A chain of events in the foot – plantar fascia rupture, stress fracture, tibialis posterior and spring ligament injury

In mid-May 2014 and I was returning to running from a fairly minor injury with unfortunate timing that had forced me to withdraw from the London Marathon. My legs felt strangely fresh and injury free after four weeks off and I launched back into training with gusto. By the end of the month I was running 100km a week and feeling strong. I continued with this mileage until the end of July when I went on a running camp/holiday to the French Alps.

By this time I had entered the famous CCC 100km race at the end of August, starting in Courmayeur (Italy) and ending in Chamonix (France). My plan was to spend the five days in July as course reconnaissance and altitude training so I really want to make it count. Rather than taking it easy to adjust to the altitude and the size of the terrain I pushed very hard on every run, naively following the phrase ‘go big or go home.’

On the third morning when I woke up and put my foot on the floor my heel felt bruised and as if I had trodden on a sharp stone, my calf muscles were also tight from the endless uphills. Before long the soreness had largely subsided and I got on with training for the day. I did a very hard run taking in the Col du Bonhomme, where I was very pleased to unexpectedly be informed by Strava that I’d beaten Kilian Jornet’s time up it!

(https://www.strava.com/segments/7462840?filter=overall)

Again the next morning the pain was back and this pattern continued when I returned home for at least a week before becoming continuous pain when weight bearing. I knew then that I’d missed a chance to listen to my body, take a short break and return without a problem. With the race only weeks away I tried to continue running but it was not a pleasant experience at all. The only mild relief seemed to come from massively overloading the plantar fascia by standing in a doorway with my hands braced against the top and pushing up in a heel raise as hard as I could with the injured leg. I later learnt that instead of stretching it into recovery this was only serving to stress it even more.

The weekend before the CCC I had a weekend long military selection course. I wasn’t too worried about this though as I knew I was more than fit enough to get by. The final morning was a timed solo 1.5-mile run and by this stage the training staff knew that I was a good runner and applied some pressure for me to break their ‘record’ of 07:20. I knew that I was capable of a sub-7 minute time if my foot pain didn’t slow me down so I took off on the run very fast, determined to impress. Within 300m a massive and sudden sharp pain shot through my heel, it was agony. I knew I’d ruptured my plantar fascia. I continued the run as fast as I could with a very strange gait, managing to finish in 07:50 much to my embarrassment. I grimaced through the rest of the day and collapsed on the train home. By this stage my heel had swollen and it was incredibly tender. I knew that my CCC dreams were over and I was gutted.

Later in the week I went to my local GP and physiotherapist who concluded that I simply had plantar fasciitis and to rest from running, which I knew was bullshit. Within three weeks the pain had largely subsided and I started running slowly again but I could feel that my foot was biomechanically very different, with little ‘spring’ in my step. I persevered, thinking that perhaps I just needed time to adapt, but within a week of running I had a lot of localised pain around my third metatarsal. This time I went to see an orthopaedic specialist who, understanding my seriousness about running, referred me for an x-ray and a CT scan. This concluded that I now had a stress fracture of my third metatarsal. I was placed in a ‘Beckham boot’ for 6 weeks, and after some time told I could return to running VERY CAUTIOUSLY. Of course, I took this to mean SMASH IT but never took my weekly mileage beyond 60km, which I thought was cautious enough! By early 2015 I’d started getting pain in the arch of my foot but ignored it as I had big plans for the season to avenge my CCC withdrawal. I ran in The Grizzly in early March, a tough 20 mile multi-terrain race, coming 2nd out of 1,500 people. I was really pleased with this but my foot hurt so much afterwards. I went back to the orthopaedic specialist and was referred for an MRI. The results found that I had indeed ruptured my plantar fascia the previous summer, and that it now appeared my spring ligament and tibialis posterior tendon were damaged too. A HATRICK OF INJURY! With some stern advice that I now had the foot of an 80 year old I finally backed off running.

For summer 2015 I concentrated more on cycling and swimming, which didn’t inflict any pain. I had regular Extracorporeal Shockwave Therapy to attempt to aid the healing of the spring ligament and post tib tendon, and started wearing Formthotics insoles.

 

Having many months of no running to reflect on what I’d done wrong, I conclude the following:

  • If I’d taken a more moderate approach in my original return to running I probably never would have started this chain of events
  • If you go on training holidays, don’t feel you have to cram as much in to them as possible
  • Listen to your body as soon as it starts complaining, not later!
  • Your feet are really important, look after them
  • Keep your calf muscles loose when you start getting plantar fasciitis
  • Avoid loading the plantar fascia by stretching it too much when in the acute phase of injury
  • Tendon, ligaments, muscles and fascia do not operate in isolation; injuring one increases the chances of injuring others if not properly managed
  • Many GP’s and physiotherapists simply are not used to seeing athletes. They simply didn’t believe that I could have ruptured my plantar fascia while ‘just running’
  • Increasing mileage often doesn’t make you any faster at running, it just injures you more quickly
  • TRAIN TO RACE, DON’T RACE TO TRAIN – e.g. if your goal was to run a sub 40 minute 10k, work on all the components that will lead to this, don’t just try to smash 10k pb’s for training. (And don’t try and beat Kilian Jornet in training either!)

 

I’m now back to running a bit but doubt I will ever be able to exceed 50km per week without risk of further problems. My injured foot has a slightly different appearance to the other, with a fallen arch (although not completely collapsed). Right now I’m just happy to run at all and it’s made me enjoy it even more.

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