Friday, March 30, 2018

It's Complicated...

Again, I am not a medical professional in any way, and am not giving medical advice.

As I have been following the recommended treatment for PTT (Posterior Tibial Tendonitis), I have noticed that the protruding area below my medial malleolus, which I had assumed was my inflamed tendon, was quite hard and bony. That always seemed very strange, so I decided to research it further...

What I found is that approximately 10% of the population has the same protrusion just above their arch, and it is called an "Accessory Navicular Bone" -- lucky me. It's basically an extra chunk of bone that has been present since birth, but is only now deciding to cause trouble for me. Once it does start to cause trouble, it they call it Accessory Navicular Syndrome -- here's a good article discussing this: Accessory Navicular Syndrome

Here's what the article has to say: "Many people with accessory navicular syndrome also have flat feet (fallen arches). Having a flat foot puts more strain on the posterior tibial tendon, which can produce inflammation or irritation of the accessory navicular." 

The article also states that the "accessory" can start to present problems due to "excessive activity or overuse". Yep, that would probably be the cause.

Here is a photo of what a protruding accessory navicular bone looks like (not my feet).



As shown in the photo, the accessory navicular on my left side protrudes further than my medial malleolus, especially when I bear weight on that foot, and my arch drops to the floor. I also have the accessory on the right foot, but it is not as pronounced as the left, and that arch has not fallen to quite the same degree.

Much of the information out there on the web suggests that surgery is the best way to take care of this condition, but some of that info also suggests that it can be a very complicated surgery with a long recovery time, as there is often tendon attached to the area slated for removal. I did find one YouTube video from a podiatrist who suggests that surgery is over-prescribed, although I don't know if he is taking distance running into account. Here is the video:



I have been trying to keep a stubborn, bullheaded, attitude about running, and even got 5.5 miles in yesterday afternoon; but this really does present complications to my overall plan. The current plan is to tough it out and complete half marathon #10 in 27 days, but after that; my plan will likely involve visits to my doctor, and likely a podiatrist and/or physical therapist. 

At this point, if I could back my mileage off and only run 10K races, I would be thrilled. Until I have a doctor tell me that I need to stop running, I'm rolling with my theme song for the next 3 weeks: Marchin On by OneRepublic



Thursday, March 29, 2018

Flat Feet, Over-pronation, and Running

The following is not intended as medical advice. If you think you have similar issues, you really should see a doctor or physical therapist.


Ever since I was first fitted for running shoes, I've known that I over-pronated to some degree -- in other words, with each foot-strike on the ground, the inside of my ankle rolls inward, my arch flattens, and things don't line up like they are supposed to.

"Stability" shoes did the trick for me up to about 10 miles per week, but once I got beyond that, I had to jump to full-on "motion control" shoes, as I started to get posterior tibial tendon pain as the miles increased. Motion control shoes have a "medial post' built into inner base of the shoe to keep your ankle from rolling inward; but unfortunately, they have limited support for the actual arch. My motion control Brooks Beasts got me through 5 half marathons in the spring/summer of 2016; but since April 2017, I have struggled with more foot pain due to this overpronation.

As you can see in the following diagram, the posterior tibial tendon starts under the medial malleolus (inner ankle bone), and runs up the back side of the tibia. Overpronation and a flattening arch put extra strain on that tendon, leading to pain and inflammation.


A while back, my doctor had recommended looking into orthotic arch supports from a local "sports medicine" specialty store, so I finally decided to stop in and see them. Their recommendation was not expensive custom orthotics, but a good quality off-the-shelf insert that would provide some cushion and support. I'm still not quite back to full-on running yet, but just wearing the orthotics around feels so much better, and I find the inserts they recommended to have a very natural feeling arch for my foot. I just bought a second pair for my everyday shoes, so I don't have to worry about transferring sweaty insoles.

As I stated above, if you have pain in your foot, you should seek the advice of a medial professional (which I am not); but it doesn't hurt to do research online to at least narrow down where the pain might be coming from. Here's a great video that I found while searching YouTube -- Bob & Brad are great:


My pain is exactly where they stated it would be -- originating in the arch area, with greatest pain focused directly under the medial malleolus, and sometimes radiating up the tendon past my ankle. Here is a video showing their top treatments for this disorder -- it seems to support everything else I've read online, although this is very simplified. There's a full list of exercises you can do to strengthen this area.


Another option that I'm trying out is the use of KT Tape (Rock Tape is similar). While it doesn't really "treat" the issue, it can provide added support, and take strain off of the tendon. I've heard that it is best to have a professional apply the tape the first time, so you can see what it feels like, but of course YouTube has videos for doing it yourself. Actually, a professional applies it in the video, but they show you how to do it -- and it is an awkward procedure when applying it yourself.


I am in the process of combining the old "R.I.C.E." recovery treatment (Rest, Ice, Compression, Elevation), but am also incorporating some of the treatments mentioned by Bob & Brad. I still have not abandoned all hope of running my 10th half marathon, which is scheduled for April 21st (just over 3 weeks away). 

I realize that at some point I need to follow my own advice and go visit an actual physical therapist; but right now, this is where this stubborn old mule is at.