Is my injury just a permanent part of my life?

Triathlon Forum
1

A little context, I am a 43 year old man, last August I did my second full Ironman and last Fall focused on PR-ing my half marathon – which I accomplished.

Last December, I started to have pain in my heel that I thought was plantar fasciitis. It’s only in one foot, and that foot has had some mild discomfort while running in prior years(I suspect in my posterior tibial tendon based on discomfort location), but this flare up that started in December was much worse – very achy heel that genuinely hurt while running. After trying lots of “conservative” treatment for plantar fasciitis(stretching, icing, NSAIDs, PT), it seemed pretty clear I had to stop running for a while. I haven’t run since April. Since April, here is a list of the many things I’ve tried for my foot, in order.

Night splint
Dry needling on calves
Custom orthotics
Cortisone shot
LOTs of stretching and PT work
PRP Injection
Professional bike fit
Second round of custom orthotics

After nearly 8 months and all that “stuff”. The spot in my heel is really no better and I have started to have other problems in my foot and ankle. I had an MRI in late May and it revealed mild posterior tibial tendonitis, peroneal tendonitis, achilleas tendonitis(which surprised me as I have no discomfort there) and a mild soleus sprain. Nothing terribly significant, no major tears or anything like that. I think a lot of these issues came as a result of me compensating for the sore heel, especially after the extremely painful PRP injection. Just to eliminate it as a cause, I’ve also stopped cycling about 3 weeks ago.

But here I am, 3.5 months after the PRP injection, 8ish months since this really started, the tendons are somewhat improving with my newest pairs of orthotics, but now I’m dealing with a very painful, stiff big toe. I’m fairly certain the stiff big toe puts pressure on the bottom of my foot and aggravates my heel. But at this point, I don’t know what to do – several doctors have said they can’t do more for me and given me referrals to others(which I haven’t tried yet), and the work various PT’s have given me just seems to make everything flare up. Is it just time to accept I’m permanently injured and will never run again? No one has suggested that, but I don’t what else to do.

2

probably just were using the wrong shoes. i had that injury from drop shoes, took me forever to find the style that works for me is rocker type shoe

3

I had a similar issue a few years ago. I eventually found a PT who is a specialist in ankle/foot issues, and he correctly diagnosed it immediately. Turns out I lack flexibility in my subtalar joint, which I had never heard of prior to seeing this particular PT. The subtalar joint is the joint between the calcaneus and the small bone above it, and most people have 25-30 degrees of ROM if I remember correctly. I was somewhere around 10 degrees, and some simple strengthening and very intense stretching by the PT helped loosen it up pretty quickly. It’s not always perfect now, but he gave me some stretches that help if it gets tight or painful. Good luck, I know how frustrating it is!

4

See a neurologist to rule out Baxter’s neuritis.

5

Whatever it is for you I hope you find peace with it and find a healthy path forward. Working with sport specialists really helped me understand my personal injuries and how to most wisely invest my time for recovery and long term health.

I had a very serious injury a few years ago. The recovery was awful yet I made it through due to great doctors who told me bluntly what I could continue doing and at what cost. I gave up running even though I can still run. I gravitated to what I really loved in sport and re-invested my time elsewhere. My sporting experience time and time again has reinforced my belief that I need to ask for expert guidance instead of brute forcing my way into an outcome. Every time I did that alone I made things worse.

Also, sometimes in my journey just stepping away helped because I had time to heal.

6

A little context, I am a 43 year old man, last August I did my second full Ironman and last Fall focused on PR-ing my half marathon – which I accomplished.

Last December, I started to have pain in my heel that I thought was plantar fasciitis. It’s only in one foot, and that foot has had some mild discomfort while running in prior years(I suspect in my posterior tibial tendon based on discomfort location), but this flare up that started in December was much worse – very achy heel that genuinely hurt while running. After trying lots of “conservative” treatment for plantar fasciitis(stretching, icing, NSAIDs, PT), it seemed pretty clear I had to stop running for a while. I haven’t run since April. Since April, here is a list of the many things I’ve tried for my foot, in order.

Night splint
Dry needling on calves
Custom orthotics
Cortisone shot
LOTs of stretching and PT work
PRP Injection
Professional bike fit
Second round of custom orthotics

After nearly 8 months and all that “stuff”. The spot in my heel is really no better and I have started to have other problems in my foot and ankle. I had an MRI in late May and it revealed mild posterior tibial tendonitis, peroneal tendonitis, achilleas tendonitis(which surprised me as I have no discomfort there) and a mild soleus sprain. Nothing terribly significant, no major tears or anything like that. I think a lot of these issues came as a result of me compensating for the sore heel, especially after the extremely painful PRP injection. Just to eliminate it as a cause, I’ve also stopped cycling about 3 weeks ago.

But here I am, 3.5 months after the PRP injection, 8ish months since this really started, the tendons are somewhat improving with my newest pairs of orthotics, but now I’m dealing with a very painful, stiff big toe. I’m fairly certain the stiff big toe puts pressure on the bottom of my foot and aggravates my heel. But at this point, I don’t know what to do – several doctors have said they can’t do more for me and given me referrals to others(which I haven’t tried yet), and the work various PT’s have given me just seems to make everything flare up. Is it just time to accept I’m permanently injured and will never run again? No one has suggested that, but I don’t what else to do.

In your list of interventions, I didn’t see any tendon loading.
In my experience, tendonitis does not respond to stretching, icing, orthotics…etc. Tendonitis responds to the proper loading technique for that specific tendon.
Also, don’t let your soleus get too far gone, that’s a hard one to come back from. Bent knee raises will strengthen it.

Good luck

7

A little context, I am a 43 year old man, last August I did my second full Ironman and last Fall focused on PR-ing my half marathon – which I accomplished.

Last December, I started to have pain in my heel that I thought was plantar fasciitis. It’s only in one foot, and that foot has had some mild discomfort while running in prior years(I suspect in my posterior tibial tendon based on discomfort location), but this flare up that started in December was much worse – very achy heel that genuinely hurt while running. After trying lots of “conservative” treatment for plantar fasciitis(stretching, icing, NSAIDs, PT), it seemed pretty clear I had to stop running for a while. I haven’t run since April. Since April, here is a list of the many things I’ve tried for my foot, in order.

Night splint
Dry needling on calves
Custom orthotics
Cortisone shot
LOTs of stretching and PT work
PRP Injection
Professional bike fit
Second round of custom orthotics

After nearly 8 months and all that “stuff”. The spot in my heel is really no better and I have started to have other problems in my foot and ankle. I had an MRI in late May and it revealed mild posterior tibial tendonitis, peroneal tendonitis, achilleas tendonitis(which surprised me as I have no discomfort there) and a mild soleus sprain. Nothing terribly significant, no major tears or anything like that. I think a lot of these issues came as a result of me compensating for the sore heel, especially after the extremely painful PRP injection. Just to eliminate it as a cause, I’ve also stopped cycling about 3 weeks ago.

But here I am, 3.5 months after the PRP injection, 8ish months since this really started, the tendons are somewhat improving with my newest pairs of orthotics, but now I’m dealing with a very painful, stiff big toe. I’m fairly certain the stiff big toe puts pressure on the bottom of my foot and aggravates my heel. But at this point, I don’t know what to do – several doctors have said they can’t do more for me and given me referrals to others(which I haven’t tried yet), and the work various PT’s have given me just seems to make everything flare up. Is it just time to accept I’m permanently injured and will never run again? No one has suggested that, but I don’t what else to do.

In your list of interventions, I didn’t see any tendon loading.
In my experience, tendonitis does not respond to stretching, icing, orthotics…etc. Tendonitis responds to the proper loading technique for that specific tendon.
Also, don’t let your soleus get too far gone, that’s a hard one to come back from. Bent knee raises will strengthen it.

Good luck

My therapist didn’t specifically call it tendon loading, but some of the exercises are:
-Inversions with resistance band - rotating ankle both directions - this is the one routine that finally feels fine all the time.
-Eccentric heel dips, up onto my toes with 2 feet, slower lower on bad foot(trying to do single calf raises on a step or even flat ground greatly aggravates the plantar fasciitis
-Single leg balance - if I tilt too far forward, the big toe is extremely painful

Is this what you were referring to? If not, I can inquire to my PT on it…

They agreed on the stretching and generally have me avoid it. The tendon injuries are responding well to the inversions, but the big toe stiffness/soreness and the continued heel pain are the probem at the moment. Soleus healed up with rest. I can do the “bent knee runners stretch” with no pain in it.

8

Whatever it is for you I hope you find peace with it and find a healthy path forward. Working with sport specialists really helped me understand my personal injuries and how to most wisely invest my time for recovery and long term health.

I had a very serious injury a few years ago. The recovery was awful yet I made it through due to great doctors who told me bluntly what I could continue doing and at what cost. I gave up running even though I can still run. I gravitated to what I really loved in sport and re-invested my time elsewhere. My sporting experience time and time again has reinforced my belief that I need to ask for expert guidance instead of brute forcing my way into an outcome. Every time I did that alone I made things worse.

Also, sometimes in my journey just stepping away helped because I had time to heal.

Stepping away is where I’m at I think - everyting I try to do seems to just make things worse or cause new problems. I’m hoping an extended break allows some healing, but my fear is, not doing “the right” PT will mean I don’t ever actually heal up…

Thanks for your words though…

9

Mark,

First off, I’m sorry to hear about the frustrating year it’s been. A mental challenge I’m certain.

My take: Don’t throw in the towel.

Some thoughts…
-True plantar fasciitis can linger up to a year or longer in some cases, good research supports this.
-MRIs show structures, they don’t give us a clinical picture by themselves. So, the MRI “results” don’t matter unless you or your provider are contextualizing them to your symptoms. We all have areas with inflammation and tissue degradation.
-When things linger this long my experience is people get, understandably, desperate. I would encourage you to utilize a provider, existing or new, who comes at it with a proactive approach. For example, a plan that focuses on finding as much pain-free and enjoyable activity as possible. Think less corrective exercise or treatment and more successful/fulfilling exercise.

Best of luck. :slight_smile:

10

Mark,

First off, I’m sorry to hear about the frustrating year it’s been. A mental challenge I’m certain.

My take: Don’t throw in the towel.

Some thoughts…
-True plantar fasciitis can linger up to a year or longer in some cases, good research supports this.
-MRIs show structures, they don’t give us a clinical picture by themselves. So, the MRI “results” don’t matter unless you or your provider are contextualizing them to your symptoms. We all have areas with inflammation and tissue degradation.
-When things linger this long my experience is people get, understandably, desperate. I would encourage you to utilize a provider, existing or new, who comes at it with a proactive approach. For example, a plan that focuses on finding as much pain-free and enjoyable activity as possible. Think less corrective exercise or treatment and more successful/fulfilling exercise.

Best of luck. :slight_smile:

Thanks - I haven’t given up yet - still working with my PT, just on a somewhat reduced basis - just doing routines that don’t cause a lot of reactive pain afterward and hoping to add more things if things get better(and swimming and strength training are keeping me at least a little bit fit). That’s a right on about the feeling of desperation - though! The panicky feeling lately is almost worse then the foot pain(almost)…

11

Also, “corrective” exercise is hogwash. A treatment plan can be based on a thorough evaluation and biomechanical perspective, but anyone who actually sees patients knows much of what we call “corrective” is theory driven because there’s patients who it works for and patients who it doesn’t (e.g. you :)).

Reinforces the idea of addressing weaknesses and finding what you can do/enjoy around your pain….WITHOUT having to obsess if what you’re doing is as you said “right”. There is no “right” for many injuries.

12

If you haven’t tried nerve flossing/gliding you might look into it. I had a bout of heal pain a few years back that I spent months trying to figure out and flossing/gliding was the fix. Stupidly simple but made a big difference for me.

13

Have you had an x-ray done on that big toe?

Your story is very familiar. I had a stubborn case of plantar fasciitis which responded to none of the non-invasive treatments, but which finally resolved after a PRP injection (the MRI showed potentially a small tear). But after getting that sorted out I immediately became aware of a painful and stiff big toe joint. I was vaguely aware prior that it wasn’t flexing as well as the other joint but there was no pain and so I was happy to ignore it. However that lack of flexion may have contributed to the plantar fasciitis.

Long story short I had to give up running due to the pain and finally got diagnosed with arthritis in the joint. I had a big toe fusion late last year. There’s a separate thread here in the forum, if you’d interested, where I recount my fusion adventures.

The thing with arthritis in the toe joint is that physios and podiatrists really don’t know what to do with it. I bounced around between them plus a sports doc with no real solution offered until I finally went to my GP and got a referral to a surgeon (I had figured by then that a fusion was the next best option). The physio simply tried giving me exercises to mobilise the joint, the podiatrist just tried to put me in orthotics to prevent the joint moving and the sports doc just wanted to sell me a PRP injection. So I really had to do my own research on this and persist with it.

Good luck, and I hope you find the cause of your particular problem.

14

I’ve had a few ankle surgeries, because of tendon damages. Before the surgeries, I’d never had a problem with PF in my life. After the last surgery, actually several months down the road once I started running again, I developed PF. Same as you, I tried all kinds of different treatment options. For me, it came down to my calves still being very weak. I spent a lot of time working on calf strength and single leg balance exercises (the wobble board has been good for this as it forces me to to use my entire leg, from the hips all the way down to the little muscles/tendons in my leg/ankle). PF is very frustrating

My wife had to have surgery for her PF, and she’s glad she did.

15

Sorry to hear you’re going through all of that. I think pretty much all of us if we stick with it long enough encounter an injury that seems intractable and hopeless. I’ve definitely been there.

There were two separate injuries separated by years, both involving feet/lower legs where just finally seeing the right person was the key. The first was Achilles tendinitis that would not improve no matter what I did. Hadn’t run on it in months and was just doing super easy cycling, but even that was flaring it up. Finally ended up seeing a running specialist PT in Boulder who found an old tear in my soleus. He massaged out the scar tissue and I was basically all healed right there on the spot. He just asked for one follow up appointment a week later to do a little more massage work to ensure the scar tissue was gone/healed but I went right back into running and cycling without restriction from that point on.

The second instance was pain in the ball of my foot behind my big toe. Again even though it was caused by running, cycling was aggravating it too. I hadn’t run in months and thought I was done as a triathlete. I was desperate enough to drive 4-5 hours to Marin County to see a highly recommended Podiatrist who typically has a waiting list of several months. After examining my feet and closely watching me walk, he diagnosed me with sesamoiditis, but the kind that was caused not by impact but by insufficient arch support, hence why cycling was an aggravating factor. He took my inserts and bolstered them there on the spot and also made custom orthotics. But again I was able to start running right away without restrictions.

Sounds like you’ve seen several people, and maybe they are excellent, but it doesn’t hurt to seek a 2nd/3rd opinion, get fresh eyes on it from someone who specializes in running injuries (both people I saw specialized in running injuries and were runners themselves).

By the way I’m 43 as well, 44 in less than a month. As a tall medium framed guy (6’5, just under 200 lbs) my running limit is now way lower than it used to be. I can stay healthy and do well at sprint tris on 10-15 miles/week. It’s not ideal maybe, but on the plus side I have more energy and time to put into swimming, cycling, and core/strength work. So in the final analysis with give and take it comes out close to even. Not saying you can’t get back into Ironmans when (not if) you get healthy, but there are certainly avenues within triathlon and multisport where you can get fulfillment while adjusting to limitations as you get older.

16

look at Dr. Lisa DPT on instagram - she does a lot of foot stability stuff that might help and is very into big toes.

the person who commented about loading tendons is spot on

I’ve also been out for a long time - since Dec - with injuries I can’t seem to heal, so I very much feel your pain.

keep us updated as to how you are, ok?