I emailed my PT yesterday because my foot did not feel much better at all. I didn’t want to overreact but, at the same time, I didn’t know what was wrong exactly and if I should do the 20 mile run on Saturday if my foot feels a little better. I just didn’t want to make it worse and perhaps become more hurt and unable to run the marathon. I sent my PT a quick email to see what he thought. His response:
It makes total sense that throwing more hills into the workout mix caused irritation of the extensor tendons in the foot. I like the rest-ice-compression-elevation strategy along with gentle stretching of the calf that you are doing. If the pain persists, then I would be happy for you to come in and we can do some manual therapy to try to loosen up the gastroc, soleus, and plantar fascia a bit to take stress off the tissues on top of the foot. Based on the symptoms you described, it seems unlikely that you have incurred a stress fracture.
Luckily there was a cancellation so I was able to get in at 4 today. My PT said he’s pretty sure it’s not a stress fracture and probably not even tendonitis. He said my tendons are definitely irritated and inflamed. He said this is probably just due to the hill running and the tight sneakers, as well as tight calves. He said my arch probably hurt because of tight calves. Movement in my left foot is restricted so he a lot of foot squeezing, stretching, massaging. Luckily after Saturday, we taper. I think my body is telling me it’s time to taper.
He thinks I’ll be okay on Saturday. My foot improved today so hopefully by Saturday I’ll be good to run…20 miles. It actually doesn’t hurt to walk at all. I’ll just have to be careful tying my sneakers!
You can see in the picture below the tendons in front of my ankle that are irritated. When I bent my foot while running uphill, there was additional pressure on those tendons, especially with tightly-tied laces!