Foot issues...help!

[Ruth Hilton]

My feet have always been quite flat, though with a titch of an arch in there (which has helped a bit). However, about a year ago, I randomly noticed that my left foot had suddenly gotten flatter - when I did the step in water then onto concrete thing, my left had no dry spot where my right does a little and my left had before. I also noticed a callous developing on the bottom of my second metatarsal on that foot. For the first half year after this (or so) I didn't really feel any big difference, so I didn't worry about it. But this summer I got PF in that foot and in the last month or so, that metatarsal has felt bruised constantly and when I try to curl my second toe it hurts like the dickens.

Does anyone have any idea what's up with my foot? Any ideas on how to make it not hurt all the time? Besides not walking or running on it and not moving my toe?

[Sasha Pachev]

We have our PF expert group (Mike, Paul, Josse) - I'll leave it up to them to share their specific treatment/prevention ideas. I will share my general injury prevention philosophy. Most people have some kind of weakness or imbalance than makes them prone to injuries. At the same time, the body has the ability to be trained to compensate for the imbalance enough to never get injured, and even to not lose biomechanical efficiency very much if at all. The form might look a bit odd, but overtime it becomes just what your body needs. This training is accomplished with a high volume low intensity running, which we also call building a base. After a long period of base conditioning the body has developed adaptation mechanisms and may be ready for higher intensity running, or in other words, speed work. Unfortunately, most high schoolers train using a short cut cramming technique - very little base, and a lot of speed work. The lucky ones who happen to have naturally good biomechanics escape injury, while the unlucky ones (like you) run into trouble. Additionally, the lack of aerobic base really hurts in long races. I can go on and on forever about how unimpressed  I am when I put a good 40 seconds in a 5 K on a high school runner that would waste me in the mile, and is ahead of me after the mile mark, or when a 4:30 mile high schooler thinks that 1:15 is a great time in a downhill half-marathon.

What I would recommend is to remove all speed work entirely and focus solely on base until you become injury resistant. Run 8:00-8:30 pace 6 days a week for the maximum amount of distance that you feel your body can handle without breaking down. Do that for at least 4 months. Race when you have to. You will find yourself a bit slower in the 800, about the same in the mile, and getting gradually better in the 2 miles. But that does not matter. Do not worry about those races. High school comes and goes, and you have your whole life ahead of you. Focus on the long-term development.

[Paul Petersen]

Probably a good place to start is finding a good physical therapist/sports therapist who understands runners and who you can trust. They will identify whatever imbalances you have, and help you with your biomechanics through stretching, strengthening, etc. They may also decide you are a good candidate for custom orthotics, in which case you will want to find a good podiatrist you can trust.

For my PF, I did months of physical therapy, massage therapy, chiropractic, cortisone, custom orthotics, birkenstocks, cross-training, ice, heat, anti-inflammitories (including diet changes), night splint, foot yoga, and more that I can't even remember. There is no one cure-all, so I did just about everything, including some snake-oil stuff that makes me laugh now just thinking about it. But different things work for different people.

The custom orthotics for me served as a crutch or cast. In other words, a temporary measure that facilitated correction and healing. In conjunction with all my PT and chiro, my biomechanics and imbalances were finally straightened out, at which point I ditched the orthotics. They had served their purpose, and I didn't need them any more. Some people think they have to wear them for life (and some pod doctors will insist on that), but it's simply not true. For training I still wear over-the-counter arch supports (Powersteps), as I too have a very flat foot. But they are pretty light weight and are cheap. I race in flats now, without any sort of insert. 

If I had to pick the 5 most effective treatments for myself, I would have to go with:
1. Massage therapy - really made an immediate impact! Find someone who goes deep.
2. Physical therapy + chiropractic - without it, the root problem will not get solved. Includes stretching at home.
3. Night splint - studies show these really help. Although not a standard splint, but try the Strassburg Sock
4. Custom orthotics - consider them to be like braces: a temporary corrective measure
5. Birkenstocks - huge arch support, plus extraordinarily comfortable. I love 'em.

[Ruth Hilton]

Sasha- I think that I have a quite good base, especially for a high school runner, so I'm not sure how much of an issue that is 

Paul- After taking it easier and wearing the strassburg sock this summer when it was bad, my PF now isn't much of an issue. The thing that really gets me is the constantly hurting metatarsal and I wonder why that one foot suddenly got flatter than it was (and the other foot is still normal).

[Josse]

The older you get the flatter your feet get (get even worse after you have babies).  I agree with both Paul and Sasha, The pain is probably coming form a pinched nerve, if that metatarsal has fallen that much it put stress on the nerves.  I would find a good PT or foot doctor, make sure they do a foot scan.  I have had many pair of orthotic made and have hated them all.  The sports chiroprator I am seeing right know is trying to talk me into them again but I agree with Paul that they should only be used temoraraly, but in your case you might need them all the time.  Just make sure you break them in slowly or you will injure other things.

[Jeff Frodsham]

Rhett F. is always telling me to tell people that he will look at them and help them. He also says that if you need anything just call him. You know him and what he can do, so if he works for you you could call him. He helps me with everything and he has always worked with my feet.