As I’ve been sharing the past month, I’ve been recovering from a stress fracture in my calcaneus (heel bone), which went right across the heel from the Achilles to the plantar fascia. From a mechanics standpoint, the stress fracture was likely instigated by a reaction/compensation to stings and swelling in my foot, which caused a tear/tightness/imbalanced pulling between the Achilles and plantar fascia on the bone. I’m not kidding when I say it felt like my foot was splitting in half when I got to the top of a hill around mile 15 at the Quebec City Marathon!
I had my 1-month follow up appt. last Monday. They took x-rays, which showed impressive healing and bone formation going across the calcaneus. You could see bone callus formation where the Achilles attaches and then a bit of a bone spur on the bottom where the plantar fascia attaches. She said the bone spur would go away, as long as I continued to stretch the feet and calves. I can tell everything is getting stretched back out from running.
Any pain I feel right now isn’t from the bone (which is healed) but rather from the soft tissue. I have (or had) a sizeable knot/scar tissue in my plantar fascia/arch, which is gradually getting smaller and less painful. It feels like the running is helping to stretch this out– I notice the knot is palpably getting smaller and less painful each day. The doctor said to give myself the next 2 weeks to ease back into running, to allow everything to stretch and normalize. When I step out of bed each day, I have some soreness/stiffness in my Achilles/ankle, but not really in my plantar fascia. This pain/stiffness is gradually becoming less, and my foot is feeling more stable.
An interesting suggestion I’ve had by 3 people (OCU trainer, Dr. Smith, and my chiro/ART guy Kevin Jones) is to wear a Strassburg sock or nightsplint at night. What happens is when you sleep, your foot is in a plantar flexed position (toe pointed down), which means the Achilles and plantar fascia aren’t in a stretched state. Since your body heals and repairs itself in your sleep, the scar tissue further creates tightness. Then, when you step out of bed in the morning… since you haven’t stretched the Achilles/PF for 7-8+ hours, plus with the scar tissue… it feels extremely tight and stiff (until you’ve walked around a bit to loosen everything up)! Thus, things such as the Strassburg sock and night splint have been created so the foot remains in a stretched/neutral/90+ degree position.
The Terminator Boot
As I talked about with Kevin, the problems with the Strassburg sock and the nightsplint is that it stretches beyond what’s normal for the foot. He believes it’s better/more natural for the whole foot to be held at a 90 degree position. I had an “a ha” moment and realized my walking boot would hold my foot at 90 degrees. Sooo… last week I decided to sleep with my boot on, to see how it feels getting out of bed in the morning. Sure enough… the next morning, I took off my boot and was able to walk around without the usual pain and stiffness! I continued to sleep with the boot on (a little clunky, while trying not to “kick” my hubby in the middle of the night!).
Between ART treatments from Kevin, getting back to consistent running, wearing the boot at night, running twice a day, and also a little barefoot running at the golf course, the foot is almost stretched back to normal… feeling better every day!
Great article. Love the boot. I’m developing a tape job that mimicks a strassburg without too much ROM and the “claustrophobia” some feel with it. Glad you’re getting better! Plantar is for the birds!
Awesome post, Camille! I’ve been wearing a boot to sleep since 2003 and I can’t run in the mornings without it.
I noticed the same exact thing when I tried the Sock. More specifically, the Sock tends to put too much pressure on my toes (pulling them back), compared to the boot. I have a special, lighweight, felt boot now that is pretty comfortable to sleep in.
For other readers, regardless of boot or Sock, it’s going to take a week or two to get comfortable at night. I threw mine off almost every night, but now I can’t sleep without it.
Wow, that’s amazing you’ve been doing it that long Jeff! Conor won’t step out of bed without slipping on his shoes with orthotics– I guess some foot issues can be permanently dibilitating.
I talked to Kevin again today, and he said the sock and even the nightsplint (which goes beyond 90 degrees) is too aggressive, esp. for someone who’s got bad Achilles/PF problems. Like you said, too much pressure for too long. Stretching the foot like that might be good for ~30 second hold a few times… but to have the foot in that position all night is overkill! With my walking boot, it’s not uncomfortable at all cause the foot is held in a neutral/normal position.
Thanks for the feedback! I was wondering if this would generate experiences from others, and it certainly has!
Funny – I also have been facing a calcaneal stress fracture. I had a really bad blister on my heel and I think that caused me to alter my gait (this was back in May) and raced a half marathon and after that, things were not quite right. I didn’t get diagnosed until sometime in July though which helped exacerbate things. I started running again and re-injured it and am now left with two weeks to go in an other long bout of rest. I have been using Low-Intensity Ultrasound, some Chinese herbal supplements and being as active as I can be, but it has been a long and frustrating summer. Any words of advice? I am getting a bone density scan in a week, but am reticent to go on bone-building drugs.
Interesting Julie! I was stung twice on my foot, including a sting on the bottom of my heel, which I believe is what caused me to change my gait and led to the stress fracture.
The problem that people face is when they return to running, they feel pain and think the bone isn’t healed or that they’re going to re-injure it…. this pain, though, is completely normal! The bone is actually stronger than it’s ever been, because of the bone callus, so if you’re going to get another stress fracture, it will be in a different location.The nerves and soft tissue had to re-adapt to the impact– you have to train consistently and reasonably (not too fast/too soon), and you’ll get over this “pain hump”. I talk about all of this extensively in my post about stress fractures: http://camilleherron.com/2011/05/11/overcoming-stress-fractures/
You can read my other recent posts about how I’ve been quickly healing my current calcaneal stress fracture. If you’ve taken off a reasonable amount of time, it should be healed– a walk-run routine can help you progress back to running and making sure your muscles-bones re-adapt.
Hi Camille, I appreciate your comments and am wondering how your stress fracture is these days? I go back to see the doctor in 7 days and hope that I get a green light to start running again. Pool running is for the birds. The only thing I feel, and it’s been like this for a few weeks, is a creepy sensation like blood flowing into the area. I see my massage therapist later this week and think I may have some fascial restrictions in my lower leg that are restricting blood flow. I have, and have had, no pain whatsoever, which makes me super frustrated that my doc ordered 8 weeks of non-weight bearing. That is crazy. I have been walking and that is the thing that feels the best right now. I am scared about coming back and re-injuring my heel though.
Hello Camille,
I’ve just surfed into this post. I need to start by saying I’m not a runner, nor am I even close to being any kind of athlete. But I’ve just been diagnosed with heel fractures in both feet (bone scan confirmation). Left is the worst, and my podiatrist put me in an Air Walker boot today, which I’m really struggling with. I’m already having hip and neck pain just from the awkward gait it imposes. And I honestly don’t know how I’ll be able to sleep in it. If you have time, I’d love any advice you can give me to help me through this. Right now I’m barely able to deal with the fact that I’ll have to wear this thing for next 2 months. I can only imagine what that will do to my (very small amount of) muscle, and so I’m envisioning physical therapy after the 2 months in the boot. Thanks in advance. And I hope you continue to be pain free!