Saturday, June 23, 2007

Plantar Fasciitis 101

I may be a doctor in the legal sense, but definitely not in the medical sense. Just a runner with plantar fasciitis, not yet cured. Nevetheless, I've done some research and talked to some smart doctors and here are my current thoughts.

Cause:

There are two things going on: (1) an underlying tightness of the plantar fascia, which is a wide ribbon of ligament under the foot, connecting the toes to the heel and thus supporting the arch, and (2) an injury at the point where this ligament attaches to the heel, resulting in inflammation and pain. It may also cause a heel spur, a growth of extra bone at the point of injury. In my case, as a runner, the injury probably came from overuse of the over-tight ligament. It could also come from some sort of blow to the heel or arch of the foot.

I ran the Avenue of the Giants marathon seven weeks ago and felt a little pain, but not much. A week later I ran a 5k at nearly top speed, which hurt a lot toward the end. That was the time of the primary injury, though the foot was already heading in that direction.

Since then the pain has resoved several times, but reappears if I run a mile or two. I believe that this happens because the plantar fascia is stretched at every toe-off, and eventually the partially-healed connection gives way again. In Grandma's Marathon last Saturday, it gave way after a mile and a half, though I had not run at all in the previous 18 days. I finished the marathon anyway, beating up on the injury, limping in quite late, and restarting the healing clock at zero.

Cure:

Both issues must be addressed, the underlying tightness and the actual injury.

Healing the Injury:

  • Stop Running: Because it seems to pop loose every time I do. Doctor BB (a very smart and experienced internist) says it will take three weeks, probably more because I'm old and because feet don't heal as quickly as other parts of the body. This is the part of the treatment that I like the least, even though I do some cross-training instead.
  • Wear Orthotics: Dr BB actually "prescribed" Dr Scholls Heel Cushions. These cost only $7 per pair at Walgreens, and I have them in four pairs of shoes now. In my running shoes they are UNDER the insoles so that they provide cushioning without adding much instability. Other doctors prefer more arch support and less padding in the heel (thanks Luke). But for now I'm going with Dr BB.
  • No Bare Feet: Not even in the house. I have the orthotics in my slippers and wear them always. Stop beating up on the injury.
  • Cold Packs: Several times per day, and especially after any exercise that could cause more inflammation.
Stretching the Fascia (taking care not to re-injure the fascia-heel connection):
  • Calf Stretch: This one, with and without knees bent, gently and frequently, especially first thing in the morning. An experienced runner recently told me I should do this up to 30 times per day. Notice that this stretches the foot as well as the calf. If it hurts the heel, the pressure is too much.
  • Towel Stretch: While sitting, use a towel to pull back on the ball of the foot, making the toes point up. Several times per day, always gently. I have not been doing this, but will start.
  • Night Splint: I use The Strassburg Sock every night. I have a splint too, but find the sock MUCH more convenient, and I think more effective. It holds the foot and toe up, gently stretching the fascia all night every night, also avoiding the pain and re-injury that otherwise occur in the morning after the fascia has tightened up overnight.
  • Tennis Ball: Roll a tennis ball or other round object under the foot several times per day, to further stretch the fascia. Some people suggest rolling a frozen bottle of water instead, but I think that's applying the cold in the wrong place and at the wrong time. Cold should be applied at the heel, the site of the injury, and not in the arch of the foot. Further, the fascia should be stretched while warm, not while cold.
This morning I mostly walked three miles with Sunshine and Sweet Pea while the other St Croix Valley runners did their weekly five miles. The heel is virtually free of pain. We'll see whether I can stick it out for three weeks without running, and whether that resolves the problem.

PB and pickle sandwich "recovery" meal:
Peanut butter sandwich
"Oregon Herb" whole wheat bread with onion & dill, organic peanut butter, dill pickle slices, organic plum. Weight Watcher estimated points = 8.

9 comments:

Anonymous said...

I am just curious, did you plantar fasciitis go away with the treatment you mentioned?

Don said...

Yes or no, I'm not sure. I wrote a more recent post on that here.

I no longer believe in STOPPING running, or in applying cold. I believe in the remainder of the treatment. It seems to me that it finally got cured BECAUSE I ran; perhaps something came apart that was healing wrong.

It went away very suddenly, and I ran a full marathon on it yesterday.

Art said...

This is very hopeful to hear. I have been icing, but also trying to stay active.

I recently developed plantar fasciitis and reading much about it on the web gets a little depressing.

I started a little weblog to document my treatment of it with regular updates.

http://heelhurts.blogspot.com

TheSitRep said...

I am on a mission to tell people how to fix there PF.
I suffered for years after a massive calf trauma. I was hobbled. With pain. I tried everything, aspirin, stretching, orthotics, different shoes etc. Then one day I learn about A.R.T. (Active release technique) you don't need to spend a dime on a doctor. You can do this yourself. You will feel relief after the first time. All this is is massaging your calf and Achilles tendon Hard while flexing your foot up and down. Do this evry morning and BAM! You will be amazed.

Wandering Sage said...

10 Ways to Care for Your Feet

1. Soak your feet in hot/warm water each night before you go to bed. The heat will bring considerable relief to your feet and prepare them for #2.

2. Massage your feet after soaking them. Taking time daily to massage your feet is a practice that reintegrates your feet back into the whole of your body. Too often we neglect the parts of our body that hurt. Massaging the area encourages blood flow to the area and stimulates the body's natural healing ability.

3. Stretch your feet in the morning by flexing them up and down 10 times before getting out of bed. Stretching and strengthening exercises will help reduce Plantar Fasciitis each day.

4. Stretch the Achilles tendon and the calf muscles. The muscles and tendons on the back of the lower leg are directly related to the stress that is put on the plantar fascia. Stretching the Achilles tendon and the calf muscle help ease the tension and relax the feet. Lean forward against a wall, keep one leg with the knee straight and heel on the ground while bending the knee in the other leg. Hold this position for 10 seconds. Switch to the other foot.

5. Deeper calf stretch. Stand on a step with the front part of your feet, keeping your heels free. While holding onto the railing, slowly lower your heels. Hold this stretch for 10 seconds then bring your heels back to a level position.

6. Massage with ice. Freeze a water bottle and place it on the floor. Roll your foot over the water bottle for about 20 minutes. This will help decrease the inflammation in the foot while also stretching out the arch.

7. Contrast between hot and cold. Ice your feet for about five minutes and then place them in a hot bath or on a heating pack. Alternating between hot and cold for at least 20 minutes should bring considerable relief.

8. Pick up marbles with your feet. Place a cup on the floor and drop a handful of marbles beside it. Practice using your feet to grasp the marbles and place them in the cup.

9. Roll your foot on a ball. Take a golf ball, tennis ball or soft ball and roll your foot over it to help stretch out the plantar fascia. Practice this exercise while reading or watching television.

10. Breathe deeply and activate the energy circulation within your body. Believe in your body's healing ability and it will respond.

Wandering Sage said...

Two ways to really care for your feet.

1. Soak your feet in hot/warm water each night before you go to bed. The heat will bring considerable relief to your feet and prepare them for #2.

2. Massage your feet after soaking them. Taking time daily to massage your feet is a practice that reintegrates your feet back into the whole of your body. Too often we neglect the parts of our body that hurt. Massaging the area encourages blood flow to the area and stimulates the body's natural healing ability.

dutchtouch said...

I'm a tennis player and suffered from PF for about a year. Like most people, I tried everything in the book...splint,insoles,ice,massage, golf ball, professional help, etc.
Then I read something somewhere about walking bare feet on sand and pebbles. I spend $15 on 10 bags of gravel at Home Depot, made myself a 30ft. path next to my house and proceeded to walk bare feet, back and forward, on the gravel for 15 min. twice a day. ( I also stopped taking Ibuprofen, which seems to slow down the healing process). Already the first day I noticed an improvement, and after a week I slowly started playing tennis again. After 2 weeks I am now back on the court full time...go figure..try it,you have nothing to loose but 15 bucks !!! Good Luck.

MARSBAR said...

If you have PF you should not use HEAT for relief, the cause of PF is INFLAMMATION which responds to ICE. For some, rolling a frozen water bottle for an ice massage works well. The night splint is critical to make it less painful to walk in the morning. I have the sock and 2 different splints. I alternate the 3 since they are all uncomfortable in their own ways, but I like the Strassburg sock best. I have chronic PF with a heel spur, have been unresponsive to cortisone shots (which works for most). I have had to stop training for now in an effort to really fix this. I had radiofrequency lesioning done last week and will see in a few weeks if it worked... keeping my fingers crossed, I have a half marathon in October!

Jeffrey F. said...

Thanks for the great comments, Don & everyone else. I just came down with PF (I think). I was diagnosed with it years ago, and got rid of it (forgot exactly how). This time, it's a little different. Whatever I have, I got it on a day when I waterskied (barefoot) and then went out for a run. I overdid it. Now - even 2+ weeks out, I can't run much over a mile before it comes back.

Anyways, I wanted to tell everyone that today I went stair climbing. As stair climbing often does, it surprised me that it did not irritate my PF at all. I did 5 climbs of 4 min each. It's a great anaerobic workout that has always treated me well. I call it "walking at interval pace" and others who've stair climbed kind of nod thoughtfully when they hear that. Thanks,

Jeffrey