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Monday, February 15, 2010

The Vibram / Top of Foot Pain Connection?

I've officially begun my next training cycle.  My goal race- Mind the Ducks 12 Hour in Rochester, NY on May 15th.  Training for this race will require something I have historically avoided- lots of miles on flat, smooth ground.  I love trails... so much so, it's all I've done this winter.  For whatever reason, I decided to go for a long run earl Sunday morning.  I woke up at 3:30 and was out the door by about 4:00.  

The original plan was 17 Vibram-clad miles.  At about mile six, I realized the mileage was a bit optimistic.  I turned back.  By mile seven, I noticed a familiar twinge on the top of my right foot.  Top of the foot pain.  The bane of barefoot runners.  By mile eight, I was reduced to a shuffle.  By mile nine I was unable to run.  I walked the remaining two and a half miles.  The frigid temps combined with thin, sweat-soaked clothing made the trip miserable. 

After returning home, I assessed the situation.  It hurt to run.  It hurt to walk.  If I flexed my foot in any way, it hurt.  I hobbled through the rest of the day.  I was expecting to be out of action for at least a few days.

I am pleasantly surprised to report the pain completely vanished.  I ran 2 miles at a fast pace this afternoon without any discomfort.  While I am ecstatic that my training wasn't derailed, my curiosity is driving me crazy.  Why did the pain start and why did it vanish?

Typically, TOFP is a symptom of doing too much too soon.  It occurs when the soft tissue of the foot adapts to the rigors of barefoot or minimalist shoe running.  It's not a serious condition and it does require one to back off training to a degree.   This was different.  The run was shorter than the trail runs I've done over the winter.  Could it be the roads?  Could the flat, repetitive nature of road running have been the culprit?  Or was it my choice in footwear?

I was wearing my venerable Vibram KSOs.  I've had these shoes for about three years.  I've run approximately 700 miles in them.  They have been my choice for gym footwear since I purchased them.  They smell horrible.  And I love them.  However... they could have been the cause of the injury.

It has long been speculated that the strap on KSOs that transects the top of the foot somehow causes TOFP.  I have always questioned this assumption... it simply doesn't make sense from a physiological standpoint.  Having said that, I've had three incidents of TOFP in the last four years.  Each one occurred when wearing those KSOs (I do almost all of my running barefoot.)  Part of the mystery may be the tightness of the strap.  If over-tightened, others have reported experiencing TOFP.  

My question to the greater barefoot/VFF running community- what are your experiences with this?  Is it something you've experienced?  Anyone have a good theory that explains the physiology?

22 comments:

  1. Jason,

    I have the standard KSO's and have never experienced this pain, either in the KSO's or when barefoot running. I have however had to stop very quickly after starting when I have noticed the strap is too tight, as it definitely causes problems.

    I have found the best way to get the strap tightness correct is to put the VFF's on without tightening them up, then stand up and adjust the strap while standing. If I do the strap while sitting I find I rarely get it to be comfortable. The foot is "smaller" when sitting and invariably the strap goes on too tight.

    I have found I can generally have the strap slightly loose (this is a very subjective term), not loose enough to rub but loose enough to not notice it, and this works a treat for me.

    My 2c.

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  2. I've had that problem with my classics, but not elsewhere. I figured it was caused by overuse, and maybe the strap on the classics.

    VFF's allow over-running without noticing it. Over training while barefoot is much more noticeable because of wear on the sole. There is my guess :)

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  3. Hey Jason, still a bit new at this but although no significant TOFP, a definite "red" mark along the top of foot where Classics are probably tight. Slight tenderness for an hour or so then goes away. But heck, still just at 5km. Glad your training on track.

    Duncan.

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  4. I definitely associate the TOFP I encountered with keeping the straps too tight. The pain would come and go, but about three months in it became really noticeable, and my feet appeared quite a bit swollen. I started running with the straps dramatically looser, and the swelling went back down. I now just keep the straps on as more of a 'decoration'.

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  5. I usually keep the strap quite loose. I could probably do without it.
    What I am noticing though is that if I take a break from running or reduce my mileage drastically, I have to retrain my feet to get used to VFF running. I can run several miles in Nike Free without problems but not in VFF's. Right now I have some pain on top of the foot (yes, I overdid it) but most of the pain is along the outside of the foot. So for me it is definitely too much too soon.

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  6. well you know, TOFP plagued me for 5 weeks after 1 bout of too tight strap. the pain originated where the strap sits and radiated down all the heads of my metatarsals. easy solution, don't tighten them... especially on road running.. you just don't need to

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  7. I started running in KSOs a few months ago. Took a while for my calves to adjust, but a little over a week ago I finally hit three miles. Calves are strong now, but getting TOFP on my left foot. I don't think it's the strap. My pain is just behind my toes, centered, with swelling. It feels like something is broken - but how would barefoot running cause it?

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  8. I had run in VFF four or five times in the two weeks prior to a half marathon I had planned (DC National). At home I felt TOFP walking around and thought it might be the strap, so I cut the strap off. It did not feel much different, maybe a little less TOFP but it was still there. (A side effect of cutting the strap was the shoe flexed differently as the strap no longer connected around the heel. I got a blister from that on the inside of one foot.) I experienced no TOFP during the race after mile 2 or 3, however, I definitely feel it even two weeks afterwards when walking around and at the beginning of runs. The following thread, whose source of knowledge is barefoot Ken Bob, suggests that pushing off with the toes is the source of the problem, since, when completely barefoot, you can't do that due to toe blistering, and VFFs mask that toe pain:

    http://www.runnersworld.com/community/forums/runner-communities/barefoot-running/vff-top-of-foot-pain-something-learned-this-weekend-kenbob/.0

    Now that I have done some research on TOFP I am going to go out for a run and try to not push off with toes. Thank you for writing this post!

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  9. This sounds like extensor tendinitis. Try the cotton ball trick to alleviate the pain during rest times:

    http://thatlinuxbox.com/blog/article.php/20100625125949716

    Barefoot Ken Bob would say that this kind of pain is caused by technique. Perhaps you get tired after a few miles and your form deteriorates just a little which triggers the tendonitis. I'm just starting out with barefooting and Vibrams so I'm sure my pain is caused by lousy technique.

    I am also wondering if this is the VFF fatal flaw... they are too snug and prevent the toes from splaying as far as they really want to. Apparently some people get this same tendonitis condition from "conventional" running shoes if they tie the shoelaces too tight.

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  10. Vibram five fingers shoes has lot of controversial just like other running shoes. But for me vibram five fingers shoes is comfortable and light on foot. I like the shoes.

    zbsports

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  11. I just bought a pair of the blue ones, I was told they were the original ones, Bikili or something like that. Anyway, I've run in them twice. the first time was 5 miles of walking/running through the hills of Ojai, California with the Hash House Harriers. I also went on a 2 mile hike today up into the hills of Ventura with them. I notice top of the foot pain with them and I don't think it has anything to do with the strap. I think they are just too tight across the top of my foot. I can barely get my finger under the top lip of the shoe to pull them on. Is the top of my foot too high/tall/fat/thick? I don't know. I was thinking about taking alittle cut into the shoe, but hate the idea of doing that to a brand new pair of $100 shoes. I'm hoping i get used to it. Otherwise I'm in trouble and may have to go back to my Teva Flip flops. Happy to report that I have calf soreness after these runs, but the shinsplints I was getting pre-VFFs is no longer occurring.

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  12. Thank you SO much for this post and to everyone who followed up with a comment. You've helped to restore my sanity.

    I've been running in Vibram Sprints for almost a year and I have some minor pain (feels like a bruise) on the tops of both feet right now. I consulted Google to see if anyone else out there experienced it as well and came across several people saying it could either be a stress fracture or dorsal interosseous compression syndrome.

    After reading this post, I'd say it's much more likely to be what I'm experiencing. Thinking back to my last run, I think I definitely over-tightened the straps. I'll try going easy on that and see if the pain goes away.

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  13. The trick to combatting top of foot pain is to relax your feet, especially your toes. You should feel like your feet are rolling forward, not bouncing from one footstrike to the next. If you do it right, you can get a significant amount of free energy back from your feet and toes; your feet should feel much better better instantaneously.

    The reason so many people have this problem in Vibrams is that VFFs have a tendency to squeeze your feet, making it a little harder to relax them. Try doing most of your running on a soft surface, such as grass, while your feet heal (if your feet are moderately or severely painful, don't run at all until they feel better). Try eccentrically stretching toes and walking with your feet and toes relaxed. You may find that you need to lean forward a little bit more to take some stress off of your metatarsal heads.

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  14. I have run about 100 miles in the Bikilas now. I experienced pain on the top of both feet because the strap was too tight. I basically just wear it loose now. However, I am still experiencing pain in my left foot and I think it is because my second toe is longer that my big toe and may be hitting the front of the toe pocket when I run.

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  15. I have very flat and very pronated feet. I have all kinds of custom orthos and have suffered through TOFP on and off for a long time. I just purchased VFF's and have put all the orthos in the closet. Unfortunately after my first run in the VFF's the TOFP is back. I think it's bad form. Tight straps or laces makes the problem worse but it all stems from the form.

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  16. My girlfriend and I both recently got pairs of Vibrams and she has been experiencing pain on the top of her feet since we started running in them. We had been wearing them around for a few weeks casually and have only recently started to wear them jogging lightly and she started feeling it after the second day. She has been wearing high heels almost exclusively for years, much to my dismay, and I have always assumed they have caused some damage in her feet. I never considered that she may be wearing them too tight and I will have to ask her about it.

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  17. I loved reading this post, and I appreciate all the comments! I have just started my VFF journey, and while I don't have the model with the strap to worry about, I do have some mild pain while my feet get used to the new shoes.

    Hope everyone's issues get resolved soon - it would be so simple if it's just the tight strap rather than a flaw in the shoe design.

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  20. Got the vibram run 3-4 mikes for three weeks and it was fantastic then yesterday I run 7 mikes and after returning home I could not walk!! I love those shoes but do I do something wrong? Help should I try after one day rest again or switch shoes? I run on concrete?
    Thank you to help
    My feet hurt on top only

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