Heel Still Hurts

The St Croix Valley Runners meet in Stillwater at the Northland tennis courts every Saturday morning at 7:00 am. The standard run is five miles, but of course a person can carve out whatever they need. This morning I walked fast with my two sweeties for two miles, then ran ahead to meet the group, intending to run one more mile. Shuffle shuffle, trying not to lift my feet, so the left one wouldn’t have to come down on the plantar fasciitis. It doesn't work, but maybe the pounding is a little less.

Fine for at least a half mile, but then the heel started to ache and I had to walk the rest or risk undoing any hard-earned progress. Later it was a bit sore. Back to ice and all of the other treatments; I hope I didn’t set it back much.

The latest Runner’s World (August 2007, p. 46) about low-level laser therapy for plantar fasciitis. I’m interested. Also our friend Mary gave me an interesting-looking device today, and I will try it and report back.


Hormone & pesticide-free pork, asparagus, organic sweet potato, organic salsa. Weight Watcher estimate: 3 points.

Great Bike Ride

Friend Jim inflated his bike tires and joined me on a nice 50-minute ride this morning. Cool, low humidity, what a great training ride. Only running would be better.

Slight pain in the right knee, not as bad as Tuesday. Icing the plantar-fasciitis heel now, stretching frequently, wearing cushioned shoes at all times except in bed, when I wear the Strassburg sock instead. Heel is pain-free, but still not running.


One of the happiest joys of summer is the fresh fruit and berries.

Organic oatmeal, organic fat-free milk, blueberries, blackberries, organic strawberries, organic nectarine, pecans, organic pomegranite juice. Estimated Weight Watcher points = 5.

I ran!

Slowly, for about 2/3 mile, using very short steps. After that distance the plantar-fasciitis left heel ached just a little, so I switched from the overhead track to the elliptical machine to burn another 420 calories.

The run was not timed. The elliptical “running” took 31 minutes, 13+ calories/minute, 170 strides per minute, “ramp” set to lowest position to most-nearly simulate running. Like all such machine exercises I dreaded doing it, snored all the way through it, but in the end was very glad I had done it. But I’d rather be running!

I’m icing the heel now, and I’m pretty sure that I didn’t re-injure it today. Perhaps I will do more short runs like this, gradually increasing the distance but stopping at the first little sign of pain, cross-training to fill the rest of the time.



Grilled free-range chicken marinated in key lime and organic lemon, organic nectarine, organic swiss chard, sweetened cranberries, pistachios, steamed with a little organic butter. Estimated Weight Watcher points = 5.

Biking Is Supposed to be Easy on the Knees

Sunday and today I treated my sore foot to a one-hour bicycle ride each day. Sunday morning early, I rode into a high-end housing development and tore up the hike/bike trails there, but never saw a soul. Today I rode into the county park, by way of my favorite dirt road along the RR tracks, then onto the park’s grass hike/horse trails. Again, never saw another person on those trails. A real shame. Plenty of people in the camping areas of the park though, that’s a good thing.

One problem: Both days my right knee hurt, directly under the kneecap, after about 45 minutes of hard biking. I hope that goes away. Can’t run, can’t bike? Tell me it’s not so! Tomorrow the (ugh) elliptical machine at the club. Barf.

But I’m going to get that plantar fasciitis fixed one way or another! No running.


Grilled free-range chicken marinated in lime, pickled beets, sugared ginger. Weight Watcher estimated points = 5.

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.

Grandma's Marathon 2007

Sunshine, Sweet Pea, and I took the train to the start of Grandma’s Marathon, enjoying the ride, the coffee, and the bathroom. The race began under full sun and a temperature of 71 degrees, to the music of Chariots of Fire. A gloriously beautiful morning, unless you wanted to run 26.2 miles as fast as you could.

I started quite conservatively, following the 4:00-hour pace team, hoping to speed up after a few miles if everything was working. I felt wonderful, running for the first time in 18 days. Not a hint of pain. We made the first mile in about 8:30, slightly faster than the target pace. It felt easy, as it should at the beginning of a marathon.

Then, at about a mile and a half, going up a slight grade, something popped in the left foot. Plantar fasciitis was back. Soon I was walking along the side of the road, being consoled by friends as they ran by. It turned out that I could run for a while until it hurt too much, then walk until it hurt less, then repeat. I stuck to the gravel shoulder on the side of the road as much as possible, and later on the grass boulevard along London Road, doing the best I could.

The other problem: Running with a limp, trying not to step hard on one foot, puts extra pressure on the other leg. Around mile eight, I started to feel a little stress in the right-leg quads, and that got worse little by little for the rest of the race. Left heel hurts, right thigh hurts. Originally hoping for 4:00, and imagining a little better, I finally finished in 5:05, 14th of 32 in my 65-69 age group. But that’s the end of whining.

I had fun, too. When you’re hobbling along the shoulder of the road, you can joke with the spectators, high-five the little kids (even some big ones), and taste a sample of beer or a piece of candy if you like. And I chatted with other runners, eventually even re-passing one or two friends who had passed me earlier. For several miles I ran with the 5-hour pace team, sometimes ahead and sometimes behind. At Mile 7, I was able greet my mom and dad again, Grandma’s volunteers since the beginning. The 5-hour pace team gave them a cheer. A little further along I was greeted by my son, who lives right along the race course. At Mile 20 I shook Al Franken's hand and wished him well. At Mile 23, high-school friends and classmates John and Cathy were still waiting to greet me, though I showed up more than an hour late.

The temperature rose to 81 at the finish. Ambulances went past me several times, as the heat and unrelenting sun got to everyone. It affected me less, however, because I was going slower than my normal pace. Toward the end, most of the runners near me were so affected by the heat that they were done running. They were walking, and I was still able to run some of the time. I passed a lot of people, and that’s fun.

Today, the day after the marathon, the right thigh hurts more than the left heel. Stairs, especially, are not my friends. But that will pass in another day or two, and now it’s time to get serious about curing the plantar fasciitis. I’ve been icing it, and will continue using the Strassburg sock at night. Beyond that I need to put together a better plan. NOT running is not an option.

Glycogen Stores

Wouldn’t that be a great name for a sports-nutrition store? “Glycogen Store!” Anyway I used the elliptical machine again. In my modest understanding of running, this last “run” two days before the marathon (one day for some people) is largely to deplete glycogen stores, so that muscles and liver and other body parts will be hungry for carbohydrates tonight and tomorrow. Then the pasta dinner tomorrow night will top those off some more, and also leave carbs in the colon for possible use during the race.

400 calories burned today, roughly approximating a 3.4-mile run, in about 30 minutes.

I’m on pins and needles wondering if my plantar-fasciitis heel, untested in 18 days, will go the distance Saturday. Muscles are a second question. But today Bonnie at the club said “Enjoy the race!” Bonnie is always cheerful and supportive, but she is SO RIGHT! That’s exactly the best attitude going into a race as iffy as this one is for me. I’ll try to run with the 4:00 pace team, and I’ll have fun as long as I can. Thanks to Jim and my sweeties, so supportive, and to everyone else who has given encouragement.

Did you know that you can take the train to the Grandma’s Marathon start line? I’ve done it more than once, and it’s very nice, especially because there is a bathroom right on the train so there is no need to stand in line for the scarce porta-potties. Coffee too. Give ‘em a call at 1-800- 423-1273; they'll save a seat for you.


Wild-caught Canadian walleye, organic lemon, rice (mix of black, brown, and wild), watermelon. Estimated Weight Watchers points = 6.