Plantar fasciitis (Read 2599 times)

I've been battling PF since October 2010. I'm just getting back to running after missing most of this year. My injury was a tear resulting from a race, not a gradual overuse injury. Here's Pete Magill's article that has some helpful stuff. I find the towel stretch to help a lot. 

From March until August of 2005, I kept a crutch at my bedside. That way, when I woke up in the morning, I didn't have to crawl to the bathroom. Plantar fasciitis is nasty, and it's a bane of us older runners.

The plantar fascia runs from our heel, along our arch, to our toes. Plantar fasciitis can be felt as pain in the heel (often mistaken in the early stages for a heel bruise), as pain where the heel meets the arch, or as pain along the arch - or even throughout the foot. And left untreated, it can linger for months ... or years.

Not sure if you've got it? Okay, here's what you do. Take your opposite thumb to the inside front part of the heel - right where it begins to slope into the arch - and dig in hard. If your scream wakes the neighbors, congratulations, you've got PF.

OKAY, STOP RIGHT HERE: If your PF pain came on suddenly during a very recent run, you need to stop running right now. Forget about the exercises below. Take a week off. Or two. If you've got a tear, you don't want to risk injuring it further. Because trust me, this is one injury that just won't go away!

If you're still reading this, then I'm guessing that means you've had your PF for awhile. I had mine for two years. Raise your hand if you tried rolling your foot over a golf ball? Over a ice cold can of Coke? If you wore a "night sock" to keep the fascia stretched? If you tried taping? And RICE (Rest, Ice, Compression, Elevation)? And anti-inflammatories? And prayer? ... And when prayer didn't work - cussing? Because I tried it all. And none of it worked. And I decided, forget it, I don't need this!, and I threw my running shoes in the trash - hadn't used them for months anyway. Sheesh, after all that time off, my legs probably wouldn't work right anymore anyway ...

And that's when it came to me, right then, like a bolt of lightning: maybe my plantar fasciitis isn't an injury, maybe it's a symptom of a foot, ankle, and lower leg that simply aren't working properly. I did a little research, cobbled together the simple exercises you're about to review, and I was running 7 days a week the very next week.

And it wasn't just me. I passed on the exercises to Rich Burns (see his Event Training entry for 1500 meters on this blog), who had terrible PF. And they worked for him. And when Tom Dalton, a 5-time USATF Masters X-Country Runner of the Year complained about his PF, well, the exercises did the trick for him too. All in all, I've been teaching these exercises as a cure for PF for 3-1/2 years now. About 50% of the people I've taught had a full recovery. Another 25% got some relief from the pain. And the final 25% got nothing - sorry.

Here's hoping you'll be in that 50% ...

EXERCISE 1: TOWEL TOE CURLS

1. Sit barefooted in a chair with a towel spread on the floor in front of you (like David Olds in the photo at the right).
2. Using your toes, drag the towel toward you, arching your foot until you've reeled in the entire towel (just slide the towel behind your heels as it bunches beneath your arch).
3. Do the whole towel 2 or 3 times.
Hint: Remember that this isn't a competition! Don't curl too hard or too fast. Also, setting a shoe on the far end of the towel prevents the towel from rebounding with each toe curl.

EXERCISE 2: FOOT ORBITS, FOOT GAS PEDALS, & FOOT ALPHABET

1. Use 1 of the 2 positions modeled by masters runner Grace Padilla. Either lie on the floor, one leg flat, toes pointed up, with the opposite leg raised, bent 90 degrees at the knee (and propped by your hands). Or else lie with one knee bent, foot flat on the floor, and the other knee drawn towards you and held just below the kneecap.
2. Perform 1 or 2 of these 3 exercises:

• Foot Orbits - Rotate each foot clockwise and then counterclockwise 20-30 times.
• Foot Gas Pedals - Point and flex each foot 20-30 times.
• Foot Alphabet - Draw the letters of the alphabet with each foot.

Hint: Hold the knee immobile. Limit motion to the ankle and foot.

EXERCISE 3: BEACH TOWEL CALVES

1. Lying on your back with one knee bent, foot flat on the floor, and the other leg raised and straightened with thighs parallel, hook a rolled beach towel around your forefoot and gently pull back your toes.

2. Hold for 30 seconds, then repeat with the opposite leg
Hint: Flex the raised thigh for maximum release (and flexibility) in the calf. Don't force this stretch! It's about loosening the calf, not stretching it like taffy.

EXERCISE 4: BEACH TOWEL HAMSTRINGS

1. Lying on your back with one knee bent, foot flat on the floor, and the other knee raised and straightened, hook your rolled beach towel around your arch and pull the leg vertically, while pulling back gently on the foot.
2. Hold for 30 seconds, then repeat with the opposite leg
Hint: Only pull the raised leg to your natural - and comfortable - limit of flexibility.

And guess what? ... That's it!

Do these exercises every day after you run - before you run if you're suffering from PF right now and need some relief just to get out the door. And do them every day for a couple weeks. And then make them part of your regular post-run routine.

If you want to make it go away quickly, and you don't want to have it for years, try the following:

--fish oil for the inflammation. When I had it, I started taking fish oil and it felt better within 4-6 weeks. I took 6-8 1200mg pills spaced throughout the day. I had tried some extra-strength ibuprofen on a prescription from a foot doctor at first, and they didn't work. The fish oil did.

--foot exercises to strengthen feet, and ankles. There are many exercises out there. Treat foot exercises like training. Don't overdo. A little more each week. Take a day off once in awhile.

--careful with stretching. Keep a yoga point of view and be very, very gentle, and only after warming up.

--walk barefoot as often as possible

--reduce caffeine.  There seems to be a connection with caffeine and raised cortisol levels. You want to keep your levels down.

--if you have a few pounds to lose, do so. 

--run barefoot in a field on occasion, or on a beach. Consider trying one of the new-fangled shoes that make your running a little closer to barefoot. There's more than a few on the market. If you do, ease into them. You might make your problem worse. Start with 10-15 minutes, the a little bit more each week.

--walk around in cheap sneakers that are flat (like a Converse)

--visualize your foot getting better. Imagine yourself walking around pain-free. Imagine taking that first step in the morning pain-free. Use whatever visualization works for you.  Do affirmations while walking or running "I have strong, healthy feet" sort of stuff. The mind and body are one.

The key is to reduce the inflammation and strengthen your feet and ankles. Food and drink should promote healing, and be as anti-inflammatory as possible.

After having it for  6-7 months with no change despite wearing an annoying night sock, taking NSAIDS, and taken some time off from running.

I started doing these things and it was gone within 2-3 months.  It might have been one thing I tried or it might have been them all. Or maybe it just went away. But that is what I did, and it healed. At the very least, I hope my healing gives you hope. Believe it will heal. Strength!

I feel for you.  I've had plantar fasciitis  since about July 2010, almost a year now, and it just won't go away.  I have tried some of those exercises mentioned, but maybe I don't do them often or consistently enough because they haven't helped all that much.  Of course, now, it probably doesn't help that I'm increasing my weekly mileage, but all of my mileage consists of really slow running.  It seems that running "fast" really aggravates the injury.

Hope you get better, George.

--careful with stretching. Keep a yoga point of view and be very, very gentle, and only after warming up.

 

--walk barefoot as often as possible

  

--walk around in cheap sneakers that are flat (like a Converse)

 

The key is to reduce the inflammation and strengthen your feet and ankles. 

All this. Going barefoot around the house made it feel better. I also ditched any stiff-soled shoes. Shoes that didn't bend easily aggravated it during the 15-minute walk from the train every morning. And I've been wearing Converse All Stars since high school. 

Hope you get better, George.

Thanks. it is better. I'm getting back on the road and hoping to race in the Fall. Got 20 lbs to lose now. 

Completely agree. My PF has finally disappeared - more or less - after a year and a half. I did all the exercises and slowly transitioned to lighter shoes. Who knows what worked in the end. Maybe it was just the time it took, exercises or not.

 Time has been the biggest thing. it's taken a lot but I think that has helped more than anything. Still not all gone but I can run now and wake up without pain. 

I am not doubting your experience or Muse's advice, but it is baffling to me. All of the things that you mentioned made my PF worse. Perhaps there are different reasons why PF appears, and different treatments to address the underlying cause.

 

I just mention this in case going more minimal is not working for someone.

Just to zero in on what you are saying. Did fish oil make your PF worse? Not losing weight? Did strengthening your feet make it worse? Visualization? Or was it just a minimalist shoe? I agree that going more minimal might not work for someone. Although certain factors can come into play when switching to a more minimal shoe. They might switch over too fast. You literally should start with 10 minutes, then build a little each week, like you would your training volume. You have to be very, very careful and slow with the switch. Even beginning with walking in them first. You have to give the muscles and tendons time to strengthen and get used to  moving naturally again. Ultimately, the body heals itself. All strengthening my feet and ankles really did was balance out things with my calf muscles. It took some stress off the injury. Same with the weight loss. The fish oil got rid of the inflammation. I really believe you have to be really careful with stretching it. That's where minimal should come in. It should be almost imperceptible how you stretch it. There should be no pain. Go to the point of pain and pull back, yet keep a stretch. Something I did worked, because nothing changed until I changed what I was doing. Though, I don't negate the possibility that it would have gone away anyway--but I've read too many reports where people have gone the strengthening, natural movement, weight loss and fish oil routes and finally seen it heal, after nothing happening for a long time, to adopt the uber-skeptical-nothing-works core belief. 

Just to zero in on what you are saying. Did fish oil make your PF worse? Not losing weight? Did strengthening your feet make it worse? Visualization? Or was it just a minimalist shoe? I agree that going more minimal might not work for someone. Although certain factors can come into play when switching to a more minimal shoe. They might switch over too fast. You literally should start with 10 minutes, then build a little each week, like you would your training volume. You have to be very, very careful and slow with the switch. Even beginning with walking in them first. You have to give the muscles and tendons time to strengthen and get used to  moving naturally again. Ultimately, the body heals itself. All strengthening my feet and ankles really did was balance out things with my calf muscles. It took some stress off the injury. Same with the weight loss. The fish oil got rid of the inflammation. I really believe you have to be really careful with stretching it. That's where minimal should come in. It should be almost imperceptible how you stretch it. There should be no pain. Go to the point of pain and pull back, yet keep a stretch. Something I did worked, because nothing changed until I changed what I was doing. Though, I don't negate the possibility that it would have gone away anyway--but I've read too many reports where people have gone the strengthening, natural movement, weight loss and fish oil routes and finally seen it heal, after nothing happening for a long time, to adopt the uber-skeptical-nothing-works core belief. 

Yeah, as I mentioned in an earlier post, I was already running pretty minimalist when I picked up the PF. I weigh 135 pounds, so losing weight wouldn't have been the trick. I have a high arch and rigid feet.

My PF was brought on by running a whole lot (80-100mpw) on hard surfaces. Probably I was training too hard. It was the weak link in the chain, so to speak. If it hadn't been the PF it would have been something else. Using arch support allowed my feet to recover, so that then they could get stronger. Building strength is always a matter of stress and recovery--if the problem of weakness is excess stress, then it makes sense to look to the recovery side of the equation.

My buddy Trent had great success with his PF by running barefoot. Maybe that's because his was not brought on by training stress but by poor form or something like that so that switching foot strike helped. Who knows. What worked for him did not work for me.

Anyhow, I am not doubting your advice, nor was I intending to adopt an "uber-skeptical-nothing-works core belief." I just wanted to share what worked (and what didn't work) for me and point out that treatment may depend on initial cause.

I just mention this in case going more minimal is not working for someone.

Agreed. Not for everyone. Mine definitely had to heal for a while before I could stretch or wear minimal shoes. I was actually taped for a couple weeks to immobilize it. One thing I've learned is that it is highly individual. Most frustrating injury I've ever had. Lots of stuff on here didn't help it at all. Trial and error. LOTS of trial and error.