Monday, August 4, 2014

Follow up to TRT Race Report: Ok, maybe it's not the shoes, it's.... Morton's Foot?

I thought that my shoes had a lot to do with the reason why my feet hurt so much during my attempt to run 100 miles on July 19. Then I talked with my good friend Mary and told her that maybe my shoes were too soft and that I needed a firmer platform. Mary, a Master ChiRunning Instructor and extremely knowledgeable about the mechanics of injury and running, and what to do when things go wrong, not so gently suggested that it might not be my shoes and that I should look in to other reasons. Specifically, what was happening with my foot muscles and, as I learned later as I began my investigation, the structure of my feet that could be causing the pain.

So I began to re-think about all the pain I had in my feet and legs during the TRT on July 19. I began to realize that I always had pain in my feet especially after 50 milers when the trail was rocky and technical. I had always accepted it as part of the deal, but then began to realize that if I ever hoped to finish anything longer than 50 miles, I needed to re-examine my logic. Sore feet and legs at mile 50 would not take me through another 14 hours. Maybe instead of a firmer shoe, specifically a stiffer rear shoe to support the arch over the uneven trail surface, I needed to look at the mechanics of my feet and legs. What was I missing? I am a ChiRunning Instructor and have decent mastery of the technique. Perhaps that was what had been saving me these last 4 years of running ultras – my ability to relax, use alignment, gravity and the road to move me forward instead of power and lower leg muscles and strength – but now that I am fit enough to increase the intensity, duration and frequency of my running, and attempt 100 miles, I am beginning to feel the stress of an imperfect body, of the running biomechanics I was not blessed with.

I picked up the “Trigger Point Therapy Book” and began to read about feet and their muscles and the trigger points in the lower leg that can be used to relieve pain. I first learned about Trigger Point therapy from Mary several years ago when I was trying to find a cause and a solution to pain that I was having on the top of my foot after the particularly difficult Way Too Cool 50K I ran. Finding trigger points in my lower leg relieved pain at the top of my foot. I’ve been a fan of trigger point therapy ever since.

The Trigger Point Therapy Book described Morton’s Foot and although I have always known I’ve had Morton’s toe, or Morton’s foot, I read about it again with interest and a bit of amazement to discover that something I thought was a minor issue all my life was, perhaps, much more.

Description of Morton's Foot and The Elevated First
Metatarsal. The top picture shows the deeper space between the first
and second metatarsal and the longer second metatarsal.
The lower picture shows the elevated first metatarsal that 80% of the
population has according to Posture Dynamics.
Taken from Posture Dynamics flier
I resemble these feet!!
Morton’s foot occurs in about 25% of the population and is defined by a longer second metatarsal than the first. It can cause many different chronic problems and pain in the feet and lower legs including metatarsal head soreness (soreness in the ball of the foot), Achilles tendonitis, and plantar fasciitis. Not to mention problems in the knees such as runners’ knee from ITB syndrome, internal tibial rotation (knock knees) that can stress the knee’s ACL, hip problems, a forward tilt of the pelvis and upper body, and imbalances in posture and gait, to name a few.

I googled Morton’s Toe/foot and found that details the definition and what the solution is. Here is how to determine Morton’s foot:

  • Simply measure the length of the second metatarsal and compare that to the first. A longer second metatarsal is Morton’s toe. You can estimate the length by measuring the length of the toes from the heads of the first and second metatarsals.
  • If the space between the first and second toe is deeper than the space between the second and third toe, that is Morton’s toe/foot.
  • Do the knee bend test: From Posture Dynamics – “Without shoes, stand on a hard floor – your feet shoulder width apart, feet parallel and toes pointing straight forward. Do a ¼ knee bend. Keep your heels on the floor, and force your knees to move straight forward over your third toes. (imagine an invisible line from the center of your knee cap to your third toe.) If you have Morton’s foot you will feel your weight on the outside edges of your feet and little or no pressure under your big toes. From this position, move your knees slowly inward until you feel weight bearing pressure under the balls of your feet behind your big toes and on the inside edges of your feet. Stop moving your knees together when you feel equal weight over your first and fifth metatarsal. If the center lines of your knees moves past your third toes towards your big toes, you probably have Morton’s toe.”
Other physical signs of Morton’s foot include:
  • A hypermobile big toe - hard to see unless the foot is in motion.
  • An elevated big toe compared to the other toes. “An elevated first metatarsal can be observed when the feet are aligned so your knees travel straight over the middle of your feet when you do a knee bend. While the second through fifth metatarsals are firmly on the ground, the first, and strongest metatarsal is not on the ground and properly weight bearing. It is elevated.” Posture Dynamics.
  • A callous under the second and third metatarsals instead of the first (normal when weight bearing is distributed over the first and fifth metatarsal correctly.)
  • Severe Pronation as the foot attempts to ground the big toe leading to overworked lower leg muscles, OR
  • In my case, supination also leading to overworked lower leg muscles.
  • A duck footed (everted feet or splayed feet) gait. 
Right foot splay with compensatory left elbow and knock knees.
November 2013
It began to dawn on me that my running gait and all my non-running and running injuries and pain might be related to Morton's Foot: 
  • My tibial torsioned lower legs (knock knees) could have lead to increased strain on my knees leading to the two ACL injuries and multiple meniscal tears I've had from skiing. 
  • My life long duck footed stance and gait
  • The huge callouses under my second and third metatarsal heads.
  • The lower leg soreness and tightness, and sore feet at the metatarsal heads
I even wrote a blog about weighting my big toe back in December 2013 in order to fix my duck feet! I was able to focus on alignment and weighting my big toe, but it took months before it began to feel automatic. Perhaps, I had been forcing my feet to do something that would not help them compensate for the Morton's Foot which they had been doing my whole life through supination, foot splay and two point weighting. 

The solution to “fixing” Morton’s foot is simple: place a small pad under the first metatarsal to bring the first metatarsal to the ground so that weighting is distributed equally over the first and fifth metatarsal instead of over the second and third. Instead of weighting on an ice skate blade (one point under my second and third metatarsals and one point under the heel), I'd be weighting on tripods like "normal" feet!

Photo by Posture Dynamics
Correct distribution of weight over equal points over
the first and fifth metatarsal heads and the heel
forming a tripod
I cut out a small piece of an old shoe insert and taped it to the bottom of my running shoe inserts with Duct tape. The Trigger Point Therapy book said I only needed about 4 mm of padding to make a difference, but I think the pad I made was less than that. I went for a couple of runs with my home made inserts and really didn’t notice a difference. The balls of my feet didn't hurt though so this was good, I thought.

My homemade version of a Morton's foot fix
So I went back to the internet and found and Posture Dynamics. There, I read much more about Morton’s foot than what was in The Trigger Point Therapy Book, then called the owner of Posture Dynamics and asked about their flexible, ultrathin inserts. She was certain that I could relieve my symptoms with their inserts. I knew I was on the right track when she questioned me about my feet and running shoes. For the inserts to work correctly I would need to be wearing a neutral, non-motion controlled shoe without posting or a curved last. All my running shoes fit that description. The conversation made me hopeful and I was encouraged that I might be able to begin correcting a biomechanical issue that I had so far been lucky not to have debilitating injuries or pain from, but could possibly worsen as I age and continue to run. So I spent the $70 and bought them. She assured me that there was a 90 day trial period and money back guarantee.

I was to start with the insert with the 3.5 mm wedge under the first metatarsal, then after about 10 days, move to the 6 mm size. I ordered a pair and they arrived in time for me to do a 3 hour, 15 miler on trails yesterday.
I put them in my Skecher GoBionic Trails, a very soft, flexible, cushioned, zero-drop, neutral last shoe and took off to run the hilly, rocky trails behind my house.

I kept an intense focus on my feet for the whole run making sure that I was relaxed and being sensitive to any pain or tension in my feet or lower legs. I could feel the elevated pad under my first metatarsal head, but after a few minutes, the sensation disappeared and I relaxed into my run.

About an hour in to my run, I noticed that my feet were easily relaxed and I was weighting the inside of my foot and the big toe with what seemed to be less mental focus and less effort! My legs felt good, my feet were relaxed and felt natural, not forced to be in a straight line position. Wow.

oh geez is this geriatric?
That afternoon, I pasted the Solemates (a thick pad with adhesive) on to the bottom of my feet under the first metatarsals so I could wear my Tevas. The folks at Posture Dynamics had kindly sent me a sample.  I was reminded of my mother who used to put pads on her bunions! I felt like I had officially arrived on the geriatric doorstep.

That night, we went to see The Doobie Brothers and Boston at Harvey’s Outdoor Arena in South Lake Tahoe and spent the whole evening dancing on my feet. It was indeed a senior event. No one under 40 here!

This morning I woke up without soreness in my feet and my calves were supple and soft. I cautiously stood up to get out of bed and my feet weren’t sore! Wow, could I have found a solution to my sore feet, knock knees and duck walk/run?
I hope so.

What's really cool is just being able to think this through and experiment to find out what will work. I want to keep running for a long time. This is just another piece of that journey.

Oh and I signed up for Firetrails 50M October 11. So, as I begin to build mileage again for that little race for redemption I'll be interested to see how this "fix" helps my foot pain. I'm an experiment of one, so if needed I can go to a stiffer shoe, but for now, one variable at a time.