Saturday, April 17, 2010

Why/How I Started Running Barefoot, Part One

One month to the Detroit Marathon. After all the long trail runs that summer out in Arizona, I was confident and ready, feeling good, back in Ann Arbor, Michigan, upping my running time on my once-a-week long runs, to a goal of four hours by the end of September: my marathon time from the previous year. But there was a problem: my right heel was starting to hurt after long runs. Not a sharp pain, so I knew I hadn’t pulled anything, but more like a throbbing ache, which tended to go away after a little while. Being a real man, I ignored it. And, the pain got worse, appearing after all my runs, even the shorter ones, and started to show up in the mornings too, when I first get out of bed, though again, it always went away as I started to walk around. So I kept running. I was long-distance runner! I could take aches and pains! I was tough! I was healthy! My body would never break down on me! My body likes me! With less than a month to go, running the marathon trumped everything. It had been my goal all year and I had put a lot of time and effort into it. Plus, the $85 entry fee would be wasted!

But the aching started to not go away after walking. In the mornings, I could barely limp to the shower. I’m also a musician, I like busking out on the streets, and after standing on a cement sidewalk all one afternoon, I could barely walk home. So, since I didn’t have health insurance, I swallowed my runner’s pride and decide to see a doctor, a sports medicine ‘specialist,’ at the medical center of the university where I was a grad student, who diagnosed me with something called “plantar fasciitis,” He asked my pain level on a scale of one to ten, ten being unable to walk. I said seven. Despite that, he seemed to mentally check me off, and give me what seemed like his usual fix for plantar fasciitis at any pain level, assuring me that, with some icing, some things called “heel cups,” and stretching with a big blue rubber band, I would be running again in six weeks. Cost: Fifty dollars. Six weeks later, after no running, and sitting out the marathon (which did not make me happy), and doing everything the doctor said, I was still in pain. I went back, reminding him about the six weeks. He became flustered and said that sometimes recovery from plantar fasciitus can take up to six months. I should continue what I’m doing. Cost: Seventy dollars.

By now I was not quite convinced he knew what he was talking about, so decided to go online and do some research on what the hell this plantar fasciitis was. I did find out that at least his diagnosis sounded right: We have ‘fascia’ all over our bodies, sheaths of tissues between our skin and muscles, that aid in just about everything, from motion, to strength, to posture. The ‘plantar’ fascia runs along the bottom of the foot (you may have also heard of, and had, plantar warts, on the bottom of the foot) and aids in arch support. When it becomes inflamed, the pain is generally felt in the heel. Plantar fasciitis can affect athletes who spend time pounding their feet on hard surfaces, like runners and basketball players, but it also affects normal folks too: I ended up working with a guy who had been a concierge at a ritzy hotel, with lots of marble floors. He was perfectly healthy, in his twenties, but claimed that just walking around all day on that hard marble ended up causing him excruciating pain. Also, my sister, who isn’t a runner at all, but was newly pregnant at the time, got it. Once I found out what plantar fasciitus was, a lot of people seemed to be suffering from it.

The second doctor, at the same university clinic, at least has the decency to admit she didn’t know anything about plantar fasciitis, and, after charging me fifty dollars, forwarded me on to a third doctor off-campus, someone she’d only heard about, who ran a running clinic for high school cross-country runners. This third doctor actually seemed angry that I had come to see him, and I found out why when he told me, as if it were my fault, “The problem is, you don’t have any insurance.” Meaning, I guess, that he couldn’t make any money off of me. He offered no other ‘advice,’ but, seemingly in order to get rid of me, at least wrote me a recommendation to see a physical therapist.

At my first physical therapy appointment I was also asked about insurance. And just having to worry about money affected my physical therapy. I’d thought a session would cost seventy dollars, but that was actually per half hour, and my physical therapist had me there for an hour. And, she used a sonogram machine on me, which was another seventy dollars. I tried to be very clear to her that I could only, barely, afford the seventy dollars I thought I’d been quoted. She didn’t seem happy with that, and again I’m not sure why, except that I think she was used to not having to worry about price, since all of the people that usually get that far have insurance. With the money barrier between us, we couldn’t trust each other: I was always defensive about anything we did, wondering if it would cost me more money, and she had to deal with a ‘problem patient’ who was constantly questioning her. But, to be fair, she didn’t charge me for everything and kept the cost down to seventy dollars. She also, again not exactly happily, arranged for me to only come for half hour sessions, once I convinced her that I could do most of the exercises she had taught at home, something it turns out most people won’t do.

I felt really really weird going there: The other patients were all people recovering from broken bones and other serious stuff, most could barely walk into the office on their own. Meanwhile, since I’d stopped running, I wasn’t in much pain just walking around. There I was, biking to the office, feeling kind of silly picking up marbles with my toes as one of the exercises, when the guy next to me could barely lift his leg. And, even though my physical therapist was trying to help me out, I once again felt like I was just being put through a set of standard procedures for all sufferers of plantar fasciitis, without anybody asking how I felt, or if I felt that what we’re doing is effective. She had just read the doctor’s diagnosis, and had me do what everyone else with plantar fasciitis would do. And I suppose that’s her job, but I just felt that these exercises weren’t doing me as much good as everyone seems to think they should, especially the sonogram treatment, which didn’t seem much better than just icing heavily for the same amount of time. By then, I’d also started going to a Chinese massage place at the mall and getting my feet worked on. Twenty-five dollars a session. More money, though less than any doctor’s appointment or physical therapy session, and I sure as hell felt better after a session there than any other place.

In the next year, in addition those three doctors and physical therapist, I spoke with three well-meaning shoe store employees, one well-meaning shoe repair person (also a former nurse), and numerous well-meaning friends and coworkers. Everybody had advice, and some of it even seemed, at the time, to help, like which running and dress shoes have the best arch support, and about certain exercises to strengthen my feet, and that applying styrofoam cups of ice directly to the affected area is more effective (and bearable!) than soaking my feet in an ice-filled bucket. But I also spent hundreds of dollars on orthotics, physical therapy sessions, and sonogram treatments, when I was making less than twenty thousand a year, and had three thousand dollars in my savings account, and I wasn’t getting better.

Meanwhile, in part because I was not running at all, I was getting really depressed. I had also started grad school, was living in a loud crappy apartment building in a loud crappy student ghetto part of Ann Arbor, and starting a new job with a supervisor I was starting to have problems with, or starting to take my problems out on. Running is the thing I would have turned to in order to help me deal with the stress of all those other things. I decided to see a (thankfully free) therapist at school, and when I described everything that was going on, and that I’d gone from being a marathon runner to not being able to run at all, she said, “Well no wonder you’re depressed!” At least she was actually sympathetic. I had begun to be a little angry at the people I had been paying to supposedly help me, especially the doctors, about whom Montaigne, from his essay, “Experience” has this to say:

"Certainly medicine professes always to have experience as the touchstone of its performance. Plato was therefore right to say that to be a true doctor would require that anyone who would practice as such should have recovered from all the illnesses which he claimed to cure and have gone through all the symptoms and conditions on which he would seek to give an opinion. If doctors want to know how to cure syphilis it is right that they should first catch it themselves! I would truly trust the one who did; for the others pilot us like a man who remains seated at his table, painting seas, reefs and harbours and, in absolute safety, pushing a model boat over them. Pitch him into doing the real thing and he does not know where to start" (1225).

None of the doctors I have seen, nor the physical therapist, have ever had plantar fasciitis, therefore, I realized later, I never quite trusted them, because their ‘cures’ seemed ‘by the book,’ standard procedures they’d only read about. Maybe that works for other people, maybe it works better for more minor cases of plantar fasciitus, and I did have to remind myself that my own stubbornness was what got me into this mess, but I felt like I couldn’t even talk to any of them. I’d try to tell them what I’d been doing, my training, my ‘story’ basically, but no one seemed to care. Maybe what I had to say wasn’t as relevant as needing to feel that someone was listening. That counts for a lot. I’d be more willing than Montaigne to work with a doctor who has no personal experience with plantar fasciitis, if they at least seem to want to find out what they can about it, from someone who does.

Fortunately, when I went back out to Arizona for my summer job as a wildland firefighter and received my first paycheck, I decided to splurge and see one last doctor, this time a podiatrist, someone who knew feet, instead of a sports medicine “specialist.” To my surprise, a miracle actually, this doctor was a marathon runner too, and he had had plantar fasciitis himself. Suddenly, somebody was speaking my language, asking about my running history, my schedule, recommending a shoe (the Aesics Nimbus: high arch support and the most cushioning) that he himself used. He also showed me an ultrasound of the bottom of my foot, where the inflammation was, how bad it was (still very, after 8 months!), and recommended stretching versus strengthening.

He also shared a very simple taping technique with me that allowed me to be running that next day. At first I didn’t believe it, already having half-unconsciously resigned myself to never running again. But no, with a simple tape job that basically lifts up the arch of my foot and takes pressure off the fascia, I was able to do a light, slow run of “four-thirties” (run four minutes, walk thirty seconds, repeat) with no throbbing pain in the heel afterwards. It isn’t until the second run, two days later, that I almost started to cry. I didn’t of course, because, like I said, I’m a real man, but I was running again! I’d been worried that if my supervisors found out I couldn’t run, they might put me on light duty for the summer, and I wouldn’t be able to work the overtime and hazard pay hours, with which I could make a lot of money in four months. But no, with doing those minimal runs, plus lots of biking, I was fine.

And yet, I still had questions. I made one last appointment with the podiatrist before I left for the summer. Would I ever heal my feet up back to ‘normal’? He said no. In fact, he still had plantar fasciitus. Would I ever be able to walk on the wood floors of my mother’s house again? Nope. Did he really tape his feet every time he ran? Yes, he said, it wasn’t that expensive. Could I expect to be able to run a marathon again? I never got an real answer on that. He did, even with his plantar fasciitus. He left me with the impression that, as I got older, because I was older, plantar fasciitus was a permanent condition I would have to deal with for the rest of my life if I wanted to keep running. But it being a permanent condition just didn’t seem right. If I pull a tendon, it heals. If I break a leg, it heals. It seemed to me that a fascia was no different than any other body part. How, after almost a year, was it possible that the plantar fascia in my feet were still extremely inflamed, when I’d been doing everything all the doctors and physical therapists prescribed?