After my calf setback in March, I set appointments with a podiatrist and a sports med doc. The podiatrist told me to keep what I was doing with the shoes and arch supports and sent me on my way. I bet that cost my insurance $120 for fifteen minutes, tops.
But I met with Dr. Gronski this morning of sports med. Apparently, he's a bit of an athlete, and know all about triathlons from his colleague, who's signed up for this years Ironman Wisconsin. We discussed many causes of my pain, what I did to overcome it, and what will happen in the future. The diagnosis is plantar fasciitis:
Plantar fasciitis, which may cause the heel to hurt, feel hot or swell, is inflammation of the plantar fascia, a thin layer of tough tissue supporting the arch of the foot. Repeated microscopic tears of the plantar fascia cause pain. Sometimes plantar fasciitis is called "heel spurs", but this is not always accurate, since bony growths on the heel may or may not be a factor...There are a number of possible causes for plantar fasciitis and they often work in combination. Tightness of the foot and calf, improper athletic training, stress on the arch or weakness of the foot are potential causes. Shoes that don't fit, certain play or work actions or overuse (running too fast, too far, too soon) may hurt the plantar fascia. People with low arches, flat feet or high arches are at increased risk of developing plantar fasciitis.
I emphasized that last line because it's very important to my problems. I have very flat feet. So flat that me calf has to do more work that it would had I grown arches as a kid. Dr. Gronski explained it like this. Basically your arch is the shock absorber of your foot. Every time you land, your arch spreads absorbs the footfall. Since my arches don't exist, my ankle must absorb the shock. The ankle is supported tendons that connect to the calf muscle. The tibialis anterior does much of this work in my case. As a result, it gets sore. Really sore.
So, Deb, the Sports Med angel, came in with a crazy looking boot thing, some thera-band and a bunch of exercises. The crazy boot thing ended up being a "night splint." The night splint looks much like a plastic cast, but only on the back half. I strap my foot into it at night and it holds it at 90° while I sleep. What that does is allows the plantar fascia to heal in the proper position. Otherwise, if I let it relax and it heal in that position, I would literally tear what had healed the during the night with my first few steps. That's the pain the people express in their heel when they rise in the morning. She then gave me the thera-band and taught me a ton of exercises to strengthen my feet to prevent further pain. Basically, I'm doing all this to prevent problems as I continue to train.
Update: I've worn the boot for a week and and my anterior tibialis is been great. My runs felt really good the whole week. I just have to remember to keep stretching and doing my exercises.