Doc types, a sport medicine question

[Pheidippides]

After a night of rest and morning of internet research, I am fairly confident that I have peroneal insertional tendonitis.

(Yes, I cut and pasted that from somewhere else).

Do you have any informal, non-binding suggestions for recovery? I am planning on switching from running to swimming for a couple of weeks/until healed and taking some ibuprofen. Would it be helpful to get my weight off of the offending foot as well by getting crutches?

I realize that this might be the equivalent of somebody asking me to describe the most recent environmental legislation dealing superfund site designation and hoping to get a coherent answer.

[ERCougar]

After a night of rest and morning of internet research, I am fairly confident that I have peroneal insertional tendonitis.

(Yes, I cut and pasted that from somewhere else).

Do you have any informal, non-binding suggestions for recovery? I am planning on switching from running to swimming for a couple of weeks/until healed and taking some ibuprofen. Would it be helpful to get my weight off of the offending foot as well by getting crutches?

I realize that this might be the equivalent of somebody asking me to describe the most recent environmental legislation dealing superfund site designation and hoping to get a coherent answer.

Rest. The best treatment for any type of tendinitis is to stop using the involved tendon. Going from regularly running to crutches seems a bit overboard, but I guess that depends on how bad this is. Pain is really your guide here--if it hurts, stop.

Incidentally, are you sure about this? This would be a fairly rare injury. You sure you're not dealing with a case of plantar fasciitis?

[CardiacCoug]

I believe my marathoner wife has had peroneal tendonitis, too. Her pain lingered for several months, but that was because she refused to follow my medical advice to stop training for a week or two -- not the first or the last time she has completely ignored my medical opinion.

I think the things you suggested make sense. I wouldn't recommend crutches. Going to low-impact exercise or no exercise at all for a week or two and a little bit of ibuprofen should do the trick. Unfortunately, it seems like once somebody has a problem like this it tends to flare up repeatedly, so it could end up being a recurring problem any time you log a lot of miles in the future.

I'm sure ER and Jarid know a lot more than I do about this and will hopefully be kind enough to share their advice.

[Pheidippides]

Rest. The best treatment for any type of tendinitis is to stop using the involved tendon. Going from regularly running to crutches seems a bit overboard, but I guess that depends on how bad this is. Pain is really your guide here--if it hurts, stop.

Incidentally, are you sure about this? This would be a fairly rare injury. You sure you're not dealing with a case of plantar fasciitis?

No, I'm not sure, but I'm thinking the way I do because of the location of the pain - on the extreme side of the foot, right around where that tendon would attach. Everything else feels normal. Also, I should mention that this foot/ankle was severely injured about 9 years ago (broken fibula and entire foot dislocated about an inch to the outside - required surgery and six months of rehab). The surgeon told me that my ligaments and tendons were pretty beat up during that injury and that I could expect arthritis problems later in life, but I digress.

Wouldn't the treatment be the same in either event - rest from running until it feels better?

[Pheidippides]

Unfortunately, it seems like once somebody has a problem like this it tends to flare up repeatedly, so it could end up being a recurring problem any time you log a lot of miles in the future.

I've been wondering if my shoes are partly responsible. I have put about 300 miles on my most recent pair, and they are definitely at the end of their useful life. The tread is fine but the midsole is at a point where I think they are worn out. Even running as much as I am and eating well, I'm still 190 or so, so I'm a heavy runner, and I require good cushioning shoes.

[ERCougar]

No, I'm not sure, but I'm thinking the way I do because of the location of the pain - on the extreme side of the foot, right around where that tendon would attach. Everything else feels normal. Also, I should mention that this foot/ankle was severely injured about 9 years ago (broken fibula and entire foot dislocated about an inch to the outside - required surgery and six months of rehab). The surgeon told me that my ligaments and tendons were pretty beat up during that injury and that I could expect arthritis problems later in life, but I digress.

Wouldn't the treatment be the same in either event - rest from running until it feels better?

Yeah, that sounds like it could be peroneal tendinitis. I guess the non-weight bearing thing depends on how badly you injured the tendon previously. Still, I'd give a trial of low impact exercise first to see how you do. You were just logging pretty good miles, so I bet a week or two off of it would do wonders.

EDIT: By the way, when I say "let pain be your guide", that doesn't mean run every day until you start to hurt. Pain means you've gone too hard or far. So, give a couple of weeks of pain-free exercise before you push things again. Also, the function of the peroneal tendon is to plantarflex (the motion required to stand up on your toes) and stabilize your ankle, so any exercise that does this will stress the tendon.

[Pheidippides]

Yeah, that sounds like it could be peroneal tendinitis. I guess the non-weight bearing thing depends on how badly you injured the tendon previously. Still, I'd give a trial of low impact exercise first to see how you do. You were just logging pretty good miles, so I bet a week or two off of it would do wonders.

EDIT: By the way, when I say "let pain be your guide", that doesn't mean run every day until you start to hurt. Pain means you've gone too hard or far. So, give a couple of weeks of pain-free exercise before you push things again. Also, the function of the peroneal tendon is to plantarflex (the motion required to stand up on your toes) and stabilize your ankle, so any exercise that does this will stress the tendon.

Thanks, ER and Cardiac. This has been helpful. I think I'm going to replace running with swimming and leave out leg work from my weightlifting until I feel better - and if I don't feel better within a couple of weeks, I'll stop in for a personal chat with one of your Hippocratic brethren.

[ewth8tr]

After a night of rest and morning of internet research, I am fairly confident that I have peroneal insertional tendonitis.

(Yes, I cut and pasted that from somewhere else).

Do you have any informal, non-binding suggestions for recovery? I am planning on switching from running to swimming for a couple of weeks/until healed and taking some ibuprofen. Would it be helpful to get my weight off of the offending foot as well by getting crutches?

I realize that this might be the equivalent of somebody asking me to describe the most recent environmental legislation dealing superfund site designation and hoping to get a coherent answer.

That is what I had 2 years ago, the 2nd time coming right after I ran the Huntsville Half Marathon. The Sports Medicine doc I went to gave me a little wedge that I put under the insole in my shoe that herlped. Of course, then I ended up getting the same thing in my other foot.

[Pheidippides]

That is what I had 2 years ago, the 2nd time coming right after I ran the Huntsville Half Marathon. The Sports Medicine doc I went to gave me a little wedge that I put under the insole in my shoe that herlped. Of course, then I ended up getting the same thing in my other foot.

You know, now that I think of it, yesterday was the first time that I have done a long distance on asphalt. Almost all of the roads I run on are concrete and flat. Yesterday, however, the first four or five miles were done on asphalt with a crown to it. I was running against traffic on the shoulder, which would have had my left foot (the one that hurts) running on the outside and therefore the more curved part.

Maybe that has nothing to do with it. But the thought just occurred to me.

[ewth8tr]

You know, now that I think of it, yesterday was the first time that I have done a long distance on asphalt. Almost all of the roads I run on are concrete and flat. Yesterday, however, the first four or five miles were done on asphalt with a crown to it. I was running against traffic on the shoulder, which would have had my left foot (the one that hurts) running on the outside and therefore the more curved part.

Maybe that has nothing to do with it. But the thought just occurred to me.

That's probably what did it, the doc told me that running on uneven surfaces when your foot is not used to it can cause this. Both times I had it I had run on asphalt more than I was used to, the first being a 6 mile run where I had just picked a direction and ran and the second being the marathon that was almost entirely on little asphalt roads around Huntsville. Of course, this time I have been running almost entirely on asphalt and the tilt in the road is what I think has caused my knee problem. There is a PT in my ward who looked at my knee briefly at church today has said it was probably tendonitis, but because of where it was, there was a possibility of a slight meniscus tear.

[ERCougar]

You know, now that I think of it, yesterday was the first time that I have done a long distance on asphalt. Almost all of the roads I run on are concrete and flat. Yesterday, however, the first four or five miles were done on asphalt with a crown to it. I was running against traffic on the shoulder, which would have had my left foot (the one that hurts) running on the outside and therefore the more curved part.

Maybe that has nothing to do with it. But the thought just occurred to me.

This actually makes sense and I'm kind of surprised it's not more common. Besides plantarflexion, the peroneal tendon also everts (lifts the outside of your foot), so running on a crowned road would stress the tendon.

Crowned roads notoriously worsen IT band problems too. I'd always tried to run on asphalt and avoid concrete because I had heard that concrete was harder on your knees, but last year I read an article disputing that. I've since been running more sidewalk (since they tend to be level) than before and have had no knee problems since.

[Pheidippides]

This actually makes sense and I'm kind of surprised it's not more common. Besides plantarflexion, the peroneal tendon also everts (lifts the outside of your foot), so running on a crowned road would stress the tendon.

Crowned roads notoriously worsen IT band problems too. I'd always tried to run on asphalt and avoid concrete because I had heard that concrete was harder on your knees, but last year I read an article disputing that. I've since been running more sidewalk (since they tend to be level) than before and have had no knee problems since.

It puts me in a pickle, because I don't have any knee problems at all, no matter what I run on (so there's no need to run on asphalt from that perspective) but most of the Houston Marathon is run on asphalt, and it would probably behoove me to get my feet and muscles used to asphalt from that perspective.

Morning update: I am still in some pretty good pain and have no intention of running today. But the pain is less than yesterday, and I'm not even on any NSAIDs today.

[ewth8tr]

It puts me in a pickle, because I don't have any knee problems at all, no matter what I run on (so there's no need to run on asphalt from that perspective) but most of the Houston Marathon is run on asphalt, and it would probably behoove me to get my feet and muscles used to asphalt from that perspective.

Morning update: I am still in some pretty good pain and have no intention of running today. But the pain is less than yesterday, and I'm not even on any NSAIDs today.

I think it more the fact that you were running with the crown than the asphalt itself. When running the Houston Marathon, you'll be able to stay closer to the middle where the crown is much less, if there at all. I ran the Provo River half in between the 2 times I had this and was fine because most of it was pretty flat. The Huntsville Half that I reaggravated it in had a lot of running on the side of a road at the beginning, then it looped through some small, residential type roads. I also was having some leg pains that I think changed my gait a little as well that time.

[bluegoose]

In addition to plantar flexion and eversion, by virtue of its attachment, the peroneus longus tendon also acts to stabilize the first ray, and as a result, it helps to support the transverse and medial longitudinal arches of the foot.

The symptoms that niku is describing (we could use some more details to help with the diagnosis) could certainly be a peroneus tendonitis due to friction at the cuboid pulley on the lateral foot. It could also be inflamed simply due to having to help stabilize the arch through 2 hours of pounding. IIRC, that was quite a jump up in mileage from the previous longest run, so it probably just wasn't accumstomed to that much work.

I guess what I'm trying to say is I wouldn't be surprised if the foot feels noticeably better in 2-3 days and, as long he drops the mileage for the next couple weeks, should be good to go for upping the mileage again soon.

[Pheidippides]

In addition to plantar flexion and eversion, by virtue of its attachment, the peroneus longus tendon also acts to stabilize the first ray, and as a result, it helps to support the transverse and medial longitudinal arches of the foot.

The symptoms that niku is describing (we could use some more details to help with the diagnosis) could certainly be a peroneus tendonitis due to friction at the cuboid pulley on the lateral foot. It could also be inflamed simply due to having to help stabilize the arch through 2 hours of pounding. IIRC, that was quite a jump up in mileage from the previous longest run, so it probably just wasn't accumstomed to that much work.

I guess what I'm trying to say is I wouldn't be surprised if the foot feels noticeably better in 2-3 days and, as long he drops the mileage for the next couple weeks, should be good to go for upping the mileage again soon.

Simple translation: as long as he stays off the road for the next three days, I'm golden!