Top-of-the-Foot Pain

Jimmy Hart, of Plano, Texas, has practiced the philosophies if 'being barefoot' for the last decade, teaching many the importance of strong, well-trained feet as a running coach and personal trainer. His website is a growing resource for everything barefoot. The following article on top-of-the-foot pain, a problem that I have been dealing with over the past months, is an example of his insight and expertise. Jimmy suggests, "Injuries are signs of doing something wrong, and learning to correct those issues will make the switch easier." For the complete article and more from Jimmy Hart visit his site, gobarefooting.com.

... The foot is an extremely complex mechanism that gets seriously underused while wearing conventional shoes. It is made up of a lot of muscles, connective tissues, and nerves that are constantly handicapped by the stiff and cushy soles of most shoes. When a person decides to let his feet out of those shoes he is essentially taking his foot out of a supportive structure...

When running in a conventional shoe, the foot comes down on the heel, which means the toe is up, and the calf muscles are lengthened. That lengthening of the calf muscle puts it in its weakest range, and other muscles will have to make up the difference. One effect of this calf lengthening is the shortening of the muscles and tendons in the top of the foot and front of the lower leg or shin... When landing on the fore- or mid-foot, the foot is pointing down as it approaches the ground. This will lengthen the foot muscles and flex the calf muscles. You have essentially changed the muscles that are being engaged at foot strike and every joint has a balancing act that it goes through to work and stabilize the joint. The difference in foot strike will make a change in the joint’s balance and start using the muscles in a different way.

The typical runner making the switch will usually complain of sore and tight calves after the initial barefoot runs. This is because the calf muscles are now being tightened and flexed. After that initial shock is gone and the calves begin to adapt, the same runners typically complain of pains in the tops of their feet...

With top-of-the-foot pain you should stretch the calves and arches as well as taking anti-inflammatory meds. Getting the calves to relax and loosen up should be the main focus, as this will allow the release of the muscles and tendons in the top of the foot. Icing the top of the affected foot will also help in the recovery process. As with any injury the main prescription is rest. This may be the toughest of all pills to swallow, especially for someone who has just learned the pure joy of running bare, but rest and time, stretching, and ice will heal this issue, allowing you to get back out there and do what you love.

I'm afraid that I fall into the latter category of stubborn healers that Jimmy refers to. With races and planned training looming over me, it is difficult to slow down or rest. Through most of my training, I have taken extra rest days, regularly soaked my feet, often in cider vinegar to soothe and add potassium to affected tissue and ligaments, and massaged my feet regularly.

The biggest question in terms of recovery for TOFP is how long it will take to recover.  However, this question cannot be answered without first asking other questions.  It helps to determine if there are inflammatory cells present on the tendon (tendonitis).  If there are no inflammatory cells present then the injury will be tendonosis.  This is important because it determines the length and severity of the injury.  The problem is that inflammatory cells can usually only be seen with a microscope, and that can only be done with surgery.  Since the average person with tendon pain is not going to go under the knife to find out exactly what is causing the pain, diagnosing the injury can be a difficult task.

The majority of recent studies have shown that most injuries do not have an inflammatory process present, which means that TOFP is caused by tendonosis.  However, it is still not common practice to just assume there are no inflammatory cells present and a general prognosis will be tendonitis.

If it is tendonitis (inflammation present) then the injury should respond quickly to anti-inflammatory meds and rest.  A true case of tendonitis should and can be resolved within a few days to two weeks.

If the issue is tendonosis (no inflammation present) then what you are dealing with is a degeneration of tissue that must be rebuilt.  The majority of barefoot runners with this injury will likely fall in this category because they are now putting strain on tissue that has not felt that strain in many years.  The tendons of the foot have degenerated, and the sudden switch in loading has caused an injury.  If this is the case then the affected person must avoid loading the muscles and tendons involved in the painful area.  This can be done with bracing, taping, supportive shoes, and avoidance of exercise/stress.  It takes time for tissue to heal and regenerate, and it is especially true for tendons so the recovery time will be much longer.  The time it takes to recover from an uncomplicated form of tendonosis is 6 to 8 weeks, while chronic complicated tendonosis could take 3 to 6 months. The only way to determine which of these time frames applies is to rest and see.

You may be able to rest for 4-6 weeks with a tendonosis injury and then test the area with a short bout of exercise that will put stress on it.  If the response is pain or an unusual amount of discomfort then continue resting.  If there is no pain present then you may restart your normal routine with a few things in mind.

First you should consider all possible causes for the injury in the first place.  This will mostly include form and level of exertion prior to the injury.  Analyzing your footfall and making any necessary changes will be vital in the avoidance of a re-injury scenario.  Second you should start extremely slow as you work your way back into a safe routine that will allow you to progress from the injury and not from the point where you left off in your training.  Once you’ve suffered an injury, your new starting point will typically be far behind the last point you were training at, and that adjustment must be made in order to avoid future setbacks.

Comments

[Jimmy Hart]

Thanks for using my information Nathan. I hope it's helping you which is what I started gobarefooting for. I want it to be an educational source for people when it comes to running. For those of you who have a question, injury, or anything else please feel free to let me know. I will either contact you personally or if need be I will write an article on a subject, whatever needs to be done. In the meantime keep your attention right here because this is also a good place to get info. Thanks again.