My Achilles Heel: Transitioning & Balancing

I went to the doctor today for a four-week followup in the wake of being diagnosed with a calcaneal contusion and stress fracture in my left foot. It was caused by poor training choices while preparing for a 5K race. It's been more than six weeks since I began feeling pain.

I didn't actually see my doctor. He was out of town to support a U.S. Men's Volleyball tournament in Denver. I saw his associate, a very nice gal who also specializes in sports medicine.

After getting caught up on my condition and how my ankle is feeling, she recommended that I begin water physical therapy. It will be for the purposes of building up my leg muscles again while my heel finishes its recovery. If my insurance won't pay for that, I'll do "regular" PT.

As far as weight bearing and using the boot, she feels I should be in the mode of "weight bearing as tolerated." That means that if it hurts to walk on it, don't. She didn't give me any hard and fast numbers of how many more weeks to stay off of it or wear the boot. I should gauge for myself what I think is best. She did mention, however, that she'd like to see me walking around some at home "in a shoe."


Pain is the real guide here. She doesn't want to order any images if it seems like pain is slowly going away; on the flip side I shouldn't do anything that causes a lot of pain. She did share that most of the pain I've felt likely came from the contusion in the heel and not necessarily the fracture itself. The fracture is likely healing, but the contusion will take a long time to fully go away.

Because of that and all the walking I do with my job, she feels that wearing more of a "walking shoe" or cushioned shoe at work from now on would be best. She understands my preference for minimal footwear, and I understand her points, so it may be that I'll wear the insoles that came with my Terra Plana VivoBarefoot shoes and maybe even an additional cushioned heel cup for a while. Split the difference, in other words.

So we'll play it by...er, foot, and see what happens. I'm looking forward to PT, because that tells me I'm on my way back to an active lifestyle and running. I have another followup with my regular doctor again in two weeks. We'll see what happens between now and then. As always, I'll keep you posted.

I welcome your comments below. Have you ever dealt with a foot injury? I'd be interested to hear your experience in the comments section, too.

My Achilles Heel: Three-Week Update & Vitamin D Information

Here's a quick update on what's been going on with my barefooting lately. It's been non-existent. It's now been three weeks since I was officially diagnosed with a stress fracture and bone contusion in my left heel and just over five weeks since I started noticing pain. The injury occurred as a result of poor training decisions while preparing for a 5K race.

Since the diagnosis I've been faithfully wearing my soft cast boot about 23 hours per day -- the one hour being the time from when I wake up in the morning to when I put it on right before leaving for work. By restricting the motion of the foot and ankle, it's given my heel an opportunity to heal without the achilles tendon pulling on it. That was part of the issue that led to the stress fracture in the first place. The boot's not been a terrible thing. I've gotten used to my ankle and foot being immobilized and I even tweeted a while back that it no longer feels like the boot is on my leg, but instead a part of my leg. I have noticed some atrophy in my calf. Hopefully that won't take a long time to build back up after this is all said and done.

Because of the nature and location of the injury, I've also been non-weight-bearing for most of that three weeks. I have a job that requires a lot of walking, so I've been using a combination of crutches and a wheelchair (pictured) to get around. The wheelchair is used only at work for longer distances (like from building to building) and the crutches are for everywhere else, including shorter treks or spaces in which a wheelchair's not feasible. At first using these devices was a pain, literally. My arms HURT from using them. Now, my arms are much stronger and I come away from each workday simply tired. I'm also finding that I can eat darned near anything I want because I burn most of it off pushing or crutching myself around all day.

My heel doesn't generally hurt like it used to. A lot of that can be attributed to the fact that I have been non-weight-bearing most of the time and the boot is usually immobilizing my ankle joint. I do find that, by the time I'm finished getting ready in the morning, my heel does ache a bit. I hope that it's healing well and that the aching is from the bone contusion that went along with the stress fracture.

I have a follow-up with my doctor next Friday, Feb. 26. It may be that he'll determine that non-weight-bearing for four weeks is enough and I should stick with the boot. Maybe he'll clear me altogether and put me in PT. I kind of hope that's not the case, because I keep hearing that stress fractures of the heel take six to eight weeks to fully recover. I don't want to do anything to jeopardize my recovery and delay my return to running. I guess we'll have to see.

As a side note, but on somewhat related subject, I've begun taking Vitamin D supplements. I've been hearing a lot lately from work and Twitter friends about Vitamin D's relation to bone health. What I've found out is that most people are Vitamin D deficient and that such a deficit can cause bones to be weakened and more susceptible to stress fractures.

I've begun taking 4,000 IU of a Vitamin D3 supplement each day to help boost my levels and then plan on cutting back to about 2,000 IU a day as recommended by a well-known Vitamin D researcher named Michael Holick, PhD, MD (pictured). He recently presented a Grand Rounds on Vitamin D at my workplace and shared a lot of interesting information. To put it simply, he recommends that EVERY adult take a 1,000-2,000 IU supplement of Vitamin D every day to offset the amounts we no longer get from regular sun exposure. More information is available at his Web site, VitaminDHealth.org.

So I'll be non-weight-bearing with the cast boot for another week. I'm hanging in there with only a little pain, but I'm doing what I can to make sure this never happens again by taking a Vitamin D supplement. We'll see what happens.

I welcome your comments below. Also, if you haven't found me on Twitter, I'm a regular user there at the username "BarefootMichael." Come say hi! FYI, my last few "tweets" are always listed in the right panel of this blog.

My Achilles Heel: The First Stressful Week

I thought I'd post a brief update about how things have shaken out regarding the stress fracture in my left heel.

I'll be honest, it's been confusing. My doctor originally said I should wear a cast boot (similar to the one pictured below) and my heel would heal in about four weeks. He said I could still walk on it but try to reduce how much walking I do each day. So for a couple of days following my diagnosis I wore a boot and walked on my heel like normal. This ended up causing continued pain in my heel due the cumulative effect of pressure on my foot.

With further research, I found that his recommendations seemed quite liberal compared to how many other doctors treat stress fractures. A standard treatment for an ailment like mine has usually been a cast boot and no weight bearing for at least a few weeks, with the total treatment time being six to eight weeks. Some outlets have even said that just walking on a stress fracture can cause more damage up to and including the need for surgery.

So I had a number of concerns.

First, it seemed like walking on a painful heel was a bad idea. It wasn't so much a problem for very short periods or distances (i.e. from one room to the other), but being on my feet for any length of time was painful. So I questioned my doc again whether I should even be bearing weight on my foot.

Second, walking with pain was compounded by the fact that my job is tied to walking a lot. Just to give you an idea, wearing a pedometer last year showed that I walk an average of 11,000 steps a day at work. That ends up being a little more than 5 miles each and every work day or a near-marathon length 26 miles a week. What's more, all that walking ends up being long distances in chunks spanning almost 1/4 mile one way to get from my office to another location in my workplace. I asked the doc if there was any way to help with getting from place to place during the day.

My doctor decided that I probably should be non-weight bearing if my heel continues hurting. As for how to get around, he said crutches or a wheelchair would work. I asked if an electric mobility scooter could be a viable option. He agreed it would but thought it would be cost prohibitive.

I have researched the possibility of getting a mobility scooter but have run into some bumps along the road. It seems as though insurance won't cover the rental of such things. My insurance also wouldn't pay for purchasing one as my condition is not a life-long or long-term disability. So it seems like the only options I have left are to either use some of the funds we've set aside in our Flexible Spending Account (you know, that "cafeteria plan" you can put tax-free money into at work to pay for medical expenses) or pay out of pocket. The FSA would be a good option, but we've already designated those funds to pay for outstanding bills from our baby's birth in August and other expenses. Paying out of pocket isn't a very good option because we don't really have money available to do that.

So right now I'm using a combination of crutches and a manual wheelchair (pictured), both which have been borrowed from friends who have no immediate need for them. They work out okay, but traversing the long distances has proven exhausting.

So my arms are tired and, quite honestly, my spirit is too.

It's bad enough not being able to go barefoot AT ALL for a couple of months (though I cheat at bedtime and when I shower each morning), but to have such limited mobility when my job is so reliant on me walking around? That really sucks, I won't lie.

But, I know I'll come out of this stronger and better for it. I already have a new appreciation for those that must always use crutches or wheelchairs. Maybe, just maybe, I'll also get some pretty hearty biceps, too?

I guess tickets to the gun show go on sale in six to eight weeks.

I welcome your comments below.

My Achilles Heel: Stressed. Out.

I'll try to keep this brief.

I'm reminded of a movie quote, though I can't remember who said it in what film. It goes, "I hate it when I'm right." Everything I wrote in the previous post came to pass. I DO have a stress fracture in my heel and I won't be running the 5K on Sunday. So...

An MRI image of my heel. The yellow arrow is pointing to the primary fracture, but the white area around it also indicates weakening of the bone. My heel should look evenly dark like the other bones displayed.

I honestly don't know how this would have happened. As a barefoot runner, I use a forefoot strike which should completely eliminate stressful forces on the heel. I can only surmise that all of the walking I do at work in minimalist (read: uncushioned) shoes plus the forces of my achilles pulling on my heel while running weakened my heel bone enough to cause this fracture.

So I'll be doing no load-bearing exercise for the next four weeks. That means no running. I also will wear a boot, at least to work, in order to allow my heel to heal. That, along with a note saying I should "limit the amount of walking (I do) throughout the day," will probably be enough to allow this problem to fix itself. I'm going to pursue using a motorized scooter of some sort at work so that the long walks to the other end of the facility are a lot shorter and less strenuous on the feet. My employer needs to accommodate my injury, so we'll see what our Occupational Health department has to say.

The doctor doesn't seem overly concerned about me wearing the boot all of the time. He believes the problem should resolve itself so long as I don't run and wear the boot at work. I take that to mean that generally avoiding strenuous activity or heavy use of the foot should be enough. I think I'll probably still try to go barefoot around the house. I often walk with a forefoot strike and gently touch my heels to the ground when barefoot, so that should be okay. I'll also sleep barefoot.

So, thus begins four weeks of taking it easy on the feet even if I still try to get workouts in. I want to try to find alternate ways to do cardio. The good doctor recommended a stationary bike or swimming as good non-load-bearing exercises. I'm sure our city's community center has inexpensive memberships available to use their gym, so that sounds like a good option for the bike. A local middle school has an indoor swimming pool, so I'll investigate what usage costs there are. I can always also do core exercises as they don't require significant forces on the heels.

In a way, I'm kind of glad that this happened now. If I'd gotten a stress fracture right in the middle of the spring-through-autumn months, that would have really given a hit to my barefooting. This way I'll be able to heal up, get reconditioned and go enjoy a number of runs this summer AND do them all barefoot. Sounds like a plan.

Thanks for reading. I welcome your comments below.

My Achilles Heel: A Quacked Calcaneus?

Interesting things have occurred since last I spoke to you about my ankle. You might recall from my Jan. 22 post that I was diagnosed with Achilles Tendinitis. I wore a cast boot, did heat therapy and took an anti-inflammatory drug for a week in the hopes that it would clear up. If I did, in fact, have Achilles Tendinitis, I believe that it cleared up.

But there's still pain in my ankle that has lingered. More specifically, when you squeeze in particular spots on the sides of my heel it triggers hearty amounts of pain. Now, the X-ray I'd gotten didn't show anything, so my sports medicine doctor wisely decided to send me for an MRI. Magnetic resonance imaging, in case you don't know, is a very sensitive series of pictures of the body's internals. It can show many things that X-rays can't, like the condition I now think I probably have. He wanted to see what exactly is going on in there, but didn't make any assertions as to what the problem really could be.

One thing he DID do, however, is clear me to run in the 5K I'd been planning on for this Sunday. He said, "It's only a 5K. It's not like you're running a marathon. Go for it." Now, while that might seem insulting to some readers, I took no offense and realized that he meant that the relatively-short 3.1 mile race could do very little extra harm to my heel/ankle.

So I left his office with just as many questions as answers. What would the MRI show? What if the MRI showed something bad enough that I really CAN'T run the 5K? If the issue isn't Achilles Tendinitis, what could it possibly be?

After getting the MRI done last night, being given a CD of the images and surfing the interwebs for pictures of heels and MRIs, I've used my junior radiologist deduction techniques to make a prediction of what is wrong with my ankle. It's all I can do until the radiologist gives his/her report to my doc. So I can't be sure until 8 a.m. tomorrow morning when I have a followup, but a guy can still make an educated guess, can't he?

And boy, what an educated guess this is. I'd like to think I'm a smart guy. I am kind of "techie" by trade and actually work in a hospital, so I am sure of two things about reading medical imaging: 1) MRIs are REALLY cool and really detailed in what they show & 2) Medical films are REALLY hard to read. That said...

Based on my continuing symptoms and MRI, I think it is highly likely that I have a stress fracture in my calcaneus (heel) bone. After looking at the MRI images of my ankle/heel and comparing them to images readily available via a simple Google image search, I believe there are striking similarities between them. Check it out below. On the left you see an image I found on the Radsource Web site. It shows an T2-weighted MRI of a calcaneus with a stress fracture (indicated by the white arrow). On the right, I have displayed an almost exact T2-weighted image of my calcaneus with what I believe is a stress fracture (indicated by the yellow arrow).

(Click image for larger version)

There's other evidence in my set of MRI images that lead me to believe I have a stress fracture, but the similarities between the two indicated parts of the images above cannot be ignored. Heck, the dark line in my heel (on the right) even curves in a very similar way to the fracture in the left photo.

So, where does that leave me? It leaves me waiting to see my doctor tomorrow morning to find out what's REALLY going on. I also have to wonder what kind of treatment and limitations I might have in the near future. Most articles about calcaneal stress fractures indicate that a standard treatment is a lot of rest for up to 8 weeks. That may even include a cast and no weight bearing for that period.

If I do have a stress fracture and I have to wear some kind of cast or cast boot, I'd need to work with my doc to see if it'd be acceptable to do some walking in order to fulfill my job responsibilities. As someone who typically walks about 11,000 steps a day at work -- and who only has about 1 1/2 weeks of sick time accrued -- I would really need to find workarounds so I can heal but still work. I've thought about proposing using a rented scooter to motor around my workplace and then park it when I get to whatever room I need to work in. When finished at a particular location, I could scoot away to somewhere else. Minimal walking while the job still gets done. It's worth a shot.

And the 5K? Well, if I really do have a stress fracture I doubt the good doctor would still be okay with me running it. After all, it might have been running that caused the problem in the first place.

But hey, I suppose there's a possibility that I don't have a stress fracture. Maybe, even though the MRI looks ridiculously similar to other confirmed cases of stress fracture AND the fact that I have symptoms that are completely consistent with said condition, I don't actually have it. We'll see. But as I've told my wife and a few others today, "If it walks like a duck and it quacks like a duck...it's probably a stress fracture." Wait, what?

I'm planning an update to the blog tomorrow with the final news. To stay remotely on point with this blog, however, I will finish by saying that I have a feeling this is going to negatively affect my barefooting mojo...again. Hopefully, I'll be all better by the time warm weather comes around and it's prime barefooting season. I guess we'll see.

I welcome your comments below.

Detective image: http://mohsinali.name/wp-content/uploads/2009/02/detective.jpg
Scooter image: http://electricwheelchair-electricscooter.com

My Achilles Heel: These Boots Weren't Made for Barefooters

Well, it's now been just over a week since I initially hurt my ankle.I went to a sports medicine doctor two days ago and was diagnosed with Achilles Tendonitis. Since then I've been wearing a cast boot, taking an anti-inflammatory, doing heat therapy and trying to rest as much as possible.

This Wednesday I go for a one-week followup to see how things have progressed and find out if I'll be able to run the 5K on January 31 that I've been training for. I'm hoping that he'll give me the go ahead and I can use kinesio tape such as KT Tape to support my achilles during the run.

So how is my achilles right now?

As of this morning my ankle doesn't feel much better at all, actually. It doesn't hurt while I'm wearing the boot, however any time I walk without it on, my ankle starts hurting in exactly the same way it has been. It also continues to be just as swollen even after two days of the (strong) anti-inflammatory drug.

Injuring my achilles has turned my barefooted world upside down!

My barefooted "spirits" are down, too. For a guy who normally always wants to go barefooted or wear only minimalist shoes, wearing a cast boot and regular boot (to offset the height difference of the thick sole) is almost like a prison sentence; punishment for my wrongdoing of overtraining for the 5K. Sigh.

What this does do is reinforce my feelings about going barefooted. I'd been unshod or minimalist for so long that going back to such restrictive footwear -- even in the form of a "regular" boot -- is a good reminder of how truly comfortable and unrestrictive bare feet really can be.

Honestly, I've really wanted to rip this stuff off of me. Last night, while at a youth event that I'm helping support for my church, I cam so close to getting my elastic wrap, ditching the boots, wrapping my achilles and going essentially barefooted the rest of the night. But alas, I knew that wouldn't be best. I've got to fight the good fight and be patient for my achilles to heal and me to be able to return to walking, running and living barefooted.

So we'll see what happens. If there's any more news I'll share it here, Twitter, Facebook, blah, blah, blah.

Injured Achilles/Ankle and Upcoming 5K

I've decided to pursue medical attention for my left ankle ahead of my scheduled 5K on Jan. 31. If the doc says to not run the race, I won't.

I hurt my ankle last week on what ended up being a pretty good run. Afterward it started hurting from what I thought was pressure caused by my Vibram Fivefinger shoes, and I took a couple days off. The big mistake was to go out and run again on Saturday and push myself too hard while still in pain.

At this point I'm almost totally certain that I have, at a minimum, achilles tendinitis in my ankle from overuse/overtraining. I'm beginning to wonder if the persistent swelling and pain is an indication that I could have a partial achilles tear as well.

It KILLS me to potentially give up racing my first 5K on Jan. 31, but it's appropriate for a medical pro to look further into the problem and determine whether or not my ankle will be able to tolerate it. Better to take it easy and recover than potentially make it worse.

If you're a person of faith, please keep me in your prayers, thanks.