How can I train for a marathon with a damaged toe?

Question

I've recently severely damaged the ligaments on my big toe, and can barely walk and have been advised that it is likely to take at least 6 weeks before I can run on it again.

Unfortunately, this accident has happened whilst I'm training for a marathon at the end of September. I was ticking off 15 mile runs quite happily before the accident, but I'm at a point where I can barely stand for more than a few minutes: Certainly no weight can go through the toes on my damaged foot. The toe is still incredibly painful so shoes are out of the question and until the nail comes off, I think swimming is off the list too.

So, in light of this, do you have any suggestions as to what sort of activities might be beneficial for me to still take part in the race later in the year (assuming everything heals up nicely)?

Thanks

Answer 1

“CrossFit Endurance coach and 100-mile trail run fanatic, Brian MacKenzie of Costa Mesa, California, scrawled a simple looking workout set on a whiteboard in his home gym, then spent five minutes teaching me proper rowing technique. I was in need of a workout to help me retain fitness while I rehabbed a foot injury, so he directed me to a rowing machine—commonly referred to as an ergometer or "erg." Then I endured one of the most challenging cross-training workouts of my life—for exactly 12 minutes.” (Why Runners Should be Rowers)

I would suggest you take a close look at using a rower for your training during your injury rehab. The movement of your foot horizontally may not be problematic since you’re not mimicking a running stride. This should remove some stress from your foot because it is not required to bear your bodyweight as would be the case with some other exercises.

Livestrong.com, in a recent post, Best Cardio Exercise for a Foot Injury states:

Workouts that can be performed while treating a foot injury are non-weight bearing cardio workouts, including swimming, rowing machines and cycling.

And, since you’ve indicated that wearing shoes and swimming are not possible at the moment, using a rower barefooted seems like a possibility.

In an earlier post (How to Develop Cardio with a Broken Toe), Livestromg.com again comments:

Use a rowing machine at the gym. Rowing machines provide a cardio workout that uses primarily the upper body, so the risk to your toe is minimal.

Lastly, if you decide to try a rower, do so with instruction from someone who knows and understands the machine. If it's a Concept2 rower (and, it should be), you can get additional help on correct form by checking their web site.

Answer 2

Nothing beats running of course, but it looks like you have to scratch that off your list entirely.

You might want to give cycling a shot. With clipless pedals and shoes the force is delivered through the ball of your foot, not really at the toes. Also, you can drag the cleat back on the shoe that it's pretty far to the back of your ball. Very stiff shoes, generally for racing, should help to keep a lot of the load off of your toes.

You might also want to consider doing squats, initially just a ton of air squats (like ~50) and working your way up (if you don't do them already) to barbell back squats, as the drive is (or at least certainly should be) through your heels: most coaches teach you to wiggle your toes a bit on the way up as a point of driving with the heels.

Definitely make sure you do your squats barefoot, in socked feet, or in a zero-lift shoe such as Converse. Anything with a hell (including most cushioned running shoes) will tilt your foot forward and place more load on the front of your foot.

Six weeks from now gives you about four weeks from the time you should be recovered until the time you can start running again. With a bit of strength training and keeping your endurance up on the bike, I think that's the best you'd be able to do in the mean time.

And of course if it hurts, stop. But I've found that exercising smartly and safely through injuries greatly speeds up my recovery time and leaves me with less lingering problems as opposed to just hopping on the couch for a month.

Answer 3

You can certainly find ways to keep your cardiovascular system intact while you let your toe heal. However, I think you may want to carefully consider the wisdom of trying to run a marathon less than 3 months after what you describe as "severely damaged" ligaments. If it takes "at least 6 weeks" before your doctor says that you can begin to run, that gives little time before the marathon for further healing and conditioning.

The big toe is a big thing as far as function in your lower extremity and back alignment. It is a key in your walking and running patterns. If you do not rehabilitate the joint correctly you could end up with a long term injury, pain and difficulty with the push-off phase of walking.

Ligaments take time to heal. There are basically three phases of healing:

• Inflammatory stage - The immediate response to injury involves pain and swelling to help splint and protect the joint.
• Repair phase - The body begins to lay down collagen to help repair the ligaments.
• Remodeling Phase - This phase begins to align and remodel the collagen into functional movement lines. This phase can last up to one year. It doesn't mean that you have to wait a year before you can rely on the injured joint. It means that you have a full year to gradually increase the stress to the joint and ligament to maximally align and strengthen the support of the ligament. A marathon in September would put you in the early stages of remodeling, well before it is fully healed.

There are things that you can do to help each phase of healing, but you cannot alter the fact that it takes time for tissue to heal. So you may want to check with a sports physical or physiotherapist to help guide you to successful recovery. Good luck.