Recovering from a Foot Fracture While Triathlon Training
Introduction
In this blog, I want to cover my experience, both mentally and physically, when dealing with a 5th metatarsal foot fracture. I will explain how it happened, what I did immediately after, the treatment, and the steps I took to resolve the injury as fast as possible. The purpose of this blog is to share my experience with others in similar situations. When I first googled for help, I came across a variety of Reddit and Slowtwitch posts discussing the issue, but it was a bit of work to piece together what I could expect.
Primarily, I want to provide a timetable for recovery. I will tell you exactly what the orthopedic surgeon told me. I will share where I found examples of maintaining fitness during this time and what my coach (a top pro triathlete) had me working on. With all that said, let’s get into it!
1. The Injury
April 3rd, 2024, started out like almost every other day. I was in the pool at 5 am doing laps and had a somewhat standard run planned once I got home from the pool. About 1 hour with the last 30 minutes as a progressive tempo. Standard run and standard day. I was feeling a bit fatigued from the recent training block but nothing insane or out of the ordinary. April 3rd was about 3.5 weeks before IMTX 2024, which I was signed up to do and in the midst of training for.
During the progression part of the run, I made my way to the top of my neighborhood. Dawn was starting to breach the sky, so it was not dark per se, but not too light either. I reached the peak of the neighborhood and began to run down one of the long gradients. As I was running, a school bus started coming up. The school bus takes up 75% of the width of the road in my neighborhood. I was running downhill at around 15 kph, so I moved to the side to avoid the bus. I’d made a similar move 100 times without issue, but BOOM, I was on the ground covered in blood.
First, I noticed my arm was gashed from the chip seal, my hand was ripped open, and I had road rash all over my shoulder. I screamed, "F$#@!!!" The school bus stopped momentarily, probably in shock that I had just taken a tumble. In shock, I got up and started running again. Hmm, why does my foot hurt? It felt almost like I had rolled my ankle. I kept running down the hill, heading back, but the pain was increasing step by step. At this point, I was about 1 km from my house, and I could not run anymore. I called my wife. She picks up: “Hey, what’s up.” Me: “I just fell, I think I broke my foot.” Her: “Where are you…” and the rest is history.
She picked me up, and I hobbled into the house. I took off my shoe, and sure enough, there was a quarter-sized swollen welt starting to form on the side of my foot. There was another issue: Megan was supposed to leave for the airport for a trip in 3 hours! We headed to Urgent Care, which is about 20 minutes from our house. As we were driving there, I was furiously googling “foot fracture outside of foot,” “rolled ankle foot pain,” “running foot fracture outer foot,” and so forth. I came across some information on “dancer’s fracture” and “avulsion fracture,” but I did not know which I had, if any.
I was seen quickly at Urgent Care—a perk of having good insurance, I guess (I’ve been to this place before for a bike crash). Into the x-ray and done in a matter of minutes. While waiting in the waiting room, we could hear the doctor talking to the x-ray tech and nurse outside, something along the lines of: “He says he fell while running.” Like I would lie about it? Megan joked that they were insinuating she beat me up 😀. The doctor came in and said, “Your foot is broken…” FML!!
They referred me to a local orthopedic specialist: Fort Worth Orthopedics Willow Park. Crisis mode began as thoughts raced through my mind:
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“There goes my Ironman Texas race!”
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“How much fitness am I going to lose?”
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“How long until I can run again?”
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“Can I ride my bike?”
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“Can I use my rowing machine?”
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“Can I drive?”
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“Can I take care of the dogs?”
A wave of anxiety was building, but there were two more urgent issues:
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I was scheduled to give a webinar for the ODSC at 11 am.
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Megan was leaving town at 2 pm.
We got home by 10 am from Urgent Care, and I showered and put on my nicer clothes. I was going to give the webinar with a broken foot. Megan canceled her American Airlines flight as we made alternate plans (more on that later). She called the ortho and got me an appointment for 1:20 pm.
Right before the webinar started, I got a message from the CEO of my company saying he heard I was in an accident. I briefly told him what happened and said I appreciated his concern. Then, I proceeded to do the webinar with a smile on my face. The pain in my foot was building, but I tried my best to ignore it. Over 200 people attended that talk, and I’m glad I stuck it out!
Megan’s trip was supposed to be for taking a PMP certification course in Denver. She was going to go out there two weekends in a row and stay with her parents. We made a quick decision to pack up the car and drive to Colorado—it’s about 11 hours to her parents' house—and stay there for two weeks straight.
Before we could leave town, I had to visit the ortho. They took more x-rays and told me exactly the same thing as Urgent Care. They gave me a CAM boot and told me to wear it for the next eight weeks. I asked about swimming: Doctor: “No.” I asked about cycling: Doctor: “No.” I PROTEST!! Rowing?: “No.” Driving: “No.” I AM GOING TO GO INSANE!!!!!
I hobbled out of there on crutches wearing a boot. The compression of the boot was making my foot hurt badly for the first time. Everything had gone to complete $%^& in a matter of hours. I went home and got in bed.
The following day, our plan was to leave for Colorado. I could barely pack what I wanted to bring. Normally, when we go to Colorado, it’s all about training at altitude for me. I have my bike, trainer, run kit, etc. I adamantly told Megan that I was going to ride a bike as soon as possible! I insisted on bringing my Wahoo KickR Core. She did not want me to overdo it but recognized that I was not going to back down. She offered to pack it into her trunk for me. My intention was to borrow her dad's mountain or road bike and put it on the trainer instead of bringing my own bike.
The next morning at 3:30 am, we hit the road. I slept the first few hours wearing the boot, with helpless thoughts racing through my mind as I popped in and out of consciousness. As the sun came up, more thoughts entered my brain…
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“I will fight this.”
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“I will find a way to get through this.”
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“There has to be something I can still do.”
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“People come back stronger from injuries.”
I could already tell that moving around on crutches for eight weeks was going to be a pain in the armpits. I hopped on YouTube and searched for “training with a broken foot,” “broken foot recovery,” and “broken foot at home workouts.” I stumbled upon a video where someone reviewed different options for mobility with a broken foot.
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Traditional Crutches
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Arm Crutches
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Knee Scooter
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iWalk Crutch
I had never seen the iWalk before, in person or online. Intrigued by it, I looked it up and thought it made sense. Basically, you strap it to your leg and bend your knee. This allows you to avoid putting weight on your foot while still being able to use your hands. I was going to have to go up and down the stairs as well as feed myself (carrying groceries, food plates, and so forth). As seen in the picture, I bought it from Amazon.
By the time we got there my foot had reached full blown swelling. Warning graphic and disgusting picture is next.
The other thing I decided to buy on amazon was a smaller and more portable hard soled shoe (mini boot). I figured I could wear this mini boot with the iWalk and still have protection for my foot while not having the bulk of the CAM Boot.
While we were driving to Colorado I also started remembering stories of people who’ve broken their foot. Tim O’Donnel: broke his foot, hardly ran at all and got 2nd at Kona 2 months later. Lucy Charles Barkley: broke her foot and won Kona a few months later. I stumbled upon Lucy's video where she explained how she dealt with her broken foot. I clipped the part of interest here:
2. The Recovery
Following in the path of Lucy and the Terminator, I made a conservative plan on how I was going to begin training again. I will talk a bit about what Matt Hanson (my coach) told me, but at the beginning of the recovery, it was 100% on me to decide what I was going to do and figure out what I was capable of.
Day 2: Forty-eight hours after the fracture, I went to my mother-in-law's gym. Wearing the moon boot and using crutches, I did some upper body work—light weights, pull-ups, and biceps on the machine. So far, so good, no pain. Then I decided to try the water rower. I was not able to strap my foot in due to the size of the CAM boot, so I rowed with one foot and just tried to keep my injured foot on the pad. I had no pain or issues. For the first time, I felt, "OK, I AM GOING TO BE OK."
I asked Megan to get her dad's mountain bike for me. I chose the mountain bike because it already had flat pedals. My plan was to ride with a flat pedal on the moon boot side and a clipped-in Garmin Vector on the left-hand side. That night, I set up Zwift and rode my father-in-law's mountain bike with a moon boot! I was at 6000 ft near Denver, getting some good altitude stimulus. There was little to no pain during the ride. Sigh of relief.
My Mother in law made me some vegan enchiladas and that night I went to bed feeling a sense of relief, I was going to get through this with my sanity. The next morning I got Megan to drop me off at 24 hour fitness. My plan was to row for an hour then lift. One of my primary concerns was atrophy of the muscles on the right side of my body. Having broken my leg when I was a child, I’ve dealt with some imbalance issues every since. So the primary goal of my lifting and all fitness was to mitigate that decay as much as possible.
In the gym I mostly focused on light to medium weighted dumbbell and barbell movements such as:
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Stiff Legged Deadlift
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Bodyweight squat
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Hamstring Curl
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Seated Leg Extension
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Hip adduction, abduction machine and bands
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Glute ham raise
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Also lots of upper body but usually just as super setting the leg work
Although I brought my swim gear to Colorado, my flesh wounds were still not healed, so I did not want to risk infection from the pool water touching open wounds.
For the next two weeks, I got into a decent routine. I would get up at 5 am, ride the trainer for as long as I could, and then Uber to 24 Hour Fitness to row and lift. The main issue with the boot on the trainer was feeling like I was slipping at higher power. I rarely touched 200w, mostly keeping it around 180w, which is the bottom of Zone 2 for me. It was not that comfortable, but I was trying to maintain my fitness without overdoing it. My foot was starting to feel better too!
Almost all the swelling is gone, and I feel less pain. I decided it was time to put my cycling shoes back on. On April 13, ten days post-fracture, I did my first ride without the CAM boot. To be honest, there was some pain and discomfort during that ride, mostly because I wanted to see how a bit more power felt. I got up to a 5-minute interval at mid Zone 3, around 265w. Minimal pain or discomfort during the interval. Later, there was a dull ache that I noted. It seemed I was on the road to recovery, but of course, I still needed to be very careful.
A few days later, we returned to Texas. On April 17, I visited the ortho again. She said there was good progress in the healing (I could not tell any difference on the x-ray), based on the reduced swelling and pain when she touched it. When she asked me what I had been doing, I told her I was riding my bike with the boot. She asked me not to do it… I laughed. I also got approved to drive (if absolutely necessary). Getting to the pool was absolutely necessary, right? Riiiight? RIGHT.
At this point, I discussed with Matt, and we decided to do a nice little bike block while I couldn’t run. Riding outdoors was still going to be out of the question for a while. I did not want to put a flat pedal on my bike and risk some other injury. I was fine riding inside for a while—heck, I’d been doing it all winter. On April 21, 2024, I did my first real bike workout (this was 18 days post-fracture).
Some pain in my foot but it didn't really bother me. It ached after though. My fitness was still there and I can push decent power without much pain, so it was fine. Swimming was going badly though. I could not kick or push off the wall. I dealt with it as best as I could, just kept showing up and being very careful getting in and out of the water.
I did a whole bunch of z4/5 on the bike over the next 4 weeks as well. Basically three hard bikes a week from Matt, 1 longer ride, and 2-3 swims. I added a bunch of rowing and z2 riding as well.
The next step on this journey was a trip we had planned to Mexico City. It was scheduled to be 4.5 weeks post fracture. I had barely put any weight on my foot, as I was not supposed to walk according to the Ortho, especially not without the CAM Boot. I don’t do what I’m told so I started walking for 5 minutes the week of our trip. Could I walk without pain? How much did it hurt? Was it doing damage?
You can guess where this is going…
Wearing my hiking shoes I traversed all across Mexico City on foot. This was 1 month post 5th metatarsal avulsion fracture. There was some pain but generally I was ok.
We had vegan churros and some of the best Mexican food I’ve had in my entire life.
I did my best to protect my foot. I found a nice gym with a concept 2 rower which I walked to each morning before our adventures.
Once we returned, I decided it was alright to try and ride outside.
On May 7, 2024 I did my first outdoor ride, 5 weeks post fracture.
On May 18 I did my first jog test (0.5 miles) on Caleb’s LEVER ,7 weeks post fracture.
For the next few weeks, I ran very easy. Coming back has not been easy. There has been pain in my glutes, hamstrings, groin, and shins, but funnily enough, not in my foot. I have been taking it pretty easy, mostly running at 8:00/mile. The hills have really smashed my legs, but I figured I just need to build my volume tolerance back up. On June 18, I did my first run workout.
It's June 19, and I finally feel I am through this journey. Of course, my run fitness is not where it needs to be yet, but there is progress toward where I want to be, and that's really all that matters. Before I end this blog, I have some additional thoughts on nutrition and lessons learned that I want to share below.
3. Nutrition
During the period my foot was healing, I did not track my nutrition nor did I weigh myself. I ate to hunger and tried to focus on maintaining as high a power/watts on the bike as possible. I have been vegan since 2018 and never track my protein intake. When I do, I am always over the 1.6g/kg minimum for athletes. On the day I was given the all-clear to run, I weighed myself and saw that I gained approximately 4 kg, or around 0.5 kg per week, during the time my foot was broken. I was not that shocked by this, as I had felt some additional mass in my legs and, of course, around my stomach area.
I decided then that I would start a mini-cut to get back into race shape. In the previous 5 weeks, I have gotten my weight back down closer to my race weight. I am now sitting about 3 kg lighter than I was at the end of the healing process. Cleaning up my diet was pretty easy once I got going, but I miss all the ice cream, peanut butter, and eating ad libitum in general.
I would recommend not cutting calories when you are healing from an injury. That said, you should try not to completely overeat. I was not intentionally overeating, but it seems I still gained around 1 lb a week. The injury is not forever, and you will get back to race weight!
4. Return to Running
My plan to return to running is still underway. The goal is to build up the volume slowly and only add back in intensity when I am feeling good. During the first week back, I did runs of 10 minutes, 20 minutes, and 40 minutes. The following week, I did 3 runs of 50, 60, and 65 minutes. At 3 weeks, I was able to extend my longer run out to 1h40. At 4 weeks, I did my first quality run workout, and later that week, I did a race. Luckily, the race was hot and hilly, so I was not running fast, but it felt hard!
I made a short video commemorating my first quality run workout. It felt so good to be on a comeback.
I have a 2-hour run planned for this weekend and a 25-minute tempo run. I don’t have high expectations about my performance, but it will feel good to put a bit of effort into them! I have to build up my long run over the next 7 weeks and 5 days, as I have to run a marathon at Ironman Copenhagen on August 18th! It seems like a daunting task, especially in the summer, but I will continue to feel like a kid in a candy store, building my run fitness back to its former glory.
5. Advice
My recovery was made much easier by having my wife, Megan, present, especially during the initial shock of the injury. Having someone help drive me to the doctor and make sure I was able to get help was essential. I also want to thank my coach, pro triathlete Matt Hanson, for helping me plan the training while I worked through the injury and, of course, for setting up the sessions during my return to running.
I guess I should thank the doctor for being conservative, since, in the end, I am healed. That said, I hardly listened to her when it came to cross-training. I cycled 20 hours a week, swam, rowed, lifted, and walked. I was able to heal in the expected amount of time doing all of those things. In hindsight, I would do nothing different!!
6. Summary
Breaking your foot is a horrible experience and will take you out of running for 6-8 weeks without a doubt. This does not have to be a death sentence for your fitness or endurance. Although I was knocked out of Ironman Texas and took the longest break of my fitness journey from running, I am on a comeback. Indeed, just 4 weeks after I began running, 12 weeks since the foot fracture, I was able to win a local 70.3.
I got through this phase of my journey, and if this happens to you, you will too!
7. A Small Rant
The fact that I broke my foot, how it happened, and why it happened finally feels in the past. While this is not the time and place for a tirade about failed government policies, I will cast part of the blame for what happened on a few external factors. You may be wondering what the heck government could possibly have to do with a broken foot and triathlon. Fortunately, this is not a political issue but another one that is equally divisive in nature. The first blame goes to the Uniform Time Act of 1966.
Daylight saving time makes sense in certain parts of the country. For Texas, it makes sense to be on Standard Time 365 days a year, much like Arizona is. Losing and gaining an hour does not bother me, but why does it stay dark until 7:30 AM in the spring in Texas? Because it’s really supposed to be 6:30 AM, but we are living in a world based on policies set by politicians living above the Mason-Dixon line! Daylight saving time (making it lighter at night) is an abomination, and Texas should abandon it. Rant over!
Why am I even talking about this? Because although I run with multiple lights—a headlamp, rear tail light, and a flasher in my hand—it is not always good enough to show all the imperfections in the terrain. This brings me to my second government policy that I disdain: (1) pothole repair and (2) vehicle tax regulations. Let’s break this down a bit. First and foremost, the Parker County pothole fixing crew comes through the neighborhood to fill potholes a few times a year. The problem is how they fill them! While filling them with black asphalt is convenient, doing this for 15 years straight has led to problems. Now, our neighborhood roads have been repeatedly patched with black asphalt to fill potholes. This ongoing patchwork has left the road surface riddled with uneven bumps, resembling a lunar landscape. Each bump reflects a different age and depth, creating a patchwork of repairs that vary widely in size and shape, disrupting the smoothness and safety of the road.
Now, the last issue is vehicle tax regulations. Texas has so many massive trucks and vehicles. The gas prices are rock bottom, and registration is also cheap. Heavier vehicles do exponentially more damage to the roads. Not only that, when the roads were designed, the average size of pickup trucks was much smaller and lighter. Additionally, the weight of pickup trucks increased by 32% between 1990 and 2021, resulting in a greater impact force when they collide with pedestrians. My neighborhood was initially constructed around 15 years ago, and at the time, the roads were not designed for the behemoths that occupy it now. This has led to significant damage to the road surface. I wish less of my property taxes would go to schools and more would go to infrastructure.