Podiatrist Visit

Runner friend Cal heard who my podiatrist was, and said “He’ll put you in orthotics.” I replied that I was already using orthotics. “Yeah,” said Cal with a grin, “but these will be way more expensive!”

Cal was pretty much right. Doctor B, once a sub-3-hour marathoner himself, explained the facts of life regarding plantar fasciitis, after confirming that it wasn’t something else. He was quite patient, actually, taking his time, first explaining the structure of the plantar fascia and its diminished but still significant connection to the Achilles tendon at my age. He views the issue as one of arch support rather than an inherent problem in the heel. The fascia fails at the heel because the heel becomes the weakest point as we age, but the underlying cause is that the fascia is slightly too short. He also believes that the human foot was not really designed to land and go into tension 65,000 times per week on hard pavement (my personal numbers).

Then he described some treatment options:

• Cortisone shot: He said it could sometimes jump-start the healing process, but went on to other things when I mentioned that I have already had one for this injury.
• Two-month respite from running: Also, I suppose, all other activity that could cause re-injury. Not three weeks, as I heard from another doctor. He said that two months of “hammock therapy” nearly always fixes plantar fasciitis.
• Orthotics: He was pleased that I was using the night splint (the Strassburg Sock), and for that reason didn’t at first recommend custom orthotics. But when I said I wanted to throw everything at the problem, he made the plaster casts.

Other things that he said about stretching:

• The night splint is a very effective way to gradually increase the length of the fascia, providing a gentle tension for hours at a time. I got the impression that the amount of time is more important than the force applied.
• In addition, the Achilles tendon should be stretched at least a few times per day, using a straight knee because that tendon actually connects all the way up into the hamstrings. I tried it, and it’s really different from what I have been doing.
• He approved of rolling a tennis ball under the foot, but suggested a frozen-juice can instead so that the fascia can be cooled at the same time. When we questioned the wisdom of stretching a cold ligament, rather than a warm one, he said that in any case it’s more of a massage than a stretch. In this I disagree: It feels like a stretch, plus the injury to be cooled is at the heel rather than the arch where the tennis ball is, so I think I’ll do it only with a warm foot.

Cold, heat, and inflammation:

• He likes cold, because it reduces inflammation. I understood that he likes to reduce inflammation because it reduces pain, though he also did say that some inflammation is necessary for healing. I have almost no pain unless I try to run, so in my opinion I don’t need cold for that purpose.
• He seemed to approve when I said I use cold only when there is pain, otherwise warmth (I use a wool sock). In my non-medical opinion healing happens more quickly with heat, though it may not feel as pain-free at the time. But then, if I’m so smart, why isn’t it healed already? Maybe because I have never waited long enough?

Other tools, comments, and treatments:

• Cal had the surgery, so I know that is a possibility and it works; he was back running in six weeks. Dr. B thought that was unlikely to be needed in my case.
• He thought that an MRI would be of little value unless the heel bone was fractured, and he is pretty sure it is not. I am too.
• He was of the opinion that the support to be found in running shoes does not compare with custom orthotics, so there is no reason for me to change shoes.
• When I mentioned “Super Feet” inserts (actually suggested by a different podiatrist some time ago for a Lisfranc ligament problem), he said that the custom orthotics really do work much better.
• Plantar fasciitis is apt to be a recurring problem - that's its signature.

The custom orthotics will arrive in 10 days or so, and then I will need to break them in over another 10 days. Huh - wouldn’t you think that for $400 they would come pre-broken-in? Maybe it’s really my arch that needs to get adjusted to the orthotic. I currently have 10 days since the latest re-injury, so it will be 30 days by the time the orthotics are broken in. Then, he said, maybe I could start running just a LITTLE, every other day, even though it certainly won’t be two months yet. If there is even a HINT of re-injury, I should stop immediately, don’t even walk home - call for a ride, and then ice it and wait another two weeks. Uff-da.

I wish I had asked:

• If the real purpose of the orthotics is to gradually lengthen the fascia, should I really put them in my running shoes? It seems to me that running pulls briefly on the fascia at every toe-off, which should gradually lengthen the fascia.
• But apparently it DOESN'T, so I should put them in my running shoes, but do I HAVE to use them even during races?
• What if I can still feel the slight ache in the heel after 30 days? After 60?
• More about inflammation.
• What must I do to prevent the plantar fasciitis from recurring?

Stop whining, Don. Life is really pretty good, considering all, and the die is cast - no running for at LEAST 20 more days. Suck it up and do something else. There’s wood to be chopped, for goodness sake. Or, if I get out for a bike ride today, that will make it a masterpiece :-)

Later:

Aha - I did get out for a nice ride. Into the wind for 28 minutes, then back via the same route in less than 21 minutes. Equally hard work both ways, slight pain in the right knee but not bad. I’ll skip a day now before riding again. I sneaked up on a red fox on this ride. It was sitting in the dirt trail looking the other way, and because of the wind it couldn’t hear me, as I rode toward it full tilt. Just when I wondered if I should slow to avoid running it over, it finally heard me. Off it leaped, over the RR tracks and into the woods. This day is a masterpiece.



Organic oatmeal, organic milk, blueberries galore, organic strawberries, organic nectarine, pistachios. Estimated Weight Watchers points = 4.