It has been a while since that second triathlon (a.k.a. my last post). In that time, I have finished 4 sprint triathlons, one 10K and two 200 mile bicycle rides (Seattle to Portland (STP) and Ride from Seattle to Vancouver and Party (RSVP))! The reason that all of my triathlons have been sprint distance is in large part due to my run. Specifically, my Posterior Tibial Tendon (PTT) continues to give me pain in distances longer than 4 miles.

Here’s the puzzle: last year in May of 2014, I trained up to and ran a 9 mile training run, which is the longest distance I have ever completed, and I did it without pain. How? I have no idea, and it didn’t last long because quickly after that run, I upped my training with a sprint focused run group with the goal of speeding up my runs and increased mileage on the bicycle rides to accommodate the upcoming STP. Thus, I ended up in the Physical Therapists office with inflamed PTT. Needless to say, I did not complete the sprint speed training nor have I run 9 miles since.

So, why start the blog again? Because on my last visit to Brian Crosier, my Physical Therapist, he unlocked two final pieces to my puzzle, I think, and I want to document this next part of my journey.

In December 2014, I had started training up to a half-marathon, the Whidbey Island Half-Marathon on April 19, 2015, from 2 mile runs. All was great until I started running 3.5 miles and my PTT got inflamed. I also started to feel my tight right hip tighten even more. Hip tightness is a new thing that started over the summer after my STP ride with my untried new awesome carbon fiber frame bicycle, but I can tell you that story another time.

S0, I entered Brian’s office with mildly achy PTT and a fairly tight hip. As he was trying to figure out how to help me since I had already been through PTT treatment, and I was already applying the techniques he had taught me over the summer, he discovered an immobility that he had not considered treating before: my mid-foot.

So, after Brian got the foot model, much like the picture above, he began by telling me about the three arches in the foot. There is the major arch that everyone knows about, then there is an arch on the outside of your foot between your heel and your midfoot, and finally, your toe knuckles are supposed to be an arch, but most people’s are flat and not arched at all. Hmm – I’m definitely in the flat toe knuckles camp: no surprise there.

He then added that my left big toe knuckle cannot touch the ground. I laughed and told him that my left big toe knuckle touches the ground every day 🙂 He responded by using the foot model to explain that on my left foot, my main arch compensates a lot for immobility though the mid foot or the navicular bone and the cuneiform bones, meaning it flexes or “falls” in order to allow my left big toe knuckle to touch the ground because those bones do not flex enough on their own. Consequently, the Posterior Tibial Tendon attaches to the navicular bone, which means that my PTT is already being stretched out everytime I flex my arch.

Whoa! What? When Brian told me this, so many issues that I have been having my ENTIRE life began to fall into place. I have always felt like I walk on the outside of my feet, and I have these weird outer foot calluses to prove it. Also, Brian had been coaching me to land “flat” with my feet (i.e. land mid foot with by toe and outer foot touching at the same time) because I land on the outside of my feet then roll in, which puts a lot of pressure on the PTT since it is in charge of the downward/flex motion of the big arch. Well, I have been trying to land “flat” since summer 2014, and I was not feeling very successful. Guess why – I can’t. I physically cannot get that big toe on either foot (the left is worse, but the right foot suffers as well). Finally, when I ride my bicycle, even after a fancy fitting with the spacers placed to help get my knee in the correct place, I always felt that I could not get my big toes down inside the shoes. Of course NOT! I felt so much better knowing that despite my trying and failing, it was a mechanical restraint.

But with me, I’m not satisfied with just the why. I want to know the next step – how do I correct this? Of course, Brian did not disappoint! He had invented a stretch for those small, largely immobile bones of the midfoot.  I will post a video soon with details on how to do this stretch. For now, know that after the first stretch with Brian, the tops of my feet were sore (both left and right) for two days, and the stretch is not very big. It is just that that part of my foot had never really been stretched.

Another component of the foot issue is how to get the big toes on each foot to touch the ground while still maintaining as much subtalar neutral (ankle being neutral and arch not fallen) as possible? This took convincing – Brian suggested ProKinetics® insoles that have 3mm build-up under the big toe area on each foot (see red part on the photo below). As most of you know, if you have read very much of my blog, I do NOT like inserts of any kind. After working for over a year to get out of prescription orthotics, I am not very enthused about having to use any kind of inserts again. However, Brian made a compelling point: with these inserts, my feet could possibly be placed into a better position that would allow more natural functioning with less pressure on the PTT. Hmmmmm….why does he always make such good arguments?

So, I got the ProKinetics® Insoles. They have a 3mm build-up (in red) under the big toe as well as a removeable (yell0w) arch support. In addition, they come with an extra set of 3mm build ups (orange) in case you would like a 6mm build up.

ProKinetics Insoles

Since lots of my shoes are more minimal (Five Fingers and Luna Sandals), I also purchased a really cool adhesive lift that you stick directly to the ball of your big toes called SoleMateâ„¢ Comfort MicroLiftsâ„¢. Very cool products.

I am still in the test phase of running with full insoles, but so far the first run has been good, and I wore theSoleMateâ„¢ Comfort MicroLiftsâ„¢ with my cycling shoes today and what a difference! I know what the bike fitters have been telling me about using my whole foot – I could actually do it! My inner thighs are going to be very sore since I can access their power now, too!

The picture shows how the SoleMateâ„¢ Comfort MicroLiftsâ„¢ look and adhere to your foot. Weird, but very effective. I will say that I wore them for my trainer ride on my bicycle, and I put them back on my feet after my shower and wore them for approximately 8 more hours. Around hour six, I could tell that the skin under the adhesive was getting  a little irritated. However, when I removed it I did not have any lasting redness or raw places. The website says that these can be stuck directly to the inside of the shoes, too. So, I’m going to try that to see how it works. Definitely adding the additional 3mm orange pieces to the bicycle shoes, though!

Part two: tight hip

The why – my Sacroiliac (SI) joint on the right side, as seen in the photo below, was tight, which was impeding my ability to do some rotation and other movements, and my hip muscles, specifically the gluteus minimus, were taking up the slack and ending up overworked and tight. 
Once again, bells were going off all over the place! YES! The SI joint was tight on the right side! Of course, a few years ago I had spent an entire summer using a lacrosse ball on the right SI joint when Brian had suggested that I tuck my tail bone when I run in order to use more core muscles and attain a more efficient running form. I had not really thought much about my tail bone once it had stopped hurting, but I had never really treated it. Well, SI joint, those days are done. I am not going to neglect you anymore.

The how on treating the SI joint? To have Dr. Larry, my wonderful Chiropractor, do his magic on the SI joint when I visit him and to re-start some tennis ball massages on the SI joint. Also, I have a massage therapist, Brad, who has been working on my right hip. He will be better able to attack the problem with the new information as well. Gotta love having a village to keep it all working smoothly!

So, this is the next phase – unlock mobility in my midfoot and loosen up the SI joint on the right side. I’m still signed up for that half-marathon in April, and I’m looking forward to the training! If I can find the right combo of mechanical advantage and training pace, I may just make that race! Stay tuned!