A personal worst performance

I did my first 10 mile time trial of the season last night. It was a slow night, on a slow course ridden by a slow rider. 28:28mins. 10 mile tt's are about going out hard and hanging on but unfortunately I was only able to hang on for 4 miles before the metaphorical wheels spectacularly fell off.  The next 15 minutes was a hypoxic blur of burning legs, snot and constantly changing gears. Not pretty, not pretty at all. Simon beat me by almost 2 minutes and won on the night; a sign of how far he has come and how far I have regressed.

The good news is that I can only get better.

Taking a carb holiday

Yesterday was the day of the Edinburgh Marathon. The day when I was meant to be taking another 10 minutes or so off my marathon pb and attain a 'good for age' time for a future London Marathon. The irony of me not being up in Scotland's capital running the race of my life but instead being poked and prodded by two podiatrists while I hobbled and limped about for a couple of hours was not lost on me. It turns out that my foot problem is considerably more complex than I had thought. Weak peroneal tendon; check. High arch; check. Inflammed sheath around a nerve; check.  Leg length difference; check. Complete lack of pronation; check. Completely useless orthotics; Yep, got those too.  I genuinely though that they were going to take photos and stick my feet into a medical journal.

What can I do? Well, in the main I am already doing the right thing by the stretching regime that I have but I need to focus more on my hips to get my left leg back in line. I actually need to concentrate on walking correctly and  straighten my left foot up, which is constantly pointing outwards and do the same when stretching. Other orthotics may well help but the ones I have are actually making my gait worse. I have very bent feet (my toes point upwards making the end of my foot concave which is then putting a lot of stress on the muscles in my foot to compensate) so they made up an orthotic which props up my forefoot and allows me to pronate properly. I noticed a difference straightaway, which was encouraging. Still a very long way to go. They seemed to think that I could be running again in 6 weeks but I just do not want to risk it. I am going to stick to 12 and then see how we go from there.

The other thing I am trying to control is my eating. Last week I went a bit nuts. I came home after a hard day at work on Friday and hit the food cupboards hard and then had a full dinner. I was just eating for the sake of something to do and as the second Cadbury's mini roll went in I thought 'This has got to stop.' So it has. I've been snacking on fruit rather than rubbish and trying to limit my carbs and portion sizes. Not dieting but just being conscious of what I am eating and being sensible.

Funnily enough, despite my foot forcing me to stop training for a couple of weeks, my mojo has begun to make an appearance. I guess because I have not been able to do any proper training it's made me want it more, even though in the last 2 weeks I would have settled for being able to walk normally. There's a 50 mile tt at the end of June and a 25 a couple of weeks after which I intend to enter and use that as an immediate focus to get myself on the bike and do some racing. I am hoping that this should be foot friendly.  I pick up my boat next week and so I'll be having a play around in that and no doubt be getting very wet. There's even a nasty rumour going around that Adam and I may be entering a Hasler.

Hodge; Shouldn't have done it though. It believe it's significantly delayed the healing of my foot. When will I learn? 

The Ups and Downs of training

It's been a funny 10 days or so since my last post. Quite a bit happening in the background, decisions being made and them almost as quickly being unmade. Somebody on tritalk commented on my wisdom focussing on marathon training when I have a foot injury. I had thought that I would be able to get it sorted fairly quickly, i.e. 8 week's rest and then I'd be back on the marathon trail but this foot problem is going to take longer than that, methinks. I had to cancel the podiatrist appointment as I still could not run on it for them to examine me on their treadmill by the middle of last week, so I have arranged another GP's appointment to try to get a scan and a further referral to a podiatrist. Not surprisingly, nothing showed up on the x-ray. Anyway, enough about my foot. I'm bored of talking about it, so onto other things....

Simon's six weeks out from the Outlaw and 2 club mates of his had spare entries to the Wiggle Up and Down ride starting in Dorking. Simon was going to do the 96 mile Epic route and asked me to tag along. With very few miles under my belt I was a bit nervous about it but thought 'Why not?' and it would be a good way to kick start some work on the bike and burn a few calories. (despite not doing an Ironman this year I am still eating like I am). We cycled the couple of miles to the start from Simon's house and by doing the same at the end that would bring us up to a nice century ride. My lack of fitness showed quite drastically. despite the title of the ride I didn't think that it was too hilly, but the climb out of Dorking onto Ranmoor got my heart rate up nicely. I made a conscious decision to spin as much as possible and for the first 30 miles or so I felt pretty comfortable. The ride was quite quiet; I don't know if this was because it had been rescheduled from when it was cancelled the month earlier and people had not been able to start but the feed stops were really well stocked with a good range of carbs to munch on and lots of water and maxifuel to top up on.

My ride started to unravel after the stop at approximately halfway. As we peddled out, the slightest rise began to feel like a major hill and Simon would skip away effortlessly as I hunched down on the bars trying to get out of the increasing wind. The ride flattened out between about 60-85 miles and I clung to the back of Simon's wheel along the flats taking full advantage of the draft. My bingo wings really started to ache. The Van Nic was set up in tt mode and all I had done was take the tt bars off, forgetting to put the seat and Stem back to how I normally have it set up for road use. As a result my arms were aching quite a lot and I enjoyed resting my forearms on the bars as Simon towed me along to flats. Simon would wait for me at the top of the hills but I felt bad about him having to be so slow because of me and told him to go on but he said he was happy to wait which was really good of him. The icing on the cake was Whitedown. The only thing that kept me going was seeing 2 other riders had already stopped and I really didn't want to stop as well. It was horrible but I felt pretty chuffed with myself for having got myself over the top and then able to freewheel back into Dorking. That's the thing when you do stupid stuff like Ironman and the DW; you think you can do anything.

In other news.....

I've sold my trek. :-(  The bike that got me fit again and got me back into tri. It had to go due to upcoming major renovation work at Casa Wheezy. It was like selling one of my children.

I've bought a boat! A Kirton Ranger. At wobble factor 4 it might be a bit on the tippy side, but we'll just have to see. The slight problem is that it's in Scotland so a family jaunt seems likely.

A diagnosis at last?

Since the invention of the internet, being a doctor, physio or any other member of the medical profession must be very annoying. A stream of people at your door all knowing what's wrong with them because they read a wiki article or saw a youtube clip of a similar problem and therefore they know exactly what's wrong and what the suitable medication or treatment must be. Forget the 5 year's worth of training and experience; just google it and hey presto you've got the answer. I hate those people; the problem is, I am one of those people. Being a MAMIL with a body that is spending more time failing than working, recently I have spent a disproportionate amount of my time typing in search words to get to the bottom of an injury. I have usually been wrong. I think however, that after the best part of 3 years or so suffering with this foot injury on and off I genuinely think I have got to the bottom of it.

The red herring has been plantar fascitis. After I had been suffering these attacks for a few years without any particular trigger I was finally diagnosed by a GP with PF and  I had my orthotics made up. The problem was that the GP did not see the swelling that my foot had when I would get this coming on. By the time I was having my foot prodded it was back to normal and she looked at my high arches and simply assumed it was PF. So, PF it is. Orthotics made, carry on, treat the symptoms, be acreful and it'll go away. But of course, it never did.

This time it was different because when I went to see her my foot was like a balloon, badly swollen red and hot. As I stated in the last post she mentioned tendonitis, so that evening I decided to investigate this further and so the google search of 'tendonitis AND foot' was plugged into the laptop. Within 30 seconds I think I finally found the answer to my injury.

The peroneal tendon runs down the outside of the leg, underneath the ankle bone and then splits into two becoming the peroneus longus and the peroneus brevis. The peroneus brevis attaches to the outer part of the midfoot at the fifth metatarsal. This is EXACTLY where the hotspot of my pain is before the swelling starts in full earnest and when the swelling goes down. I cannot walk on the outside of my foot and pronate properly because the discomfort from there is so intense. If I move my foot to the side, which is part of the peroneal tendon's job I can feel tightness around my ankle bone which is EXACTLY along the line of the peroneal tendon.The other quite intriguing fact is that whenever I have iced my foot I have invariably rubbed the pack EXACTLY along the line of the peroneal tendons.

Here's a quote describing peroneal tendonitis;

Patients with peroneal tendonitis present with pain and, occasionally, swelling in the outside and back (posterolateral) part of the ankle (Figure 1). This tends to be a chronic condition, so there is often no precipitating event. However, sometimes patients will report an activity that aggravated their symptoms. Essentially, the tendons are repetitively overloaded and the subsequent inflammatory response (attempt at healing) creates pain and discomfort. This inflammatory response is the reason why patients with peroneal tendonitis will often have startup pain and pain first thing in the morning.

Patients with peroneal tendonitis will often walk with a limp. Looking at the outside of the ankle, there will may be some subtle (or not so subtle) swelling behind the lateral malleolus [the prominent bone on the outside of the ankle]. Pressing on this area will often create discomfort. Many patients will have a higher arch foot (subtle cavus foot) with increased ankle inversion compared to eversion.

This is EXACTLY what I have been suffering. OK, I don't have a medical degree and I am far too stupid to ever study for one but I feel 99% certain that this is the problem. There are far too many similarities, in particular the hot spot of pain where the peroneus brevis attaches for it to be anything else. That said, I'll still have the blood test for gout and wait for the x-ray results to come, but I'll be extremely surprised if either of those come back with anything.

So what now? Well, I'm going to stick with the 8 weeks off. This has been recurring very regularly and I feel there's a good chance that I have seriously knackered this tendon; the swelling has simply been too pronounced for it to be a light injury. The usual RICE protocol will be used but once the swelling has gone down I will also work on my ankle flexibility which should help alleviate some of the stress on this tendon. It looks like I might be visiting Amazon for a wobble board. I am concerned that I might have just done too much damage to ever be able to get back to running properly again; only time will tell on that one but I'm just glad that I think I've finally found the answer.

On the couch

The world's most famous sufferer of gout.

While I have the podiatrist booked in for next week I found out that the resident physio at the Royal was around last night so I took the opportunity to get another opinion. I really wanted someone to see the state of my foot while it was ballooned up in the hope that that might make a diagnosis more accurate. Que an email to Linda the physioterrorist with my various ailments post DW and an apology at the bottom, 'I'm normally fit and healthy.'  (Although I'm not sure I believe that anymore)

We started with the wrist and numb fingers. She jabbed a thumb into my forearm and within a couple of minutes the numbness started to abate. To be fair, it's been getting much better lately anyway, particualry at night when I've found it most annoying but  I had felt something in my wrist give way during the race so I knew that there must be some damage and swelling in there. It still feels a little strange if I try to use a screwdriver or open a jam jar but it is much, much better, but Linda gave me a couple of exercises to do in order to keep it going.

We then turned to my foot and the slight numbness I have in my left big toe. This toe always suffers. If my feet get cold on the bike or in the water then this toe is my little personal barometer which tells me I'm cold and will be the first and usually only thing to go numb. It seems that my sciatic nerve has pressure on it still, and is causing the toe to get pins and needles (or as little wheezy says, 'go fizzy'). Again, more dynamic and static exercises to stretch out my hams where the nerve has to thread its way through, in the hope this will release the pressure over time.

Now to the swelling on my foot. She was not happy about this at all and fairly quickly ruled out anything to do with the plantar fascia which does not usually cause swelling of this sort. And she was quite impressed (or disgusted; not sure which) about the colour of my foot compared to my other one, being a rather unhealthy red. Linda came up with 2 potential causes. Firstly, a stress fracture. In my mind this seems to make sense to me. Two days after the Tadworth 10 and really motoring downhill I get an attack; last week, two days after doing jump squats I get an attack. However there have been quite a few times when it's happened but I cannot pin down what the trigger could have been, except for the fact of course that I may have been jogging with an 18kg kayak on my shoulder and just doing a long run and one would assume that would be enough to aggravate it, although I wouldn't realise it.

The other option? Gout!! My diet isn't the best in the world but I'm hardly having a fry up for breakfast everyday. Usually the pain for gout occurs in the big toe and not where I have it  (maybe the numbness is it? Linda seems to think not) It seems unlikely that it is gout but there's no doubt I would be upset if it was, although Linda was at pains to tell me that it's not just diet related and restricted to people who drink too much and it would be a lot easier to treat than a stress fracture.

Okay, so, armed with this I went to my GP again today. Thankfully, my foot was still swollen so I was able to show my GP what state it was in. Again, she ruled out PF straight away. I mentioned gout and so she booked me in for a blood test next week to hopefully rule this out. She felt it was not a stress fracture due to the recurring nature of the pain. This kind of makes sense but maybe it's small so settles after time but can be aggravated by a larger force than usual, like running down hill for instance? She seemed to think it was some form of tendonitis that is continually being aggravated. Anyway, she packed me off to the hospital to get x-rayed.

From what I have read it seems unlikely that a stress fracture would show up on an x-ray. In fact the radiologist asked me to hang around so that they could check the x-ray as he was quite impressed with the swelling as well and I think assumed I had really broken my foot somewhere.  The fact that 2 minutes later he sent me home, rather indicates that probably, very little will come of the x-ray. Huuummpppffff. I go back in a week's time to get the results (or lack thereof)

So what should I do now? I guess, the best thing I can do is assume it's a stress fracture or tendonitis and treat for that, which basically means a complete break from running for an extended period. I think I should take a good 8 weeks off and continue to do my core and conditioning (without the jump squats of course) and do some cycling and paddling which both being low impact should not be a problem. That makes an autumn marathon very unlikely and frankly, quite risky, so it looks like a focus on half marathons towards the end of the year. Not what I'd planned, but at the moment, very little is.

A consolation is this photograph. While it was taken about 20 seconds into the DW, we are in time, our hands are high and we've got pretty good extension (rotation could be better though! ;-)  Thank's Bob!! Proof that coaching works.

Struggling again

Two sundays ago I finally got out onto my bike with Simon for the first time this year. It was not pretty but as I kept telling myself as I struggled around the Surrey hills for two hours, what could I expect? Whitedown was particularly brutal with the last kick at the top of the hill almost getting me to dismount. I have never dismounted to get up a hill and I didn't intend to start now but I did need to coast easily for the next 15 minutes and spin gently home as a result. last sunday I was out with Simon again. This time it was a little easier and longer at 3 hours with 75 kms on the clock.

In the middle of the week I had a couple of gentle runs and more importantly I started a strength and conditioning program that I am hoping will allow me to run without getting injured. How ironic then that the same programme has now left me with my left foot in tatters. The exercises and reps are designed to strengthen my hamstrings and calves as well as working on my core strength. One of the exercises was to do jump squats and I think that it may have been these that are now responsble for my foot once again being swollen. Frustrating is not the word. I am booked it to see a podiatrist next week which will hopefully start the process of getting rid of this injury once and for all, although I am certain that it's going to be a lot of work before I can run freely again. In the meantime it's RICE, stretching and nurofen.