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#187588 - 11/04/14 04:11 PM Shoe/Boot -- Ankle Issues
Noonie Offline

Registered: 10/21/14
Posts: 22
Short description: high boots make my achilles sore, minimalist shoes give me tibialis posterior pain. Feeling stuck!

In the last few years I developed very minor Tibialis Posterior Pain. It started after I switched some footwear to minimalist shoes, and first came on when running. I was always careful to not push it, and as a result the pain/sensitivity never got worse than 3/10. I stopped running for a year, and the pain was either not there, or a 1 or 2. I've been to physio and ultrasound worked nicely. This was about a year ago, after it happened again when I started running. When wearing minimal footwear I infrequently get this pain, but I'm only wearing this footwear at work, around town, etc. No long walks, hikes, etc. I've googled this condition and to compare what I'm seeing/reading, I have a very minor condition (but it lingers).

I've now taken up hiking, as an alternative to running. I went for a 10k hike a couple of weeks ago, in new soft winter boots. I took it easy. The boots actually felt awesome. During the hike I was very comfortable. Later in the day - still great. Next day, and about a week after, sore achilles. I had achilles tendonitis about 10 years ago...never surfaced again until after this hike. I'm assuming it's because the higher boot wrapping around the tendon.

Frustrated, I did my next hike (5k) in my minimalist footwear (vivo barefoot). Again, felt amazing during the hike and later that day. Next day, and several after I feel that sensitivity, I think, due to the tibialis posterior.

I'm now confused between wearing hiking boots, trail runners or similar low cut shoes with cushioning, drop and maybe even stability...versus continuing with my minimal footwear (which I've worn for years). Lastly, I'm just a day hiker, out there exploring for no more than a few hours at a time...and my trails are not too technical (though there are rocks that want to turn my far no issues there).

I'm fairly certain my PT (going next week) will say to get an orthodic for shoes, and likely not wear boots (unless needed).


#187590 - 11/04/14 04:32 PM Re: Shoe/Boot -- Ankle Issues [Re: Noonie]
aimless Offline

Registered: 02/05/03
Posts: 2964
Loc: Portland, OR
My basic thought is nothing earthshaking: what works for you is all that is important, so unless our personal experience closely tracks with yours, our advice will only be guesswork. On the other hand, if your PT has the kind of experience and training necessary to correct your problem, then your PT's advice will count for much more than whatever we can suggest.

My only other thought: if at first you don't succeed, try something different until you succeed or exhaust the possibilities.

Good luck.

#187595 - 11/05/14 06:28 AM Re: Shoe/Boot -- Ankle Issues [Re: aimless]
Gershon Offline

Registered: 07/08/11
Posts: 1109
Loc: Colorado
In my opinion the problem may lie in the distance and not the shoes. I advocate never walking far enough to cause pain. It may take months or even a couple years to build up to the distances you like, but in the end it's possible to walk injury free.

In general, I recommend not trying to walk quickly. Speed comes naturally when the body is ready and the brain has learned how to safely walk faster.

My pain management opinion is to turn the mechanics of walking over to the subconscious. Inform the subconscious you want to walk without pain. Part of the deal is to stop for the day at the first signs of pain in critical areas.

I suggest getting a pedometer like the Fitbit Zip. I've found steps count the same whether walked around the house or walked on the trail. Steps around the house seem to be a bit more strenuous because of added time on the feet.

The simple method is to limit yourself to the steps per day that doesn't cause pain over a seven day period. If you are planning a hike, limit your random steps so you don't exceed the daily average mileage by much. I suggest taking a day or two off if something starts to hurt -- even a 1/10 pain level.

This sounds extreme, and it is extreme when compared to most opinions I read. The reward after about 2,000 miles, yes, 2,000 miles, is a walking system that can walk many miles with no pain or fatigue.

The reason it takes so long is different areas of the walking system will start to hurt a bit as different distance plateaus are achieved. The Achilles tendon is an "early mile" injury. It can also be devastating if allowed to get worse.

Later, you may experience other problems. My progression of minor pain was a tender heel, minor knee issues and what I'll call non-specific tired foot syndrome. In each case, I reduced the miles, took some time off and approached the previous mileage cautiously. Eventually, the pains stopped occurring and I was able to increase my mileage.

If a doctor recommends medication, I would stop walking while taking it. When the pain disappears, then you can start walking again beginning with low miles. If you mask an injury with medication, you are likely to make it worse.

Another issue may be wearing the hiking boots only when hiking on the weekend. There are many micro-muscles in the walking system which develop specifically for the footwear you wear most of the time.

It may be impossible to walk many miles without injury if you don't wear the same shoes all the time. The reason is the muscles develop differently for different types of shoes. The development for a soft midsole shoe may be the opposite of that needed for a hard midsole shoe.

There is absolutely zero research on walking without pain and there is zero research on walking normally. All the research is directed at people with problems caused by age or injury. There is little research on the proper type of footwear. My opinion is that if the footwear leaves enough room for the toes and it doesn't cause any obvious issues from pressure points, it will work. The differences will be in efficiency.

Walking without pain requires almost daily walking with time off for slight pains, general fatigue or a need for more sleep. The micro-muscles in the walking system start to atrophy after a few days.

#187616 - 11/07/14 06:00 AM Re: Shoe/Boot -- Ankle Issues [Re: Gershon]
Noonie Offline

Registered: 10/21/14
Posts: 22
Gershon - your advise is wise thanks

What is challenging though, is when you complete a hike/walk, and at the time feel no pain. Then you wake up the next day with pain. This was the case with me and my achilles a couple weeks ago. And I did adjust my hiking distance the following week (down to 1.5 hours and slightly less technical terrain), but in minimal shoes that never bother my achilles. Result was no pains afterwards.

I guess with my winter hiking boots I'll need to go out for maybe a 1hr hike and then monitor during and after for any pain. If good, I can increase next time.

Here's the thing that makes me shake my head...I'll go with the family to an amusement park and walk for 6-8 hours (not continuously, but I am on my feet 99% of the time). I'm tired after, but never in pain. Sure it's not technical...but when I'm on technical terrain I'm "trying" to wear suitable footwear, but then maybe it doesn't actually make the terrain less harsh on the body?

I'm sure I'm over over-thinking it, but it's a little frustrating when you want to be involved in an activity, and one that (where I live) doesn't on the surface appear to be too challenging, and you're held back by issues that don't crop up anywhere else.

#187630 - 11/09/14 06:27 AM Re: Shoe/Boot -- Ankle Issues [Re: Noonie]
Gershon Offline

Registered: 07/08/11
Posts: 1109
Loc: Colorado

It sounds like we are both over-thinkers. One of the best things I did in this past year is record my over-thinking and write a book about it. The second best thing is I split my brain into two parts: my coach and myself.

My coach is my subconscious and I'm my conscious.

If you want to see a sample, you can look at the inside view of the book here.

There is some science to making it a conversation with your subconscious. The way to program your subconscious is to talk to it. If you don't, your subconscious will absorb information from others. That information, including mine, may not be appropriate for you.

If you keep a journal, you may be able to find the answer yourself. I turned the book into an audio book and sometimes I listen to it when I walk. I did this using "Natural Reader." Reviewing my journal reminds me of the various training contracts I've made with myself.



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