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Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE
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As is the case with most of us who have been doing endurance sports for any length of time, the occasional injury rears it's ugly head. Seems like every other year for me. The current one has been ongoing since about August. In the past, I've had long-lasting ones that eventually resolved with little or no action on my part. This one bugs me. I was still able to do 2 50Ks, a 50-miler and a trail marathon since having this as well as two half IMs and one full IM.

Background:
No specific traumatic injury...just gradually appeared. I do run quite a bit (25-60 mpw depending on upcoming races) as I do several ultras per year.

Symptoms:
Pain that feels like my toe is dislocating or broken at the spot I'm pointing to with the pen in this pic:


I start out on a run not really feeling it (I run in Hoka Bondi 3s and Altra Olympus and haven't changed shoes for years). After about an hour of running, I start to feel mild pain in that spot (deep in the joint) and then "bam"...a sudden pain that feels like my big toe has dislocated at the joint. I stop running (because it hurts too much to run), and reach down and push really hard with my thumb on that spot and massage it for 10 seconds and then I can run again for another 1/4 mile before that sharp pain hits again.

On some runs, that sharp pain doesn't come, but I do have a general ache of that spot after the run, and I have to walk somewhat gingerly on that foot almost all the time now to avoid lots of pain.

Oddly, in the 50-miler, I had the sharp pain around 1/3 of the way into the race and then zero pain in this area for not only the rest of the race, but the next two weeks after...almost as if I'd "popped it back into joint".

How I've treated it:
I have bought super-stiff carbon inserts for my "walk around" shoes that seem to help, but don't eliminate this dull ache.

I have put my old orthotics from an old foot issue I had inside my running shoes that offloads the first met and that helps a bit with staving off the sharp dislocation pain feeling until later in the long run.

My theories:
Pre-dislocation syndrome?
Neuroma?
Hallux Rigidus?

I guess my next move is going to the podiatrist, but I wanted to throw this up here in case any of you in the know might have some theories. I find myself avoiding jumping on the trampoline with my son to avoid the pain, and thinking twice about my next ultra to avoid injuring further. I want to get this resolved. Anyone?

Thanks in advance...

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My business-eBodyboarding.com
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [TriBodyboarder] [ In reply to ]
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Yep, time to see a doctor

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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [TriBodyboarder] [ In reply to ]
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I highly recommend Dr. Ed Chin in Irvine. He is a podiatrist and athlete. Really understands endurance athletes and their issues. He is currently treating my wife for a broken foot.
949-450-0200.

Gary Mc
Did I mention I did Kona
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [TriBodyboarder] [ In reply to ]
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You likely have hallux rigidus.

On X-ray, you will see the osteoarthritis of the joint that is typically worse on the dorsolateral aspect of the joint. The occasional sharp pain can be from a "joint mouse" that gets impinged in the joint/top of the capsule.

The stiff plate/orthotics help because they limit dorsiflexion of the joint.

Time to see someone now. Won't go away, but there are lots of treatment options. Make sure whoever you see knows of your athletic endeavors since the surgical options (if applicable) vary a lot.

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [rroof] [ In reply to ]
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Thanks Rod. Ugh...here we go again!

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My business-eBodyboarding.com
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [Gary Mc] [ In reply to ]
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Thanks Gary. Have to see if he accepts my insurance...

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My business-eBodyboarding.com
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [TriBodyboarder] [ In reply to ]
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Maybe too much time with your feet in fins over the years...:-)

But seriously, good luck getting it sorted out, Jay.



"Honestly, triathlon is a pussified version of duathlon on that final run."- Desert Dude

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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [teekona] [ In reply to ]
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Yes, the fins didn't help, I'm sure!

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My business-eBodyboarding.com
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [rroof] [ In reply to ]
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Rod, I finally went to the podiatrist and his diagnosis? Hallux Limitus. He wanted to give me a cortisone shot, but I declined. So, he gave me some cream to rub on the toe knuckle which I used once. I'm able to manage the pain for now with some old orthotics that offload the first met. Here's a printout of the films. What's your professional opinion?


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My business-eBodyboarding.com
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [TriBodyboarder] [ In reply to ]
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Yup - as expected. Prefer a weight bearing lateral view though as more information is gleaned from that view then the AP. Hallux limitus/rigidus pretty common. It is the symptoms that matter and unfortunately, it is generally progressive as well (especially in a runner).

Not much of a fan of topicals, but no side effects if helpful. Best is to limit motion of the joint and an "orthotic" can help. If you can tolerate, you want one with with a Morton's extension like this.

http://www.grtconline.org/content/view/1054/9/


http://www.myfootshop.com/turf-toe-plates-carbon-graphite-molded





____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [rroof] [ In reply to ]
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Rod, thanks for the links! Here's the other view:



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My business-eBodyboarding.com
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [TriBodyboarder] [ In reply to ]
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Little rough on the quality ;-) but mechanically otherwise good. Just OA of the great to joint. That dorsal osteophyte you see will slowly enlarge, so make sure you have a deep/wider toebox to accommodate. Easier for me then women and easier still for you CA types that can live in a stiff sandal more (i.e. Birkenstock)

____________________________________
Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD
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Re: Calling all podiatrists, RRoof, and assorted foot fetishists- INJURY ADVICE [rroof] [ In reply to ]
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Ha, ha. Birkenstocks? I better grow a beard and get my hipster on! I wear Crocs sandals. Love 'em!
My running shoes have switched from Hoka Bondis to Altra Olympus, so AMPLE toe box room. We'll see how long this takes to progress, and yes, I do see that bone spur on the top. If I ever progress to needing surgery, I might have to invest in a plane ticket to Ohio. :(
Thanks for the advice Rod!

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My business-eBodyboarding.com
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