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:

"Oregon Herb" whole wheat bread with onion & dill, organic peanut butter, dill pickle slices, organic plum. Weight Watcher estimated points = 8.