The Frustrations of Medical Care (and My Body) (Day 5)

Last spring, a newly-found problem in my right foot prevented me from running a marathon. It started after an 18 mile training run, went away, and eventually came back on runs over 5 miles. Then I couldn't even run 4 miles without pain. I attempted my 20 mile run and by mile 14 it was so bad I could barely walk.

First I went to a PCP at my medical group with a focus on sports medicine. Extensor tendonitis, likely, he said. Ice it. It will get better.

Then I went to the physical therapist who helped me with my sprained ankle. She fit me in before the marathon and I wanted to see if she could do anything for me. She suggested I see a podiatrist. Also suggested that maybe half-marathons were enough to me; she herself had never been able to run a full because her body seemed not to handle it.

I went to an in-network podiatrist to whom I was referred by my medical group. She listed to me for about half a sentence, then informed me that I had hallux limitus and send me for x-rays. On my second visit with x-rays, she confirmed that yes, I did have hallux limitus, basically arthritis of the big toe joint. She recommended a shoe store to get me set up with over-the-counter insoles and suggested I might want orthotics. Also noted that eventually I would decide whether running was good for me or not.

The first run with the insoles I was fine, and I grew excited. But on the next run, the pain came back. My body worker suggested maybe I should go see a podiatrist (out-of-network) who specializes in sports injuries. I had heard of him before as he gives clinics for Team in Training. He is well known and regarded by many famous runners.

So I gave him a try. He looked at my foot and my x-rays, and said, no there's no arthritis. I think you just have a "highly mobile" first metatarsal that is causing jamming of the big toe joint with every step. He videotaped me running and quickly reviewed it. Based on the fact that the over-the-counters had not fixed me, he recommended expensive orthotics. He guarantees them for a year and gives you free appointments to have them adjusted. And he was sure they would work for me. So I went for it. The orthotics were created just by scanning my feet while I was standing on them.

Unfortunately the orthotics did not give me immediate relief. Apparently foot irritation takes a long time to go away. By this time I had taken up cycling for something to do instead of running. Eventually I was able to start running without pain again, although I had other issues with this that eventually led to my diagnosis of anemia. On the day I was scheduled to go in to check on my orthotics because my foot was starting to bother me again, I sprained my ankle, and it took a long time to recover from that. So I didn't start running seriously until probably 6 months after I received the orthotics. I started to notice some discomfort, so I went in for an adjustment. This actually seemed to make a difference.

Sometime during this period I decided to get new shoes, as the doctor had suggested that with orthotics I no longer needed motion control shoes. I went to a highly recommended store where the proprietor is a physical therapist. He spent a lot of time talking with me, but talked me into buying shoes which I felt were too snug for me. He said they should be snug to hold my foot on my orthotics and that I would get used to it. I believed. The shoes first started causing me pain in my little toe and then just caused general discomfort in other places. When I went back to the podiatrist he said I shouldn't be wearing shoes that narrow because it was pushing my toe. There's a waste of $100. I went back to my motion control shoes.

However, last weekend, the pain cropped up again, and in a big way. I was only able to go for a 5 mile run instead of a 15 mile run as planned. The pain did not immediately stop upon walking. However, I discovered there was no pain when walking barefoot. When I got home I discovered that my orthotics seemed to be wearing quite thin under the big toe joint and were extremely flexible. These things are supposed to last 5-10 years...

The pain also cropped up while cross country skiing the next day, although probably not until 20k or so. I got through 32k. The next day the foot was fine while snowshoeing. I didn't run that week, and when I went to see my bodyworker, she taped my toe and calf (which was extremely tight). I skied 16k on Saturday with limited discomfort, but I quit skiing early to avoid irritating it. After all, my event is next weekend.

So Monday I will try to make an appointment with the podiatrist to see about getting my orthotics fixed again. We'll see how that goes.

Meanwhile, one of my coaches recommended that I try barefoot shoes. This has been suggested to me before, but not by anyone who actually used them to fix a big toe problem. This person told me he could not run with regular shoes but has no pain with barefoot shoes. It took him a year and a half to work up to a half marathon in the barefoot shoes, however. But he swears by them. He said that all running shoes have something of a heel, which naturally pushes your foot forward into your big toe joint. This  kind of makes sense. So I'm thinking maybe I will actually try it, although I think my podiatrist will refuse to treat me if I injure myself further while running barefoot.

So once again my marathon plans have been shot, and I'm just hoping to get through the ski event next weekend. The good news is that I'm told I'm not doing damage to my foot, just irritating soft tissue.

It's so hard to know how to find the proper doctor, physical therapist, shoe store, or anything. How do you know who you should trust? How do you know what shoes or orthotics to trust? How do you know if barefoot running is for you? There are so few relevant medical studies on these topics. What works for one person does not always work for another. I just want to be able to exercise without pain. Maybe I should have become a doctor so I could figure this out for myself. I know I would spend enough time with myself at my own appointments, after all.