Rx: Ironman

Diagnosis

So I did a lot of reading (and it seems not much else) on what I thought my foot conditions could be last week, and none of it seemed to completely fit. I finally decided that I had components of a couple of different common athletic injuries but still wasn't confident in my own self-diagnosis, so I scheduled an appointment with a sports med doctor. Some things just weren't making sense, like why it hurt more for me to bike than to run, why it hurt for me to push off the wall during my swims, why I didn't have pain right away in the morning, why my heels hurt so bad, and why I was having pain near but not quite on my Achilles tendon. I made the appointment on Thursday and got in today. I just wanted to know what exactly I'm up against here.

I came in to work early this morning so I could leave for an hour to go to the appointment. The doctor came in, took a look at my feet, listened to my description of the pain, had me walk barefoot for him, stand on my toes, and push against his hands with my feet. He then felt all over them for pain and finally tapped right on the part that has been sore. He asked if it tingled, and I told him that it did tingle down my foot and toward my toes. Diagnosis: Tarsal Tunnel Syndrome (think carpal tunnel syndrome for your feet). Apparently it's fairly rare, but it totally fits with my symptoms. Working with physicians every day, I know that they are not always right, but in doing a little bit of research, this really does seem to be my problem. It's likely caused by my VERY flat feet and thus tendency to overpronate. The posterior tibial nerve gets compressed and then causes pain, tingling, burning, or other abnormal sensations in your feet. It may radiate through the arch, around to the bottom of the foot, or to the toes. I asked the doctor what will happen if it gets worse. He told me that if the pain gets worse it could start traveling up my leg and down my foot, or things may just start to go numb. Great.

My problem: biking irritates it the most. Every time I push down on the pedals, it compresses the nerve. The doctor told me to try using insoles for fallen arches and also try new bike shoes. Sweet! I was feeling a little guilty about the new pair I bought last week and hadn't used them yet. I guess it's time to break them out of the box. I'm going to need to figure this biking thing out, though. It's not like I can just cut the biggest IM component out of my training. I guess I'll just have to see how this week goes. Due to time reasons this weekend, I had to cut the long ride out of my training, which I was feeling super guilty about until I realized that I could modify the next couple of weeks of training. More on that later.


The other treatments that I need to keep doing include icing (check - I've been icing a couple of times a day already) and NSAIDs. Being a pharmacist, you'd think I'd have been on that already. Not so much. Daily scheduled NSAIDs for 10 days here I come.

I promise to post again very soon. Work has me gone almost 12 hours a day, and by the time I work out and try to get some sleep, there is literally no time left in my day. I made a few modifications in my training program yesterday. I was worried because I missed my long bike on Sat (had to head up to a 1 1/2 day vacation with Steve's family). I was also worried because this Sun I am scheduled to do a 1/2 IM, but my training plan called for a 5-6 hour bike ride. In looking toward the end of my program, week T-4 was supposed to be a recovery and then week T-3,2, and 1 were supposed to be tapers. I wasn't really excited about doing essentially a month long taper. Three weeks sounds much better to me, so I'm cutting out week T-4. I'm going to repeat last week's training plan, which fits in perfectly with my half IM this weekend. Fri is a long swim, Sat is off, and Sun I'm replacing my 4.5 hour ride and 30 min run with the race. That means that I have room for 3 more long rides after my half IM, which makes me much more comfortable (assuming the foot holds up). I'm not as worried about the run, and I'll keep working on the swim. Darn. I was hoping to feel more confident at this point. Guess the last two weeks have just not been confidence builders.