape you from the front and side. Try to stay off roads or sidewalks (lots of impact)
Phase four. Work up to doing 5 sets of 30 single leg hops two days per week. Gradually increase your running. Keep your running minutes the same for three weeks then bump up 20% for three more weeks. Still also good to keep up with side leg lifts 1-2 times per week.
Phase 5 – Celebrate!
I imagine this seems like a huge effort – and it is. But i think you will find that you will again be able to enjoy running.
I wish you the best
one comment so far...
Jennifer,
Sorry to hear of your painful foot journey! Unfortunately, your story is a fairly common one. When you you sustain an injury on one leg, whether it is foot knee or ankle you will develop weekness in the side hip muscles on the side of the injury. Partially because you are shifting weight to the other side and partially because your brain inhibits the hip abductors when there is pain in that leg. Additionally the muscles in your foot become week because of the immobilization and decreased weight bearing. Wearing orthotics is good for support initially but limits the foot muscles from regaining their previous strength. Most rehab programs fall short of restoring muscular balance in these key areas. It is probably amazing you got as far as you did in the marathon.
So, what to do?
Phase 1 is relative rest – meaning you cross train doing anything you can that is pain free for aerobic fitness and sanity. For your foot you need to focus on stretching (calf muscles (bent and straight knee) and extend and flex each toe individually using your hand, even try the orange trick). Strengthening your foot in this phase is working on simply standing and balancing (shoes off – eyes open and closed) and the hip abductor strengthening (lie on your side with your back and leg against a wall – lift your leg directly sideways (keeping foot close to wall and horizontal) goal is to be able to do 20-30 reps with a 10# ankle weight. Great time to hit the abs as well. Wear the orthotics during this period. Topricin cream may help keep the pain quiet and aid in healing. You may also want to look at your nutrition. Vitamin D3 would be a great supplement (1000units per day).
Phase 2 is progressing to more weight bearing cross training like an elliptical, cycling, roller blading, walking. Continue stretches but increase the foot strengthening to standing on one foot over the edge of a step or stool and repeatedly raise and lower – goal is 20-30 reps with minimal balance assist from your hands. During this phase you also need to begin walking bare foot for 3-10 minutes (not just around the house but a purposeful walk – optimally on a track or grass field). Reduce orthotics to every other day. Keep doing hip abduction shooting for 30 reps with 10#.
Phase Three. Continue stretches. Begin hopping on one foot. At first it may be uncomfortable to do 10 gradually work towards 30, alternating days that you hop. When you can do 30 without any pain you can begin to jog 2-3 days per week and hop on the other days. You still need to walk bare footed. Cross train as much as desired to supplement training. Consider not using the orthotics at all unless the feel comfortable in work shoes. It would be nice at this point to work on your running form. Get friend to video tape you from the front and side. Try to stay off roads or sidewalks (lots of impact)
Phase four. Work up to doing 5 sets of 30 single leg hops two days per week. Gradually increase your running. Keep your running minutes the same for three weeks then bump up 20% for three more weeks. Still also good to keep up with side leg lifts 1-2 times per week.
Phase 5 – Celebrate!
I imagine this seems like a huge effort – and it is. But i think you will find that you will again be able to enjoy running.
I wish you the best
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