Dr. J on Running

Zero to 26.2

On July 23rd, I fractured the fifth metatarsal in my right foot when I stepped off the pavement during a routine noontime run at work. The urgent care physician diagnosed it incorrectly as a Jones fracture. My orthopedist explained that my fracture occurred near the base of the bone, not along its length. Jones fractures carry a fifty-fifty chance of healing without surgery, and necessitate often implanting a pin the length of the bone. Fortunately, mine was not a Jones fracture, and conservative treatment sufficed.

Dr. C gave me a choice between a cast and a boot. Standing in a boot proved extremely painful, so I opted for a red cast. I wore the cast for two weeks, then wore the boot for two weeks, then wore a post-operative Reece shoe for two weeks. On an out-of-town trip to Norfolk where nobody knew me, I swapped the post-op shoe for a New Balance 903 with a homemade aluminum insole, and slipped under the cover of darkness for my first post-injury mile walk. The fracture hurt a lot over the last quarter mile.

I machined the eighth-inch Al-insole last time I fractured a foot 20 years ago in an identical mishap. I had saved the Al-insole as a memento, so I pressed it back into service. I wore the Al-insole to protect the healing bone whenever I exercised on a stationary bike, on a Stairmaster, on a rowing machine or on a treadmill.

Two days after my Norfolk adventure, I went out again for another mile walk with the Al-insole. My foot did not hurt this time. With two workouts under my belt, the time had come for a long-distance weekend workout. So, on Saturday, I went through the weekend ritual of taping my nipples with Band-Aid, carbo-loading with banana and raisin bread, sipping a hot skim cappuccino, and headed to Onondaga Lake Park. I walked successfully two-miles, albeit with a painful last quarter-mile. Week 1 of the journey from zero to 26.2 was behind me.

Dr. C took another X-ray of my foot and proclaimed that the foot was healing, but not healed. He prescribed throwing away the boot and the post-op shoe in favor of a protective running shoe – my faithful 903. He gave me permission to walk but not to run, and ordered me to stop at the first sign of pain. He scheduled another X-ray and another examination four days before Harpers Ferry.

Walking without plantar support proved painful at first, so I reverted to my post-op shoe and Al-insole for several days. I increased gradually my weekly mileage so that the long run equaled the sum of the previous two long runs.

	Short Walk	Short Walk	Long Walk	Week Total
Week 1	1	1	2	4
Week 2	2	2	4	8
Week 3	3	3	6	12
Week 4	4	4	10	18
Week 5	4	4	16 in 4:20	24
Week 6	4	4	10	18
Week 7	4	X-ray	Marathon

Every long run stressed the injury just enough to bring back tenderness and a dull pain for a couple of days. Ibuprofen, rest, ice and elevation helped. Compression was out of the question. I feared that the upcoming X-ray would tell Dr. C of all the liberties that I kept from him.

After examining the X-ray, Dr. C proclaimed the famous “healing, but not healed” diagnosis. He gave me permission to continue walking, but no running yet. I practiced the military policy of “Don’t Ask, Don’t Tell” – I did not ask him if I could walk the Harpers Ferry Marathon on Saturday, and he did not tell me I could not. I asked when he wanted to see me again, and he proposed at my next injury.

Two weeks before Harpers Ferry, I walked 16 miles in 4 hours and 20 minutes, giving me the confidence that I can walk a marathon. Uncertainty remained on whether my fifth metatarsal would withstand 52,000 bends and twists, or whether it would re-fracture. I rested my fate and my faith in Him who gives me strength. I took off a few days after the 16-miler, walked a 10-miler the week before, then tapered off for my 23rd marathon and 23rd state.

Dr Kamal Jabbour feels ready to walk at Harpers Ferry. Dr. J's RUNNING Column appears in Cyberspace whenever endorphins call.