I was training for the marathon avg. between 40-50 miles per week longest long run 18 miles. Left hip/knee pain that hurts on impact. Pain goes from inner groin area to top of inside knee and in front below patella. If I sit on a stool and let longs hang left thigh has a shoot pain up it if you press on leg. Chiro said biomechanics and imbalance issues or possible stress fracture. Do you have a recommedations?

Reply - Janet
When someone describes symptoms like that I always want to rule out stress fracture first -- perhaps your physician could do a bone scan or MRI?  Other diagnoses that come to mind include lower back problems (often have radiating symptoms, though not usually pain when you press on a leg in the sitting position).  I think your chiropractor is on the right track with the diagnosis, but it would be vital to rule out a stress fracture sooner rather than later - and they often do NOT show up on x-ray.  If it's a stress fracture, the key element will be patience as you heal and a slow and sytematic return to training when the time comes.  Janet Hamilton, MEd, RCEP, CSCS, Running Strong coach

Reply - Janet

It's hard to say for sure, but my guess is that the big toe pain is related to the change in your biomechanics (or what you are calling the "global foot issue").  New orthotics every other month lead me to believe you're using a fairly soft orthotic, and you mention you've been increasing the arch size as your foot has continued to collapse recently. Has your practitioner ever suggested a firmer orthotic with the correction built in to the rearfoot and forefoot region rather than just in the arch? By "posting" the orthotic in the forefoot (actually at the leading edge, just behind your big toe joint) the practitioner might be able to relieve some of the big toe pain as well as the increasing medial ankle pain.  Would you ever consider dropping your weekly mileage a bit?  It might enable you to run for many years to come if you back off a bit now.  Just a thought. 

My gut instinct tells me the big toe thing isn't related to shoe width nearly as much as it's related to the global foot issue. 

Janet Hamilton, MEd, RCEP, CSCS, Running Strong coach

Reply - Janet

Cassie - this is not good.  Anytime someone tells me they felt a pop in their calf I always think the worst... a partial tear.  I hope that's not the case with you but you're wise to take the next couple of weeks VERY easy.  You're right, you're in taper mode and that's good... but I'll also tell you that I'm never a fan of trying to run any race (especially a marathon) if you're injured.  It's just not worth it to risk making your injury worse.  There's no way to speed the healing process -- the best you can do is avoid slowing it down by "testing" it with activities (like running) to see if it still hurts.  Rest, ice, gentle massage - along with the magic element (time) --- your body will work the miracle of healing as fast as it can.  Make sure you're getting good nutrition and staying adequtely hydrated.  You may be able to do whatever exercise you can do that doesn't cause any discomfort (swimming? biking?).  If the symptoms don't resolve in a couple of days - see your orthopedist to figure out if you do have a partial tear of the Achilles.  If you do, it's a serious injury and will need to be protected during the healing process to avoid progressing to a full-blown Achilles rupture.  Take this one seriously -- hopefully it's just a minor strain, but you need to be prepared emotionally to let that marathon go if things don't get dramatically better.  Best of luck in your recovery.  Janet Hamilton, MEd, RCEP, CSCS