When adapting to running barefoot or in minimalist shoes, things change. Sometimes it may be difficult to tell the difference between injury and adaptation. Here is one of my experiences:
I had noticed for years that my left leg and foot behaved differently from its twin. Apart from the leg being longer, I noticed that my left foot had a higher arch and a less flexible ankle: in a squat, the left ankle showed some limitation. When I started running barefoot, or at least with a heelless, minimalist shoe, I noted that my left leg was less supple than the right at absorbing the shock of landing when running downhill. I was working on just this when something shifted in my foot, causing pain in several areas of my foot. I had to walk the rest of the way down the mountain. My foot swelled up on both sides of my ankle, and all around my instep. In fact, for a couple of weeks, I could barely walk, let alone run. It took me a few days to understand what was happening.
The pattern I had observed and was working on when the “injury” occurred involved limiting the pronation of my left foot, and pushing-off prematurely in my stride. This worked fine when running with cushioned, traditional shoes, and even seemed O.K. running on the flats. But it clearly created an artificial stiffening of my leg when running downhill, so, when I worked on softening the leg, and I allowed it to pronate normally, the bones in my arch shifted, causing really impressive pain on each step, even in simple walking.
After a couple of days of doubt, walking with great difficulty and pain, I embarked on a period of rollerskiing for an hour each day, at first just double-poling, which enabled me to work on flexing and extending the left leg with only part of my body weight upon the foot. I was convinced that I did not have an injury (a doctor friend thought it was a stress fracture), but rather I had simply torn some old scar tissue. Resting and immobilizing the foot would simply allow it to “heal” back to where it had been. I was convinced that the change was a positive one, and required movement to prevent the foot from returning to how it had been.
Gradually, I was able to put more and more weight on the foot, and after two weeks I was able to ski diagonal stride, pushing with pretty much full force on the left foot. Walking was still difficult, though there were times when I was able to inhibit the pattern of limiting pronation in my foot, and I could walk pain-free for a few minutes. Every morning, the old habit would re-assert itself with force.
Then, I began experimenting with running, first running barefoot up and down my hallway, trying to soften my foot and ankle, working on waiting until my weight moved forward of my metatarsals before extending my leg – exactly what I have been teaching my running students! Clearly, my left foot was weak – after more than 50 years of preventing it from normal movement – so I had to proceed slowly, but I also had to keep working to strengthen the muscles. I noticed that, if I stood sideways on a step, with only the first metatarsal on the step, and I tried to extend my ankle, it was very difficult with the left, not at all with the right.
Finally, after nearly a month of rollerskiing and working on walking, I ran for a painful 15 minutes. I found it extremely difficult to prevent my pattern of prematurely pushing off of my left foot. Afterward, I was quite sore, but felt better the next day, especially after an hour of skiing. I then did two 45 minute runs with an hour of rollerskiing on the day between the two runs. The runs were difficult, painful and awkward, but with periods during which I was able to run smoothly. The day after each run my foot felt better, so my belief that it needed to be strengthened was confirmed.
During a weekend camping trip, I decided not to run, and I went for long swims on three consecutive days. At some point, I felt the unfamiliar sensation of the toes of my left foot touching the tip of my shoe. My left foot had always measured more than a half size smaller than my right. It was now the same length as my right. It seems that my arch has softened and dropped, and the foot resembles the other one now!
The weekend break from running and skiing did not help my foot at all. As soon as I returned, I went for a run, and the following day, had a very good rollerski, during which I was able to push strongly off of my left foot.
Finally, after a month of struggling, something shifted as I was walking/running. I was in a rush to get home from a meeting, and I decided to try easy running. Walking and running were suddenly pain-free, and I could feel my foot working differently, pushing nicely off of the first metatarsal and big toe.
I guess I’ll never know the origin of the rigidity in my left foot. At first, I thought that, early in my running years, I had developed a pattern of limiting the pronation of my left foot as a means of avoiding the pain of severe tendinitis of the peroneus tendon below my left ankle joint. But, as the foot was measured smaller than the other as far back as I can remember (buying soccer boots in the 7th grade was a problem), the condition obviously went back to well before my running days.
Now, six months after the big shift, my foot feels great. For a couple of weeks, I had a little swelling around the insertion of the Achilles tendon, due to a foot that now pronates normally, putting a different angle of stress on the tendon. And, of course, once I started engaging the toe flexors (especially the flexor digitorum longus), I had really interesting pain and swelling midway up my tibia and fibula. Fortunately, I could rollerski every other day during the period of adaptation, to avoid stressing the tendon and nearly atrophied muscles excessively. However, I needed to continue to run, rather than resting, to complete the adaptation. I believe that if I had stopped to let something heal, I would simply have healed back to the unnaturally protected and slightly rigid condition.
Follow-up – about six years later:
After an easy rollerski, I sat in front of my computer for a bit, catching up on correspondence and generally wasting time. I stood up rather quickly without noticing that my left foot (yes, the same one I had written about above) was asleep. My ankle gave out and I fell to the floor awkwardly. Getting to my feet after a minute of shouting obscenities, my foot, now awake, had some pain, as though I had sprained the ankle. I went about my day’s activities, walking a mile to do some shopping, and generally getting around without limping, although I had some minor pain. Towards evening, the pain increased, without any visible swelling, and by the time I prepared for bed, I was limping badly. It took me a while to find a position in bed in which I did not suffer intense pain in my foot. I considered that I might need to go for an x-ray. I got up several times during the night — the first time I could only walk on the heel of the left foot. Each subsequent trip to the bathroom (beer!) was easier. By morning, almost all pain was gone and I could walk normally. I put on my running shoes to run to the bakery for some breakfast pastry and felt no limitation of any kind. By the end of the day, the foot was completely pain-free. WTF? as the French say! Did I have another shift in my foot like the first one covered ad-nauseam above? Was there more hardened tissue waiting to be released by my stupid fall? I can feel absolutely no difference in the foot from before my fall…