I’ve met a few miracle workers during my time as a runner, and I just met another one: Pedorthist, James Drain, who works at Elite Feet in Edmond.
I tweaked my right foot back in ’09. We believe I subluxed my right cuboid and over time developed chronic cuboid syndrome. As a result, the bone/ligaments never healed properly back in place. Because of the quirky cuboid, it somehow irritated my peroneals and/or changed my gait, and I developed a very prominent 5th metatarsal tuberosity where the peroneal brevis inserts. I also don’t have much fat padding in my feet, so this prominent bone bears A LOT of pressure. I also had some popping where the peroneal longus wraps under the foot (between the cuboid and 5th metatarsal) and ocassional swelling where the two tendons wrap under the fibula.
My quirky foot has bothered me off and on the past few years, sometimes getting stiff and sore but not hindering my performance. My foot seems to “flare up” when the seasons change, and sometimes with various shoe changes and running on uneven terrain. I was dealing with my hip problems when the foot issue first started, which was a far worse problem and sort of distracted me from my foot. I saw various doctors and health professionals:
One doctor (orthopedic surgeon) recommended a shoe change, but didn’t specify exactly what he thought I needed. I went to a shoe store, tried on a gazillion shoes, and settled on 2 different pairs. My foot generally felt better.
I saw a podiatrist– like the first doctor, he didn’t think I needed an MRI because he assumed I had a cuboid problem (a mechanical issue), which would show nothing on an MRI. He had me troubleshoot the problem with various pads and tapes. First I tried an arch support pad, which definitely didn’t help. Secondly, I tried a cuboid pad, which made my foot feel somewhat better, so we knew the problem had something to do with the cuboid/lateral part of my foot. While the pad felt Ok running easy, it didn’t feel Ok running fast, so I’d take it out.
I’ve had massage, ART, acupuncture, graston, PT, used The Stick/various massage balls, and tried all kinds of recommendations on stretching, strengthing, and balancing exercises for my foot.
I rested for 7 weeks when I had my hernia surgery. The foot felt quirky, even not running, and it flared back up immediately when I started running again.
I’ve tried lots of barefoot running, always my “go to/cure-all” for a lot of problems. While it seemed to help somewhat, because I wasn’t in the right/modified shoe for the rest of my running…. no amount of barefoot running could fully cure the problem.
I saw another doctor, who also recommended a shoe change, but was more specific– needed a beefier shoe, being firm in the heel and flexible in the forefoot. I ultimately settled on the Inov-8 233s, which felt perfect for the marathon and carried me to my two 2:37 marathons this year.
Anyways, my foot problem sporadically flared up last month, which seemed to coincide with the changing weather and a new pair of shoes. I went back to the doctor, again, and finally…. someone did an MRI on my foot. It turns out it showed nothing wrong with the cuboid (as the prior podiatrist mentioned), but it showed stress to the calcaneus and peroneal tendonitis (particularly to the peroneal brevis, where it wraps under the fibula).
Finally, we knew I had a peroneal issue, which assumingly was either caused by the “loose cuboid” and/or possibly causing the cuboid to be loose in the first place (because of how the peroneal longus wraps under the foot, plus the tight peroneal brevis pulling on the 5th metatarsal). I saw chiropractor/ART specialist, Kevin Jones, who noted that my ankle felt tight, but my cuboid felt loose. He began working on the alignment in my foot/ankle and getting the mobility and strength back in my peroneals (~ART and band exercises). Within a few days, my stride/pushoff started getting back to normal!!! It was miraculous! Finally, we figured out what the problem is and at least partially how to make it feel better.
Now the shoe woes– I’ve tried a gazillion different shoes, and it’s been tricky figuring out exactly what my foot needs. Enter pedorthist, James Drain, who owns Elite Feet in Edmond. I’ve had a few people tell me to go see him, and after finally meeting him this weekend and picking his brain some, I realized he really could help me figure out the problem. All it takes is one person, the right person, who understands a problem and knows exactly how to solve it.
James had mentioned this weekend about “excavating” my inserts/shoes to relieve pressure where it hurts– basically looking at your insoles and cutting out the part where the pressure and pain is the greatest. You can see this on your insoles– where the “wear” is the greatest. LIGHT BULB GOING OFF IN HEAD– why hadn’t I thought of this before, and why had no one else told me to try this?!!! It’s soooo obvious if you just look at my feet…. I have a HUGE lump on my 5th metatarsal!
After talking to him, I went home and began butchering old insoles. I first cut out the part under the cuboid– no relief. Then, I looked at my old insoles and noticed how much pressure I put on that 5th metatarsal tuberosity. I cut out the insoles in this location. Ah ha…. foot feels much, much better!!!
I went to see James yesterday, told him what I did, and he looked at my feet, insoles, and shoes. He said it was very obvious what the problem is– the feet/insoles don’t lie! He began working away on excavating my shoes and insoles to take pressure off the 5th metatarsal. He noted that I’d likely feel better with a softer insole/shoe (to cushion and accomodate the 5th metatarsal). He also believes functional/hard orthotics aren’t the answer, as it would screw up my “ingrained mechanics” too much.
We spent a good 2 1/2 hours working on the shoes and insoles and running around the parking lot to figure out how to tweak them. While he modified the part where the 5th metatarsal tuberosity is located, it felt I needed additional excavation where the peroneal longus wraps under the foot between the cuboid and 5th metatarsal joint. It feels like I get popping here, so the excavation relieved the popping/pressure.
He also was able to modify the upper– stretching it near the ankle/fibula/cuboid.
Lastly, he has a tying technique that takes pressure off the lateral heel. He equated it to how you’d tape your feet, except with shoe laces. Mechanically, it felt like my foot moved better/toed off better with the upper using this technique. See pic below.
I am completely blown away by how James thinks! I wonder why I never thought of this, and why no else thought of it either! I’ve always believed a simple shoe change could solve something (whether you know how/why it helps). No shoe is perfect for a foot (being mass-engineered)… and sometimes no foot is perfect either (even barefoot)…. especially after putting thousands of miles on them over many years! I have a very specific problem that needs a very specialized answer.
I don’t know what will happen to my foot longterm and what I’ll need, but at least for now I’ve figured out what the problem is and how to provide relief for it. If you have a foot problem you can’t solve, I highly recommend seeing James. He can get the shoe to match the foot.