Foot Injury

Lunch Pail

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BLUF: I have muscle/tendon pain on the outside of the left foot, located near the 5th metatarsal. X-Rays showed no structural damage. The doctor at the urgent care seemed to agree with me that it was inflammation of the peroneal tendon. I received a referral today to see a sports medicine specialist on Wednesday, 12/2. 20160105 is when I leave for 11x OSUT. I have played sports my whole life and have no history of foot injury and have never felt the need to have my gait/foot analyzed as generic shoes have always done the trick. My plan right now is to let the situation develop by seeing the specialist, get a prognosis, and contact my recruiter to review options if necessary.

Situation: This summer, towards the end of July, I was averaging 15-20 miles per week, in shoes that by this point were completely worn out. Virtually 100% of my logged mileage is on asphalt or a country gravel road. My workouts at the time typically included an 8+ mile long run, 2-2.5 cumulative miles of sprints ranging from .25-.5 miles, and either 30/30 sprints or a tempo run. I suffered a minor groin injury (now 100%) playing soccer, so I took 2 weeks off running. After returning and completing two 5 mile runs (same shoes), I was forced to stop due to fairly severe pain. The sole of my left foot near the heel became swollen. I applied RICE and the pain localized to where it is now, near the 5th metatarsal. My educated guess after research was that this was due to inflammation of the peroneal tendon, cumulative wear from horrible footwear, and not running in said shoes for two weeks.

After some more RICE and trial and error, it seemed that the length of the run, rather than intensity, instigated pain. I resumed running in new shoes (random Asics that were comfortable and relatively cheap) with my “long runs” now starting at 2 miles. I had one sprint day and 2 “long run” days, with each bumping up by .25 miles. On 11/2/2015 I had slowly built up to a 5 mile long run with absolutely no pain over the past weeks. Feeling confident and still applying the cumulative 10% rule I ran 6 miles on 11/9/2015 with no pain. With my ship date getting close, I thought I would try to be smart and use caution for once and take a week (11/16) off from running.

Upon resuming my running workouts on 11/23, I began to experience pain on mile 4 of 6, but had no choice except to finish. I figured the pain was a minor setback resulting from stupidity, but that I would be fine if I took the rest of the week off and stuck to short distance workouts until OSUT. Today, I was going to go conservative with a short 2 mile tempo run, but began to feel pain at the 1 mile turn-around point. The pain was minor, maybe a 2 or 3 of 10, but I knew it was the same injury and something was jacked up, so I immediately drove to the local urgent care once I made it back. My insurance dictates that I need a referral to see a specialist. Right now I have very little, if any, pain while walking, and if history is an indication, I should have absolutely no walking pain tomorrow.

As mentioned above, I have seen a doctor and will see a specialist on Wednesday. In the short inspection today, the doctor mentioned that my arches might be an ancillary cause as well. This is the first I have ever heard of this, so I will bring it up on Wednesday. My hope is that he is right and that a few weeks rest and better shoes might fix everything, but I realize hope is not a plan. Thus I came here to hopefully get some perspective or experiences. If that is not possible with the information provided, I will report back on Wednesday after my appointment to provide some more detail. Thank you for reading this far, I tried to keep it short while not omitting needed details. I realize there might not be much to add, (I saw the thread from someone hurt before AF BMT) but since I jumped the gun and mentioned this “situation” in my intro I figured clarification was needed.
 

LibraryLady

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Recognize also, that OSUT will not start running at the levels that you are accustomed to, rather, they begin at a beginners level and increase intensity.

Make sure your specialist knows what will be facing you in January as this can play a part in the recovery process.

LL
 

Diamondback 2/2

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What LL said is very true, you will start running around a track in formation slow as slow as slow gets.

If it was me, I would follow my doctors advice and I would lay off the intensity from now until OSUT. Not saying don't stay in shape, but give yourself plenty of time to heal.

Also, there are stretching and worm up exercises for your ankles, feet and toes that you can do before running. Google them, they have helped me immensely with reducing foot and ankle injuries that have plagued me since high school.
 

Lunch Pail

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@Red Flag 1 -Understood. I try to avoid taking pills as much as possible for that very reason.

@LibraryLady and @Diamondback 2/2- I appreciate the insight and had not thought of that. I will be sure to mention this to the Doctor tomorrow.

As far as staying in shape, I plan on swimming, cycling, and rowing to maintain as much as possible. It is not the same as running, but I have found some rowing workouts targeting your VO2 max that might be beneficial.

On the mobility end, I will Google what you said and also ask the Doc. I used to suck at all things mobility, but one of the first things I learned from this site was the importance of “Pre-Hab”. Since then, I try to either foam roll or static stretch 4-5 times a week at night, in addition to a thorough warm-up before workouts. I focus the most attention on calf flexibility and rolling the IT band, but have never done anything for feet.

I will report back tomorrow after my appointment.
 

Lunch Pail

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BLUF: Doc thinks I should be good to go for ship date, but not 100% yet. He believes I have a stress reaction in 5th metatarsal or near about. MRI to confirm is upcoming. He was much more open to the possibility of me leaving on time after I mentioned the 10 days of reception and progressive nature of the running at OSUT. Again, many thanks to @LibraryLady and @Diamondback 2/2 for that.


Update: I have been put in a walking boot, so looks like my hunting season is over. Doctor told me to study up on metatarsal stress reaction and Jones Fracture (Dez Bryant, Julio Jones, and Kevin Durant). No running, deadlifting, or squatting, but he did mention running in a pool with a buoyancy belt. Cycling and swimming are okay, although he was hesitant on rowing. Additionally, he advised against taking any anti-inflammatory as it might interfere with the healing process.

The first thing he tested for was pain during active foot eversion (symptom of peroneal tendon pain) but there was none. I forgot to ask for explicit confirmation, but it seems that the repetitive pounding on asphalt with bad footwear was the primary factor. Clearly I should have gone to see the Doc when this happened back in the summer, another lesson learned the hard way.

I have contacted my recruiter and am waiting for a response. I suspect there is currently too much ambiguity and they will need concrete dates for recovery and proof of healing before I can leave. With that said, I will be asking about the process to delay leaving. Through other sites, I have seen some 11x option 40’s leaving 1-2 weeks later, and I believe it would be prudent to see if that is a possible course of action. Most likely that is a pipe dream and not simply done, but I would gladly take an extra week or so of recovery. If not and I am cleared to leave on 1/5/2016, then FIDO.
 

Lunch Pail

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@x SF med Thank You. We don’t have an REI close to where I am in VA, but I checked out the Superfeet website and their store locator. Coincidentally, a running shoe store my sister’s boyfriend has been encouraging me to get my gait analyzed at carries them. I will go there to check out the insoles, although I will hold off on the gait analysis until a later date as a precaution for my foot.


After talking with my recruiter, he said there is a renegotiation process, but he has yet to go through it. I looked up USAREC Reg 601-96 to see what the process looks like, and will most likely not pursue unless required after the MRI.


In case this may be of help to someone now or in the future, here is a good video I found on YouTube regarding pool running with a buoyancy belt. It describes technique and how to target the different energy systems.
 

TLDR20

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Go to a fleet feet or something, and get your foot diagrammed, get shows that match your foot type.
 

Lunch Pail

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Go to a fleet feet or something, and get your foot diagrammed, get shows that match your foot type.


Will do. I looked at Fleet Feet’s fitting process and it is very similar, if not the exact same, to the place I mentioned above. There is a Fleet Feet store about an hour from my location, so I will use that as a backup. Both carry the Superfeet insoles.
 

Lunch Pail

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In keeping with Red Flag 1's request, I will continue to document my recovery process. This past week, I have experimented with different cross training methods and have developed a tentative plan to maintain fitness. Due to there being little to no impact stress, I plan to add more total training volume through stationary bike tabata intervals 3 days a week and swimming/aqua jogging workouts another 3 days. Depending on recovery, I might build up to multiple cycling tabata sessions in one day.

On Monday, I will experiment with aqua jogging for the first time. I was skeptical at first, but after some research it appears to be an extremely valid method of cross training used by many. In an attempt to help others in the future, below I will add some sources regarding stress reaction/fractures and an article with a 9 week plan regarding running with a buoyancy belt.

I have an MRI on Thursday (12/10) and meet again with the Doc Tuesday (12/15).



Bone stress injuries in runners – an overview for runners, parents and coaches - Physiokinetic

Pete Pfitzinger - Lab Reports - A Nine-Week Water Running Plan to Stay in Shape While Injured

Pete Pfitzinger - Lab Reports - Nine-Week Water Running Schedule
 

Lunch Pail

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Just finished meeting with the doctor. Nothing showed up on the MRI, but he thought that might be a possibility as the pain was minor. If I went when I should have during the summer when initially injured, he said there would have been a concrete diagnosis. I am cleared to start running, deadlifting, and squatting again. The next step is to send all the documentation up for a med-read, but I do not foresee any problems and hope to leave on time. My plan is to keep up the majority of the cross training I have been doing and slowly start running again. I mostly want to build up mileage, to get my foot back used to the stress, so I plan for the runs to be at an LSD pace, albeit at much shorter distances, starting at 1 mile.

An interesting note the doctor mentioned was that regardless of fat or muscle, the foot obviously just perceives added weight. I am still fairly skinny at 5’10”, 164 and plan on adding a decent amount of weight wherever I end up after training. He said that when adding weight you need to be cognizant of the added stress and adjust your mileage accordingly. Additionally, he said that once an individual gets beyond 20 miles per week there is a noted increase in the chances of injury.

As far as the pool running goes, I was not much of a fan. I can see the utility of it if someone is seriously injured and the other options give them pain. Tabata and other interval workouts with the bike and rower combined with 60min sessions on the elliptical seemed to do the trick for me.

Below, I will post a programming guide for rowing workouts put out by Concept 2 and another video on aqua jogging. The one I posted above does not give the complete picture. From my research it seems that there are 2 forms mainly used. The “high knee” form is for interval sessions and “cross-country” style is for longer endurance sessions.

All that being said, these are just my observations and worth exactly what was paid for it. Thanks to everybody for the help and advice, it was greatly appreciated.


http://www.concept2.com/files/pdf/us/training/Training_Guide.pdf

 

DocIllinois

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I'm glad to see you're taking steps to not just heal but ensure good performance of your feet and legs, Lunch, and did not self-doctor and treat.

Infantry Basic and AIT will include a lot of running and eventually some light rucking. Also, unless things have changed drastically at Sand Hill since the 90s, endless hours of Drill and Ceremony on hardball are part of the Basic curriculum.

You'll also be wearing basic issue Army boots which, although not the hard black leather of yesteryear, can still be less pliable and supportive than comfy civilian wear.

(This isn't even mentioning your Option 40 school. The running, rucking, buddy carrying, etc. there will be, ah, kicked up a notch or two. Get to know the difference between discomfort and genuine injury.;-))
 

Lunch Pail

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A couple updates and observations:

-Still no word on the med-read. Hopefully I will get news soon because I am supposed to leave next week.

- I went to our local running shoe store to get my foot sized. There is a lot more to it than I ever knew. The type of shoe they recommended for me was a “moderate stability shoe” which gives extra cushioning all around and also helps with mild over-pronation. Also bought some Superfeet insoles, the guy working with me recommended the green as well. It is expensive, but worth it in my opinion. For a pair of running shoes and insoles, it cost about $160 after a discount.

- I am now 100% certain the main factor in my injury was running shoes, stupidity, and ignorance. My left foot (the injured one) has always been larger than my right, so I have tried to buy shoes that feel okay on both feet. Turns out this is a bad idea. The shoes I was wearing when the injury occurred fit my right foot fine, but the outside of my left foot was hanging off the sole. This was discovered early in the day when I had not been walking much, so I am sure it was much worse after running 8+ miles. I could not feel anything different while running but the added stress of impact on the edge of the sole was hitting right at that 5th metatarsal where the stress reaction was. Odds are if I had not went to the running shoe store to get new shoes, I would have been re-injured, because the replacement pair I bought after the summer was just the newer version of the previous shoe, so the same problem existed. At the time I had thought those shoes were very comfortable and the best I had, but obviously I was wrong.

-The employee said when there is a size difference in your feet, you need to buy shoes for the bigger foot. My left foot is a ½ size larger than my right, so this left a lot of play in the heel. The guy showed me how to use the “heel lock” lacing technique and this fixed everything. I assume I will run into this problem when sized for boots at OSUT, so I looked around for similar techniques with boots. I found one for hiking boots and another that looks to be more relevant to the lacing style of boots given at OSUT.

-This morning I ran a diagnostic 2 mile so I know what my baseline is after the injury and before OSUT. I clocked in at 13:16 and was fresh going into it, so not a mock APFT. Not happy with it, but it is an acceptable starting point since I have not ran hard since the week of 11/9/2015. Before this 2nd bout with the injury, I was hanging right around a 13:00 2 mile, give or take a few seconds.

-I am not sure how fast the body loses running fitness, but I had about 6 weeks of no running with only a slight decrease in my 2 mile time. Much of the last 6 weeks was spent experimenting with different cross training regimens, but towards the end I believe I had finally settled into a routine that worked for me. Overall I would do 3-6 cross training workouts in a one week period. Within that week, I would do 1-2 tabata interval sessions on the stationary bike, 1-2 500m rowing interval sessions, and 1-2 45-60min sessions on the elliptical.

-In my limited experience and opinion that is worth exactly what you payed for, the tabata protocol has been bastardized by popular culture and is used with almost any exercise. If you look at the original study, there are only a select few modes of exercise that can get you to the required heart rate and % of VO2max. They used a cycle ergometer, but I did not have access to one, so I substituted with a stationary bike. I used the heaviest setting possible where I could maintain 120-130+ RPM on the work sessions: 4 min total, 8 sets. At the end of the attached study they give the guidelines of 20s exercise, 10s rest @ 170% VO2max. I could not estimate exactly but I used the, balls-to-the-wall; can-barely-see-straight-at-the-end method, and it seemed to work okay.

- For the 500m rowing intervals, I used the damper setting that allowed me to get the best/most consistent times. I performed them like I do 400m running intervals, where I find a decently challenging pace (or goal pace) on the first rep and try to maintain until the last rep where I try to beat that time. I have no idea what is good or not, but for me this turned out to be 28-30 strokes per min at a damper setting of 3. I typically turned in the 500m at 1:45. I got my idea from this, specifically workout 18. I started at 5 reps and increased as I went along.



Thanks again to everyone for the help and suggestions and hopefully this helps someone in the future.
 

DocIllinois

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It is expensive, but worth it in my opinion. For a pair of running shoes and insoles, it cost about $160 after a discount.

A good first lesson in the value of investing in good gear vs. cheap crap as a soldier, IMO.


Taking care of your feet in the manner you're discovering pays big dividends in the career track you're hoping for.

I make all of my guys carry a small 'foot care kit' in the field. Med tape, small scissor, foot powder, benzoin, , nail cutter, etc.

You'd be wise to do the same if you make it into the operational force. An ounce of preventive regimen is worth avoiding a pound of sadistic 68W treatment.
 
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