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.

Tour de France

Not exactly the Tour, but I did ride the bike this morning. Short ride out, then 15 hilly loops in a quiet residential area, then a short ride back. Total of 14.25 miles in almost exactly an hour. Gosh that seems slow. I’m watching the Tour de France right now and they are SO much faster! Uff-da. Average of 27 mph today for over 100 miles, on Belgian roads as flat as a pannekoeken.

Nevertheless my heart rate and breathing were at least as fast as they would be running 8:30 miles or so. This was a good workout. Best of all, NO knee trouble. Is that because this was a hilly ride, with a lot of pedaling while standing up? Or maybe my knee is just getting better. Also best of all, my sweeties were running on the same roads, so I gave and got a smile and a wave every few minutes.

I love this time of year when I can watch the Tour de France every day. In fact I just leave the TV on and watch it several times a day.

Foot doctor tomorrow. I'm learning to enjoy biking, but I'm really a runner and will return to training when the plantar fasciitis is resolved. Soon, please!



Organic oatmeal, organic milk, organic strawberries, organic nectarine, blueberries, banana, organic candied ginger. Estimated Weight Watcher points = 5.

Too Many Food Pix

Running is on hold because of plantar fasciitis. I'll see the sports-medicine podiatrist about that Tuesday.

I've been taking pictures of the meals that Sunshine makes for me, and posted about that recently. These are the real food that we actually eat. We probably don't eat perfectly, but Sunshine is pretty smart about foods that are good for all of us and which might also help me with my cancer.

Right now there are too many pictures in the "to be published" folder, so it's time to publish a couple of days worth. They get bigger if you click them.


Breakfast:

Organic gluten-free pancakes (organic oats, organic corn, no-aluminum baking powder, sea salt, organic eggs, organic milk, walnut oil), organic nectarine, organic pecans, dark maple syrup. Estimated Weight Watcher points = 8. Good breakfast after a long run or the day before a marathon.

Lunch:

Spinach feta salmon patties from Whole Foods (Wild Alaska salmon, spinach, feta cheese, sea salt, black pepper, anise, fennel, garlic, parsley, paprika, canola oil, breadcrumbs), blackcurrant jam, organic strawberries. Estimated Weight Watcher points = 9.

Dinner:

Hormone- and nitrate-free ham, organic butternut squash with organic sweet potato, local organic carrot, vidalia onion, two kinds of organic cheese, organic beans, almonds. Estimated Weight Watcher points = 6.

Breakfast:

From the bottom: Organic oatmeal, organic milk, blueberries in season, organic nectarine, banana, organic strawberries, organic cashews. Estimated Weight Watcher points = 6. Life is good!

Lunch:

Smoked wild-caught Alaska salmon, no-hormone no-nitrite ham, broccoli, organic strawberries, organic black seedless grapes. Estimated Weight Watcher points = 5.

Dinner:

Lemon-pepper free-range grilled chicken, broccoflower (honest!), organic "wild" lingonberry preserves, vinegar cucumbers. Estimated Weight Watcher points = 4. Broccoflower is really pretty good.

Mountain Biking

What a wonderful, high-energy bike ride. I really want to get back to running, but this is an excellent substitute. Up the road a couple of miles, along the railroad tracks for a mile, then into the park, with miles and miles of hilly grass hike/bike/horse trails.

The ride is rough on my $150 hybrid bike, but quite enjoyable, switching constantly from high gears into the lowest gear and back again. I could take a lot more of that kind of punishment :-)

The “bike knee” problem surfaced again, but wasn’t bad. Perhaps I’m riding through it, I hope. I do the elliptical at the club, and could do water running at the beach, but this is much more enjoyable because the scenery changes all the time.

I'll see a sports-medicine podiatrist Tuesday regarding the chronic plantar fasciitis in the left foot.


Decadent brownie breakfast:

Organic oatmeal, organic milk, blueberries, succulent organic nectarine, leftover July 4 party brownie ("No Pudge" fat-free fudge brownie mix plus organic yogurt, Hershey's chocolate chips, vanilla extract). Estimated Weight Watchers points = 5.

Plantar Fasciitis Escalation

I feel so frustrated and impatient. The conservative approach to healing plantar fasciitis includes: (1) Not running, (2) Orthotics, (3) No bare feet, (4) Cold packs several times per day, (5) Calf stretches, (6) Towel stretches, (7) Night splints, and (8) Arch massage with a tennis ball under the foot. I've done all of those things, though I did run a short distance last Saturday, stopping when the heel started to ache. All in all, though, conservative treatment hasn't worked; the injury is still there.

I think about running through it, like I did in Grandma's Marathon. Just run in spite of the pain and keep up the other treatments, hoping that the problem will eventually resolve. But running with this level of pain is not enjoyable; I need to find another approach.

Two interesting-sounding treatments are suggested on some web sites:

Low Intensity Laser Therapy:

Infrared light at a low energy level is applied to the injury. In theory, the right wavelength of monochromatic light at the right intensity can somehow aid tissue regeneration. The treatment is repeated several times or until the pain resolves. A one-page article in Runner's World, August 2007, p. 46, details the successful treatment of one runner.

In an internet search, however, those who sing the praises of low intensity laser therapy (LITL) tend to be those who profit by its use. Disinterested reports are not so rosy. I was unable to find any high-quality studies that clearly demonstrated the benefits of LITL.

I did, however, find a 1998 study by Mayo Clinic concluding that LITL has no benefit for the treatment of plantar fasciitis. Further, I found a 2004 PDF document by the state of Washington which referred to a 1995 study suggesting that a placebo was slightly better than LITL.

Maybe it works for some runners, maybe I missed some recent research, maybe not, but count me out for now.

Extracorporeal Shock Wave Therapy:

High-intensity ultrasound is applied to the injury. How does it work? Two theories: (1) The ultrasound creates microtrauma, permitting new blood flow to promote healing, and (2) The ultrasound somehow reminds the brain that this area needs attention, and the brain renews its forgotten attempts to heal the area. This treatment is actually FDA approved for the treatment of plantar fasciitis.

Unfortunately, again, I found no high-quality studies demonstrating any benefit. The Journal of Orthopedic Research and the British Medical Journal (reporting on a German study) both found no benefit for plantar fasciitis. Another German study, however, did find some benefit when treating calcific tendinitis of the shoulder.

Nevertheless, I won't seek out this treatment either, unless recommended by someone whose opinion I trust more than mine.

In that regard, I have an appointment with a sports-medicine podiatrist in Stillwater next Tuesday. Meanwhile I am changing my treatment protocol from ice to mostly heat, which (according to me) promotes healing. I will apply ice if I re-injure it, then later apply heat again.

Good Resources:

• Heelspurs.com: A rather complete reference for plantar fasciitis.
• SportsInjuryBulletin.com: Describing an exercise plan which the author believes will relieve the underlying cause of plantar fasciitis. Much of this I have not tried.

Dessert:

Cantaloupe, organic yogurt, blueberries, blackberries, organic grapes, organic nectarine, on the picnic table. Estimated Weight Watcher points = 4.

160 Flights of Stairs

At 14 steps per flight, that’s 2,240 steps up and the same number down, in 40 minutes. Definitely not running, it’s actually only four round trips per minute. Nevertheless it got my heart rate up to 140, and breathing was similar to running 9-minute miles. For Weight Watcher purposes I calculate 12 points (600 calories) per hour, but that may be a bit low. I wore running shoes for cushioning and grip.

The left heel with plantar fasciitis ached a little; I’m icing it now and using the P.F. Arch Brace that Mary gave me. The jury is still out on the brace, though it does feel good; I'm still doing the stretches and wearing the Strassburg Sock. The right knee, which hurts under the kneecap when I ride the bike long enough, started to hurt early on but settled down.

Years ago I did stairs quite a lot, as cross-training, but stopped because it put too much pressure on the hip flexors when combined with running and other cross-training. More running worked better then. Now, though, since I’m not running at all, stairs are a very convenient aerobic exercise. All I really need are shoes and a sweatband, though modesty demands more.


Bottom up: Organic oatmeal, organic milk, blueberries, blackberries, organic strawberries, organic plum, pistachios. Estimated Weight Watcher points = 5.

Food Pictures

Exercise:

I rode the bike again today, mostly on my beloved sandy-dirt road along the railroad track. Occasionally bumpy and rocky, it's inappropriate for a road bike, but my hybrid bike with wider tires and shock absorbers works fine. It's fun, in fact. Today, about an hour of mostly hard work.

The knee complained a little, but less than before. The plantar-fasciitis foot is still sore from yesterday's run but getting better. I'm trying Mary's "P.F. Arch Brace" today; we'll see if it helps.

Food Pictures:

As you see, I am currently into publication of food pictures. Mostly high-quality food that is very good for me, and which also can be arranged to look appetizing in a photo. In truth, it's the food that we normally eat, not prepared specially for the camera, maybe just arranged a little.

My Sunshine does the cooking, bless her heart; I couldn't do it. I arrange the food on a plate or in a bowl, perhaps adding fruit, berries, or nuts. Then I take my prospective meal out to the picnic table, if possible, and shoot it in sunlight with a decent digital camera. Or inside with poorer light or flash if necessary. The photography delays my enjoyment of the meal by perhaps two minutes, not more.

This happens once or twice a day. It might be a fruit-laden breakfast, a delicious salad, a dinner plate, or even a dessert bowl. In every case, it is eaten and enjoyed within seconds after the photo is taken. By me.

Later the photo is downloaded and processed so that it becomes roughly full screen (max 800 x 600) if you click on it, and so that it downloads quickly. I save the original higher-resolution JPG for some photos, but for most the internet copy is all that remains.

I usually also provide my estimate of Weight Watcher points, as I am a lifetime member of Weight Watchers and active in the "flex" program. Most of the foods (except for nuts) are also Weight Watcher "core" foods.

So far I've had favorable comments on the pictures; thank you for those. I like the whole process: arrangement of the food, photography, enjoyment, and publication. The pictures will keep coming for a while. I'll probably tire of it when the most-picturesque foods become less available in the winter.


Live one day at a time and make it a masterpiece! Guilt-free fruit dessert:

Organic nectarine, organic strawberries, blueberries, organic red seedless grapes, slight drizzle of local honey. Estimated Weight Watcher points = 3.