Lessons learned on foot injury management and shoe design: Capping off a 100 mile training week in Hoka Challenger; Avoiding "Toe Spring" in running shoes

This weekend I capped off a 100 mile training week, peaking up for the 2015 Angeles Crest 100, with a 33 mile run yesterday and a 20 miler this morning up Mt. Wilson.

Yesterday's 33 mile run with my pal Alex started at the Lake Avenue trailhead and ascended the Sam Merrill Trail to the Mt Lowe railway, on to the summit of  San Gabriel peak at 6100 feet, and then down through Red Box to Switzer's, returning via Red Box to Eaton Saddle and  back down.  It was a fabulous, technical run with tons of climbing (7840ft!) in a run time of 6:09.  The 20 miler today was my traditional Sunday  fast hike-up/ run-down climb-fest on the Mt Wilson Toll road.  I felt solid and the running was fabulous!

But this weekend's training almost did not happen.

All through the last week I had been playing a game of tag with two increasingly painful foot problems:

1. A problem in my left foot --symptoms being sharpish pain in the bottom of my foot mainly at the big toe joint--  which has been building over the last couple months.  This started, I believe,  with an unfortunate stone bruise while running technical trail in very lightly armored Merrell Trail Glove-1s.  (I believe this to be a case of case of sesamoiditis/metarsalgia --self-diagnosed!-- based on readings online, not a medical diagnosis). 
2.  A two-week old case of severe pain in my right foot at the base of the second and third toes, that is particularly exacerbated when I put my weight on my feet with my toes dorsi-flexed (i.e. pulled up).  This is of course a problem  when running uphill!   Other positions that caused pain:  squatting on my heels  with my weight on the balls of my feet (think baseball catcher's position), or standing up weighting the ball of my foot with the toes flexed and my ankle pulled up off the ground.  The pain was mostly on the top of the toe joints (the dorsal side as opposed to the plantar side).  This new problem came on after  about one week of running in a new pair of Brooks Pure Grit 3 trail shoes.

What I had found was that the left foot pain would go away if I ran in the more heavily padded Brooks, but running in the Brooks was just killing my right foot!  Switching back to Merrell Ascend Gloves, the right foot pain was substantially palliated, but the left foot pain was exacerbated!  Also, walking barefoot, the pain in the right foot went away completely -  unless I weighted the foot as described above -  weighting the ball of my foot with my ankle lifted off the ground.

I pulled out a pair of Inov-8 Trailroc 255s from last year and by the end of the week these were the only shoe I could tolerate for running:  They alleviated the right foot pain quite a bit and the left foot big-toe pain was tolerable.  I took a rest day on Friday and walked in the Trailrocs, and was contemplating the prospect of scrubbing my planned heavy mileage  training weekend, just at the point where I need to be peaking up my mileage for the AC100 race coming up in 5 weeks.

What the hell?  What was it about the Inov-8s that seemed to be working and what was it about the Brook's that was so wrong?

Researching the problem I came across a thought-provoking article on shoe design mistakes, and in particular, an analysis of a shoe characteristic called "Toe spring":  Toe spring is the characteristic of most running shoes wherein the toe box curves up from the ground (think elf shoes!), so that one's toes while wearing a shoe with a lot of toe spring wind up in a very flexed position, pulled up off the ground:
Explanation of "Toe Spring" characteristic of running shoes

The problem with toe spring is that naturally, the toes are supposed to contact the ground!  Pulling the toes up exposes the metatarsal heads, the sesamoid bones, and the ligament capsules of the toe joints to quite unnatural stresses.

Here are photos of the Inov-8s, the Brook's and the Merrells that illustrate the differences:

Inov-8 Trailroc 255s:  Virtually NO "Toe Spring" (GOOD!) - rather stiff sole is absolutely flat, with moderate midsole cushioning.

Brooks Pure Grit 3:  Crazy amount of "Toe Spring"  (BAD!) with a very stiff sole. Lots of cushioning.

Merely Trail Glove 3:  Lots of "Toe Spring", but the sole is flexible and tends to straighten out when worn;  minimal cushioning

Merrill Ascend Gloves: Moderate "Toe Spring", minimal cushioning

Looking at these photos it seems clear why the Inov-8's were working for me and the other shoes were NOT:  The Inov-8 shoe design respects the anatomy of a normal human foot while the others simply do not!  I believe that the reason the Brook's were helping the left foot problem was simply due to their soft padding and relatively heavy armoring.   This was protecting the big toe metatarsal/sesamoids, but the stiff sole combined with the excessive toe spring was wrenching my right foot's toes up and creating the new problem on the dorsal side of the right foot toe joints.

In desperation, Friday after work  I drove over to the local Pasadena running store, Run With Us, to see if I could get a new pair of Inov-8s as the old pair I have is fairly worn.  It occurred to me that the midsole was fairly compressed--  I was thinking that in a  fresh pair, my left foot problem might be OK.  No luck:  The store was out of stock in my size.

Looking over my shoulder to make sure that I knew no one in the store,  I asked to try on a pair of Hoka One Ones, the Challenger ATR trail shoes.  After a few years of extolling the virtues of minimalist shoes and mocking my ultra friends who wore what I called "Hoka clown shoes", I was desperate enough to try them.  Given the irritated state of my feet it was clear that my weekend running plans would have to be cancelled unless I found a fix fairly radically different to what I have been trying.

Here is what the Hokas look like:

Hoka Challenger ATR

At first glance it would seem that the Hokas have a lot of toe spring-  but this is not correct.  Inside the shoe, the foot sits on a very flat, horizontal surface so that effectively there is very little toe spring.  What looks like toe spring is a design feature Hoka calls "meta-rocker" technology. The outsole curves up but the inside of the shoe where the toes contact, does not.  As a result, in these shoes, one can climb uphill with minimal toe dorsiflexion.  Just what I needed to deal with the right toe problem!

The Challengers have an extremely thick midsole (29mm at the heel) but a low heel-to-toe drop of 5mm.  The low heel-to-toe drop is a parameter that I have found important to preventing knee problems.  I was concerned about the massive midsole thickness,  however, while thick, the shoes are both feather light (as light as my Merrell Ascend Gloves) and the midsole in the Hokas is quite firm, not mushy at all, allowing for secure foot-plants.

I bought the Challenger ATRs and on Saturday morning I headed out wearing them, but with my old pair of Inov-8s stuffed in my backpack as a back-up plan in case the experiment proved disastrous.  I was fully prepared to scrub the run and turn around if the Hokas didn't work out.  To my great joy, I experienced no right foot pain at all, and the heavy midsole padding did a good job of protecting my left foot big toe joint.  I had a great 33 mile run.  This morning I ran 20 miles in the Hokas again, this time experimenting with a Pro-tec metatarsal pad in my left shoe to see about improving the protection of my big toe joint.  It felt great.  My running form is unaffected in these shoes-  forefoot strike with a high cadence and a short stride.

I will continue to be careful with this problem and continue icing the feet but it does seem at this point that I have a solution that will get me through my high mileage training phase while allowing the foot problems to settle down.   I am very relieved!

Change begets change...

This week I  took it light  as I spent the  Father's day weekend at a scout camp with my son.  Taking Friday off, I hit Mt Wilson for a 20 miler in the morning before heading out for the camp.  Altogether, 62 miles this week;  I plan to ramp it up to 90-100 miles for the next three weeks prior to starting a taper for the AC100.

Last weekend I had tried a pair of Brooks Pure Grit 3s,  more heavily protected trail shoes than my usual Merrell kicks, as I had been sporting a sore left foot-  quite tender at the ball of the foot and the base of the big toe.  On my  20 miler on Mt. Wilson last Sunday in the Pure Grits, the left foot felt fine andso I was very excited about these shoes.  I ran in them every other day last week and on Thursday, after my run, I noticed that the base of my second toe on the RIGHT foot was extremely tender when bearing weight with the toes in the dorsiflexed position (toes pulled up, as occurs when  running uphill).  This seemed a fluke, a one-off problem, so I ran in the new shoes again on Friday.  By the top of Mt. Wilson my foot was bothering me; afterwords the right foot felt worse! No fluke!

The Pure Grits have removable insoles made of a soft foam that felt great initially but after 50 miles had become permanently crushed down on the balls of both feet.  In the right shoe in particular this left a depression with a bit of a hump right at the base of the second and third toes.  I think this is the reason for the irritation.   I spent the weekend at my son's camp walking around and standing all day -  I quickly found that my feet felt better in a retired pair of completely trashed Merrell Ascend Gloves.  The feet felt progressively better through the weekend.

Tonight I replaced the stock insoles in the Pure Grits with a pair of foam insole replacements-  with foam that doesn't crush.  I thought I would try this to see if getting rid of the crushed insoles would solve my problem.  On a six mile test run, the feet felt fine.  This coming week I will alternate between the Merrells and the Pure Grits to see which feels better on the feet, and decide how to proceed based on what happens.  Its a bit puzzling as I have been free of any foot troubles for the last two and a half years running in minimalist shoes.   This year is proving to be different.  I believe this is all an unintended consequence of using heel inserts to help me through some nagging achilles problems this season.  Change begets change.  The focus now is to sort this out quickly with the AC100 coming up on August 1.

Week ending June 14: 94 fabulous miles; Metatarsalgia, and Brooks Pure Grit 3

This morning I capped off a 94 mile with a fantastic workout on Mt. Wilson wherein I tested my new pair of Brooks Pure Grit 3 trail running shoes for the first time-  just fabulous!  The workout was my standard end-of-week power walk-up/run down 20 miler with close to 5000 feet of climb and descent.  It came on the heels of an epic 28 mile lollipop loop from Lake Avenue up over Mt Wilson returning through Idlehour  that I ran yesterday with my pal Alex:

Beautiful view on Saturday looking west from Markham Saddle-  photo by Alexandre  De Sant'Anna

    So I started today's workout pretty tired and indeed it took me 2:52 to hike the 9.7 miles up to the summit -  very slow.   However, the 10.3 mile  trip down (via the  Skyline Observatory gate and upper part of the Toll Road) was fast and the total run time was 4:12.

What was great about today's run is that I experienced no foot pain at all.  With the Pure Grits I was able to really push on the downhill and it felt great.

Let me back up a step to explain.

Over the last month I had  been experiencing increasingly problematic  pain in the ball of my left foot, which has become increasingly severe and had begun to affect my gait.  I believe the problem started with a stone bruise, but I can't be sure.  Certainly once the ball of my  left foot became inflamed, foot placements on stones became a big problem (I typically run in very minimalist shoes such as Merrell's trail glove), to such a degree that   about 2-3 weeks ago I started running in a pair of Skechers Gobionic trails from last year-   because this shoe has a bit thicker and much softer midsole than my standard line up of Merrells.   No joy, the problem got worse!  Next I tried using a home-made rock plate for my left shoe from ~1mm thick Polypropylene sheet (Target sells these as thin, flexible cutting boards in their kitchen department).   This helped, but the problem continued to worsen.   It seemed I had come down with a case of metatarsalgia and was coming up empty looking for a solution!

Studying my Skechers this week I  found that the liner and midsole on my left shoe had become very compressed   right in the ball of my foot, which was not the case on my right shoe:  For whatever reason on my left footfalls I tend to come down right on the ball of my foot and this was starting to wreak havoc.  I strongly suspect that there is a systematic issue with my running gait this season since coming back from my right hip-socket fracture, as this asymmetry was never a problem before.

So on Friday I went to the Monrovia running store "Snails pace" after work to look at some other trail running shoe options.

The available  trail shoes that I looked at spanned the gamut from the Altra Olympus,  to  various Hokas, to the Saucony Peregrine.  The Altra Olympus seemed about as flexible and as thick as a brick and I was not too impressed with the flexibility of the Hokas and their ginormous stack heights.  The Saucony Peregrines were nice low profile shoes, but their integrated rock plate seemed to make the shoe very stiff, similar to the Solomon Utra-SGs that I had tried unsuccessfully earlier this winter:  I'd found that the rock plate in the Solomons forced my foot to bend in  a way that hurt my foot.

Fortunately the staff there called my attention to the  Brooks Pure Grit 3.  The sales person helping me was wearing a SD100 finishers' shirt-  she was none other than the #3 female from last weekend's race:  She knew what she was doing.  While the Pure Grits fit nicely I was a little concerned over the reduced flexibility relative to what I am used to running in, but hey, I was there after all to find a shoe that would provide a bit more protection to my tender left foot!   The Pure Grit 3 has a  15mm stack height up front with  a 4 mm heel-to-toe drop; a rock plate and very aggressive lugs:  I decided to give them a try.

I bought the Pure Grits but decided NOT to try them fresh out of the box on the 28 mile run yesterday:  That is an awfully committing route if the shoes didn't work out.  I ran in my old  Skechers and at the end of the run I was limping a bit, and proceeded home to ice my foot.

 This morning I thought, what the heck, lets try the new shoes.  They felt great!  Zero foot pain and I was able to push the pace on the rocky downhill.  The lugs are also quite a bit more aggressive than the Merrell's I have been running in and I found the Pure-Grits extremely sure footed.  All in all, a great run and so far I love the Brooks.

Lessons:

• Watch out for midsole compression that causes the ball of the foot to sit in a compressed cup with no protection
• Minimalist shoes are great but armor has its place too!

Volunteering with the Ultra Medical Team, SD100, June 6 2015

Last week from Memorial Day through Sunday  May 31, I ran 99 miles:  Long runs included  20 milers on Mt Wilson on Monday and Saturday followed by a Sunday 27 miler with the AC100 training group from Islip Saddle to Chilao.  It was a great running week and I was reminded just how ethereally beautiful is that stretch over Mt. Williamson through to Chilao.

After peaking up the mileage thus, this early in the season, it was time for a planned rest week.   Happily this coincided with the SD100  race weekend on June 6-7.  I had made plans to volunteer at SD100 as an Ultra Medical Team medic.  UMT Director Nick assigned me to Penny Pines 1 and 2 (mile 34.5 and mile 56 respectively).   I spent an extremely fun day helping out runners at these aid stations,  dealing with blisters and hot spots on feet, extreme bonk, nausea, and the various sorts of "-itis" that crop up in these races.  A very interesting "case"  involved a runner who came in at mile 34.5 with achilles pain.  After examining the runner's achilles and shoes I saw that the runner's shoe had a very stiff heel cup that was irritating the achilles tendon.  Based on my own experience with this situation, I made the recommendation that we try cutting the back of the shoe to take the pressure off the tendon;  after being reassured that the runner had a spare pair of shoes in case this didn't work out, we proceeded to cut vertical slits in the heel cup adjacent to the achilles tendon.  The runner went on and came through at mile 56 reporting that the fix had eliminated the tendon pain!

Nick as always was everywhere on course.  Here is photo of our Director heading off into the night on a trail bike to reverse sweep the course:

It was a fabulous day and great fun to part of the UMT and the SD100.

Here are some more adventures I have had with the UMT:

Volunteering with the UMT at the 2014 AC100:
http://fredippides.blogspot.com/2014/08/volunteering-at-2014-ac100-great.html

Race medic at Kodiak 100, Sept 2014

http://fredippides.blogspot.com/2014/09/Kodiak100