Side of Foot pain that started a couple days after long run

Question
QUESTION: I'm 5'2", about 133 lbs (36 yr old female) and have been following a gradual walk/run plan for the last 13 weeks in preparation for a 1/2 marathon that's in 6 weeks.  All my other attempts at running have usually resulted in injury from too much too soon, so I've been trying to be conservative.

However, I think my treadmill has done me a disservice in that it doesn't prepare you for the uneven surfaces of the planet.  Most of my training has been on the treadmill, including 2 long runs of 8 & 10 miles (because I had to fit them in at 3am and didn't feel safe doing them outside) I do shorter runs outside and haven't had any problems over minor soreness.

Sunday, I did my 8 mile run outside, mostly on a park path, with some sidewalks and roads in places, nice hills - not too steep on the ups and downs. I'm a slow runner, and did not try to go for speed, but a comfortable pace.  I stretched beforehand and felt great for the whole run, until the last mile or so, when my knees were starting to ache a little and I figured all the uneven surfaces, and the downhill was finally starting to be felt. When I finished, my knees immediately complained, right under the kneecaps. I iced, ibuprofen and elevated the knees Sunday, last ibuprofen taken on Monday morning.

Monday my knees only hurt if I was going up/down stairs, but my calves were now tight and sore. By the end of that day, the outside of my right foot was starting to hurt (but not much.)

Tuesday my knees were back to normal, my calves had no pain, just a light tight feeling - but my right foot felt like I was walking on a giant bruise with every step. I took some more ibuprofen that afternoon.

Massaging it causes no pain, and it doesn't hurt if I'm not doing anything with the foot. Pointing my toes makes it hurt a little, putting any weight on it hurts significantly more. There is no swelling or visible bruising.

The pain is mainly on the outside - side of the foot about halfway between the little toe tip and back of the heel. When I walk, the pain radiates out to underneath and along the sides (but not all the way to the heel, ankle or toes, or the even the whole arch) I've been icing, elevating, compressing. The ibuprofen isn't helping with the pain when I have to walk. Shoes of any type seem to make it hurt more & faster than walking barefoot.

The weird thing is that there was not a hint of this foot pain during the Sunday run or after it until Tuesday. After doing research, I think my sore calf might have contributed to it. (even though both calves seemed equally sore, only one foot hurts)  I haven't done very much walking and no running (although a short run was planned for Tuesday, it got skipped) since Sunday. And no other activity (like getting kicked in the foot by a horse) to explain the problem.

Do you have any idea what this could be?  And why it took so long to present itself?  I'm planning on going to the doctor if it doesn't get better soon. But I'd like to have some idea in case I get the standard "stop running" advice. (My doctor is better than that, but she's not always who I get when I have to do a drop in, and some of the others are lazy.)

Sorry this is so long, but hopefully it's more interesting to read than it is to run 10 miles on a treadmill in the basement. :)

ANSWER: Erica,

This one is difficult w/o seeing the "exact" spot on your foot.  My first thought is tendonitis of the peroneal muscle tendon.  This tendon attaches at the location you describe having pain.  Your peroneals stablize your foot when walking/running.  Your injury sounds like its from a combination of a long'ish run + slightly unstable surface that you're not used to + weak peroneals due your regular treadmill running.  Treatment for this injury is the same as other soft tissue injuries....anti-inflammatories, ice, massage, etc.  I believe this injury should respond quickly to the treatments you are giving.

There is a chance that this is plantar fasciitis or mortons neuroma but bc you describe the pain on the outside primarily, I doubt that these are the culprit.

I would consider buying a $20 stability disk and doing balancing on 1 leg....starting out at 1 minute per leg and building to 3-5 minutes each.  This will increase peroneal strength and ankle stability.  I would also try to run more regularly on the roads.  I know, easier said than done.  Finally, you can buy a $20 foam roller that will massage your calves and peroneals and break up any scar tissue.  Painful at first, but gets better over time.  And, its cheaper than paying $60 a visit for a massage therapist.

This is the best I can do given the information you provided.  More details on the "exact" location, the quality of the pain, how its doing now after a few days, etc. may help to pinpoint a bit better.

Hope this helps, Larry

---------- FOLLOW-UP ----------

QUESTION: Thank you so much for the advice! It's now the Sunday after the run and it's been getting better each day.

Saturday it didn't hurt at all until we ended up out on errands and I had been walking for over two hours on hard surfaces.  Then it starting aching a little when I'd complete my step before picking up my foot. It no longer hurts to put weight on it.  I even hopped twice on the right foot to test this theory. So now it instead of hurting mainly from putting my weight on it, it seems to only start to ache from stretching the foot as my heel comes off the ground to finish the step right before the ball of the foot leaves the ground.  (like standing on your toes, calf raise type motion)

This achiness (I hate to call it pain now, it's not that bad anymore) is pretty much staying in the middle outside side of the foot and not radiating out at all. The pain radius is about the size of a nickle.

I've ordered the disk and roller, so I'm waiting for them to arrive.  I'm planning a test run around the block later today, when my hubby can run with me, just in case I have a problem.

The quality of the pain: Tuesday when I woke up and got up it was pretty bad, I was limping and every time it touched the floor with any weight there was more pain. Not putting as much weight on it made it hurt less and it would slowly hurt slightly less if I hobbled around enough carefully, but still hurt enough to limp the whole day. (and it would seem to hurt more after I'd been sitting for a while) I would put it on par with bad cramp pain or really bad bruise pain.  To compare: It wasn't as anywhere near as bad as my knee injury almost 10 years when I heard & felt something pop and the next morning I almost cried when I put weight on it getting out of bed and it gave from the pain.  I went to the doctor for that as fast as I could. (It healed great, btw, no surgery was needed and it hasn't given me problems since healing.)
This was more awkward and painful, with fast relief when I'd get off the foot & let it be.  Ice seemed to help the most.  It hurt, but not acutely enough to make me hurry to the doctor.

Each day it hurt a lot less. Wed & Thur were each better, but hurt enough that I limited my walking and kept icing as needed, and took some ibuprofen once a day. Friday it barely hurt in the morning, but walking irritated it fairly quickly (no limping.) Saturday: no pain in the morning & took quite a bit of walking to irritate a little (no limping.) This morning I can tell I walked awhile yesterday, but it's more like a minor muscle soreness quality of pain, like I should be able to massage it, or work it out a little and make it stop hurting. (still no limping.)

I had called and to get my doctor would be middle of the week, and I figure it will be pretty much better by then (and I'll seem like a hypochondriac with no pain to present) - so I'm hoping armed with this new knowledge I can keep training and be ready for the half in five weeks.

Thank you again for the help. If you still think it's probably peroneals after the additional information provided, is this the kind of thing that you can run through a little to help it get stronger (as long as you can keep your form?) I had to do that with shin splints to ultimately get over them (with my doctor's approval and things to look out for.)  More importantly is this the kind of thing that if it happens halfway through the half, I can still finish?  I want to finish the race, but not if I'll have to spend 6 weeks recovering from stupidity.  I want to run as a lifestyle after the race for as long as I am able. The race is just a means to an end to build up some endurance for the long term.

Thanks again, Erica

Answer
Erica,

I'm still going with peroneal tendonitis.  Treat it gently.  It is obviously not healed yet.  Even though its getting better, if you start training again as if nothing happened, it could bring you back to square one pretty quickly.  The bottom line is that you have the fitness to finish the half, even if you do no more long runs.  You've completed the 8 and 10 milers, thats plenty.  The number one thing that will stop you from finishing is being aggressive with this injury...and training through it.  I would recommend cycling or some other non-weight bearing activity for a few more days...continue the icing, NSAIDS, etc.  Two other things you could try.......relace your shoes to give yourself more width in the forefoot....sometimes pressure from the shoes can irritate the tendon............number 2, put a piece of moleskin or a foam pad on top of the site of pain....this may also relieve pain.

My usual rule of thumb for soft tissue injuries is that you feel like you're healthy 1 week later, but you really are healthy 2 weeks later.  It's the second week where people start trianing at 100% and re-injure themselves.  Stay conservative this week, try some non-weight bearing cross-training....work yourself on the foam roller when it arrives.....start slowly on the disc...dont want to irritate the tendon......i'm guessing your running should be pain-free in another week if you take it easy.   again, don't worry about losing fitness, you've got the endurance to finish...even w/ no more long runs.

Re: running through pain......in training, I would say that aching or discomfort is acceptable, but pain is not....altered gait definitely is not.  Icing immediately after the run is the best thing you can do for it.  In the race, achiness or discomfort is OK.  If you feel pain, I would recommend a 1-minute walk, then return to running....and continue throughout the remainder of the race.  Basically, run until it hurts...then walk until it doesnt, repeat........this will get you to the finish line if pain pops up during the race.  However, if it still is painful during walks, I would actually stop for a few minutes and sit down.  Then, get up and try again.  If pain doesnt subside at this point, I would consider dropping.  It's only one race, there's plenty more down the road.  Hoping this isnt the case.

Good luck to you, Larry