An Unscheduled Interrupture

It’s tricky to write a race report about a race that results in injury. Hard to write about running when you can’t run. So yes, I won the Tampala Headlands 50k over a month ago (yay!), but the victory will always be tinged with something sour. At mile 25 of the race, I ruptured the medial branch of my plantar fascia.

Oddly enough, that’s not even the worst of it.

It had been the kind of build-up we all hope to have and almost never quite achieve. An even-keeled, deliberate ramp-up that delivered peak physical fitness at exactly the right time. Even better, this was coupled with a mental state of stoke that is often equally as elusive. Within an eight-day period on my biggest training week, I hit over 110 miles and over 16,000 feet of climbing. I should have been tired, but I was hungry for more. During this same period, others were training for UTMB races in a manner that left me feeling like something of a slouch. Talk about motivation.

For as fit as I was, there was a nagging heel issue that flared up whenever I did a big vert run. This didn’t hold me back because, well, isn’t there always something? It would calm down in between efforts, but never quite went away. No matter, I thought, the taper will fix that. And for the first half of the race, it did.

Racing on the Marin trails is always a treat. It’s been a while since I’d been up there and I’d almost forgotten the delight of freefalling down singletrack with sideways glances of the Golden Gate Bridge, or the grind of steep climbs in thick fog over the Pacific. I had run some of the trails before, but there was a lot of new ground to discover. The kind of trail running that’s at the very essence of why we do this. Exploring something new, fast, on foot. It’s pure joy.

img_5127

Photo: Victor Ballesteros

The trails were a mixed bag of everything Marin. Fire road, singletrack, road, steps — so many steps! — the infamous Steep Ravine ladder, roots big enough to act as (more) steps. Steep climbs, long climbs, switchbacks, screamers. In advance, everyone said to save some for the last long ascent. Then they paused and told me again, looking me straight in the eye. The last climb is brutal, they said. But hey, this is ultrarunning. Wouldn’t want it to be too easy.

On the day, it was more brutal than I could have imaged. Sure, I was working hard, but this was a 50k. I was prepared and had paced it reasonably well to endure steady suffering over what for me is a fairly short, if intense, distance to be racing. No, the brutality was the rip I felt in my plantar on an especially steep section at mile 25. I paused for a few moments, not sure quite what to do. Ultimately, I realized that the damage was already done. I still had almost 7 miles to go (the course ran a little long this year due to a re-route) and I was in the lead. If this turns out to be the last race of my season, I reasoned, I may as well win it.

I lost plenty of time over those last miles, hobbling up to Cardiac aid station, asking if they knew how close F2 was. They assured me she was some way back, but I guessed that F2 was Kate Elliot, a strong runner from Santa Barbara that I’ve run with before. My lead wouldn’t last long at the rate I was going. I made my way up the trail by putting all the weight of my damaged foot on the outside ball rather than the heel. That wasn’t going to help me on the three-and-a-half mile descent down to the finish though. As I crested the hill and started descending, the severity of the injury was apparent, since there’s not much way to avoid using your heel on the downhill. Still, I was determined to press on. I could almost see the finish line from there. Bombing runnable descents is my favorite, but not that day. That day I cried as I made my way down the switchbacks and then onwards to the finish.

img_5123

Landing on my injured foot at the finish. Note the pain face. (Photo: John Medinger)

Fast forward and four weeks later the plantar was healing well. It had taken a couple of weeks to get an MRI and diagnosis that there was a full rupture (and a partial rupture of the central branch). I had tried a couple of runs but I knew it wasn’t ready. So I hopped on the Alter G (anti-gravity treadmill) and had a few sessions. It felt amazing to run again and my foot felt acceptably fine.

After just three runs on the Alter G, which were alternated with pool running to be on the safe side and allow for recovery, I felt something odd on the top of my foot. Pinpointed pain. I was confused by this, and dismissed it as a tweak. It didn’t go away.

A few days and a few runs later I had another MRI and another diagnosis. It was a bone bruise caused by unconscious compensation. My footstrike had changed with the plantar injury, causing an undue amount of pressure on my outer foot bones. My 4th metatarsal found this unforgiving, swelled up and caused microfractures on the inside. Essentially, a pre-stress fracture.

I’m in a boot for a couple of weeks here as I allow things to heal. It’s definitely going to change the game plan for the rest of the season. After at least six weeks of injury, there’s going to be a lot of fitness lost. I was in a rush to get back to things initially, but that was before the bone bruise.

Realizing that I was doing too much too soon was hard to accept. After the new diagnosis, it forced me to take a step back and accept the reality. I could take two weeks now, or risk months of injury. The process of getting to this point, when I had big dreams and goals for the end of the year (always my strongest part of the season!) was something akin to grieving. Denial. Anger. Bargaining. Depression. Finally: acceptance.

I don’t know when I’ll be in good enough form to race again, but I’ve come to accept that uncertainty. It won’t stop me dreaming big or trying hard. I’d love to get in a race or two before the end of the year if my body permits it, though I don’t know if that will happen. First and foremost, I’m committed to giving myself the time I need to truly recover. If you’re curious about how I’m handling cross training during this non-running period, check out my Strava. Over the past few weeks, you’ll see, it’s all there. The denial, the anger, the bargaining, the depression and, yes, the acceptance.

img_5126

Enjoying catching up with friends at the finish. Almost better than the race itself. I love this ultrarunning community. (Left to Right: Victor Ballesteros, me, Alex Varner, Jena Ballesteros. Photo: John Medinger)

9 thoughts on “An Unscheduled Interrupture

  1. Caroline,

    I didn’t write a report after my race on 8/19 which resulted in a boot/stress fracture. I am hoping to be cleared soon, and totally relate with your post! I wish you a speedy recovery! Great job writing this! It helps me too 🙂

    • Thanks for sharing that Traci. I’m so sorry to hear about your injury! I didn’t want to write about it for the longest time, but injury is part of running and life isn’t always roses. Heal fast lady!

  2. I’m very sorry to hear of your injury, Caroline, but you will be back very soon. I had the exact same injury last fall, but my foot still isn’t quite “right”… maybe never will be. Unfortunately, I’ve got heel pain on the same side again. What did your heel pain feel like in the weeks leading up to the race? Medial/lateral, morning/night, etc. I’m curious how PF and PF tears present in different runners.

    • The heel had been bothering me off and on for about 18 months. It flared up badly doing big runs with lots of climbing and descending. The majority of the pain was in the attachment to the calcaneus (heel bone), which is much further back than I think of with classic PF issues. The arch only started becoming irritated in the last few weeks before rupture. I hope you’re able to get back to 100%. Don’t delay seeing a true expert on the matter — I did, and look where it got me.

      • Thank you for the reply! My original case was somewhat atypical as well, definitely not “classic” PF before the rupture. I work in medicine, so thankfully I was able to get appropriate imaging and care right away. I rehabilitated well and continue to do maintenance foot rolling/strengthening/mobility but as I said… that foot still doesn’t feel quite right. Especially now that I’ve got heel pain again, but even at baseline, the foot just feels weak/uncoordinated at times when running. Hard to explain, even harder to fix – please be patient with your recovery and remember to build up the rest of your legs… your weak foot will magnify any imbalances higher up in the chain when you get back to running.

  3. Pingback: Ultramarathon Daily News | Mon, Oct 2 | Ultrarunnerpodcast.com

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s