1

Plantar Fasciitis Treatment Experiences? (Read 47 times)

Kerry1976


Master of the Side Eye

    I have acute on chronic PF and have not gotten any relief with months conservative treatments, including: icing, Epsom soaks, night splits, stretching/strengthening, PT, steroid injection, oral prednisolone, podiatrist-approved shoes, etc...

     

    My podiatrist gave a few options for next steps. The non-surgical options are not covered by insurance, but surgery is covered. However, surgery is not an easy decision, especially knowing that an Endoscopic Plantar Fasciotomy (EPF) only has a 75% success rate. Here are options other than EPF she advised me to consider. Has anyone here had experiences with the following?

    • Deep Tissue Laser Therapy
    • Microcurrent Point Stimulation
    •   Platelet Rich Plasma (PRP)
    • Gastrocnemius Rescission (Strayer)

    TRUST THE PROCESS

     

     

     

    flavio80


    Intl. correspondent

      1 - What is the root cause for the PF though? Has anybody diagnosed that ? What causes the issue that causes the pain ?

       

      2 - Is it the fascia itself that is ruptured or otherwise inflammed, or is it a nerve that pinches the fascia ? Or both ? Is it possible that you have some sort of hip alignment issue / or weak gluteus medius , or something else up the chain that causes extra strain on the fascia ?

       

      3 - What kind of strengthening have you done ? Was it something like Barbell Squats and deadlifts to strengthen the core in general (abs, lower back, gluteus, hip flexors etc ? Or was it something specific to the foot or ankle ?

       

      4 - What kind of shoes do you wear ? Are they very low to the ground ? or more like Hokas ?

       

      5 - Do you wear inserts ?

       

      6 - Was the physiotherapy one of those that do warm or cold patches, or micro shocks ? Or was it the kind that does manipulation massage to diagnose the root cause and release some of the tighter muscles / nerves ?

       

      In my case, the root cause was usually the calves that were too tight, or it was a nerve that runs on the side of the calf under the fascia. In both cases physical therapy via manipulation massage plus foam rolling the calves, glutes and hip flexor before every run helped.

      I know I had a lighter case though.

      PRs: 1500 4:54.1 2019 - 5K 17:53 2023 - 10K 37:55 2023 - HM 1:21:59 2021

      Up next: some 800m race (or time trials) / Also place in the top 20% in a trail race

      Tool to generate Strava weekly


      ultramarathon/triathlete

        I had PF that lead to a tear in the fascia.

        Kept me from running half of last year.  That sucked.

        Eventually had PRP and shockwave therapy.  It's been 4 or 5 months since treatment and I've been running 95% pain free.

        I'll be pacing London in 3 weeks so I'd say I'm back to pretty good run fitness (will work on speed after the marathon but didn't want to over do it while building back my mileage).

         

        Happy to provide more info -- just PM me.

        HTFU?  Why not!

        USATF Coach

        Empire Tri Club Coach
        Gatorade Endurance Team

        Kerry1976


        Master of the Side Eye

          Thanks for the replies and sorry for my delay in response - allergies knocked me out last week. I am doing Deep Tissue Laser Therapy now. If that doesn't help, I may elect to move to Gastroc/Strayer surgery. Fingers crossed that this helps! I've had three treatments though, and so far, not much of any relief. 

           

          Here are my answers to the questions asked:

          1 - What is the root cause for the PF though? Has anybody diagnosed that ? What causes the issue that causes the pain ?

          • Tight calves, flat feet (had since I was a kid), and nearly no mobility in ankle - likely a little bit of overuse compounded with movement issue.

          2 - Is it the fascia itself that is ruptured or otherwise inflammed, or is it a nerve that pinches the fascia ? Or both ? Is it possible that you have some sort of hip alignment issue / or weak gluteus medius , or something else up the chain that causes extra strain on the fascia ?

          • Fascia inflamed - acute PF on chronic PF. No nerve pinching seen on MRI.
          • And yes, definitely working on balance/strengthening exercises from PT for the hip on down

          3 - What kind of strengthening have you done ? Was it something like Barbell Squats and deadlifts to strengthen the core in general (abs, lower back, gluteus, hip flexors etc ? Or was it something specific to the foot or ankle ?

          • Foot arching, marble pickups, ankle side-to-side/ankle front-to-back, one foot balance stand, one foot balance stand with other foot extending out to side and back (2x 10x sets), stretching on slant board, squat/side steps with resistance band, etc....

          4 - What kind of shoes do you wear ? Are they very low to the ground ? or more like Hokas ?

          • Asics Kayano-30s or Oofos Recovery Sandals - both podiatrist approved  

          5 - Do you wear inserts ? NO. Podiatrist did not feel they were necessary/helpful in my case. I tried inserts (RX and OTC) in the past during other flare ups of PF and found they didn't help, either.

           

          6 - Was the physiotherapy one of those that do warm or cold patches, or micro shocks ? Or was it the kind that does manipulation massage to diagnose the root cause and release some of the tighter muscles / nerves ?

          • PT was exercises and then Graston work on foot and calves. We did a little kinesio taping, but I have sensitive skin and it does not like most any adhesives. 

          TRUST THE PROCESS

           

           

           

          flavio80


          Intl. correspondent

            Thanks, it might be helpful to check this video: https://www.runningahead.com/forums/topic/886602f12ff546279a91f65c835dbf4c/resume#focus

             

            Especially because she states that surgery should be avoided at all costs. She states that the success rate of these surgeries is lower than 25% and that the consequences of the surgery are sometimes worse than the original symptoms.

             

            Of the 3 root causes you mentioned I'd think the super tight calves could be the worst offender. The poor ankle mobility could also be partly  cause the tight calves (that happens to me as well).

             

            Follow up questions:

            1 - Have you checked if your talus bone has moved forward ? That's also something that happens sometimes and when it does that it blocks the path for proper ankle dorsiflexion.

            2 - Have you tried heavier lifting like barbell squats and deadlifts ? The reason I ask is because over time that has helped me a lot in off loading the lower leg and having the core (hips, glutes, abs, hamstrings) take more of the brunt of the work to stabilize and cushion each step.

            So now the lower leg (calves/achilles/fascia) have a bit less work to do.

            3 - Does foam rolling your calves help with alleviating some of the tightness ?

            PRs: 1500 4:54.1 2019 - 5K 17:53 2023 - 10K 37:55 2023 - HM 1:21:59 2021

            Up next: some 800m race (or time trials) / Also place in the top 20% in a trail race

            Tool to generate Strava weekly

            Kerry1976


            Master of the Side Eye

              1 - Have you checked if your talus bone has moved forward ? That's also something that happens sometimes and when it does that it blocks the path for proper ankle dorsiflexion.

              • They haven't mentioned that as an issue and I've had MRIs done.

              2 - Have you tried heavier lifting like barbell squats and deadlifts ? The reason I ask is because over time that has helped me a lot in off loading the lower leg and having the core (hips, glutes, abs, hamstrings) take more of the brunt of the work to stabilize and cushion each step.

              So now the lower leg (calves/achilles/fascia) have a bit less work to do.

              • Good call out! I have not done that in a while - I used to lift though. I would like to get back to lifting, but I am so inflamed that putting any weight on it is difficult at this point - and it sometimes hurt with no weight on it.

              3 - Does foam rolling your calves help with alleviating some of the tightness ?

              • It does somewhat, as does the percussive therapy gun and/or self-massage.

              TRUST THE PROCESS

               

               

               

              flavio80


              Intl. correspondent

                Also, if you were to go down the surgery route, wouldn't it make more sense to have a surgery to correct your ankle mobility instead?

                Cause that stiff static ankle is probably what causes the super tight gastroc and soleus which in turn irritates the plantar fascia.

                Maybe there's a tendon malfunctioning in your ankle, maybe the bone grew too much, but either way, it seems that fixing the ankle mobility would be key to improve everything else.

                 

                How do you score in this knee to wall test ?

                https://www.youtube.com/watch?v=U7woPNLUT3Q

                 

                I score 12cm on the right side and 9cm on the left side. The minimum dorsiflexion to run is said to be at 5 inches, 12.5cm, so you can see I fail both.

                PRs: 1500 4:54.1 2019 - 5K 17:53 2023 - 10K 37:55 2023 - HM 1:21:59 2021

                Up next: some 800m race (or time trials) / Also place in the top 20% in a trail race

                Tool to generate Strava weekly

                Kerry1976


                Master of the Side Eye

                  Good question, but I'm just following the podiatrist's recommendation. She said of the two surgical options, the Gastroc/Strayer would probably have more success for me. I do not know my score on the wall test.

                  Also, if you were to go down the surgery route, wouldn't it make more sense to have a surgery to correct your ankle mobility instead?

                  Cause that stiff static ankle is probably what causes the super tight gastroc and soleus which in turn irritates the plantar fascia.

                  Maybe there's a tendon malfunctioning in your ankle, maybe the bone grew too much, but either way, it seems that fixing the ankle mobility would be key to improve everything else.

                   

                  How do you score in this knee to wall test ?

                  https://www.youtube.com/watch?v=U7woPNLUT3Q

                   

                  I score 12cm on the right side and 9cm on the left side. The minimum dorsiflexion to run is said to be at 5 inches, 12.5cm, so you can see I fail both.

                  TRUST THE PROCESS

                   

                   

                   

                  flavio80


                  Intl. correspondent

                    Good question, but I'm just following the podiatrist's recommendation. She said of the two surgical options, the Gastroc/Strayer would probably have more success for me. I do not know my score on the wall test.

                     

                    Have you consulted a second opinion, preferably a physiotherapist that constantly deals with running injuries ?

                    Doctors in general do not have proper training nor experience to deal with that.

                    Quick anecdote: My wife sprained her ankle on a trail race last Sunday. She was seen by an orthopedist on the same day.

                    He prescribed pain killers, an ankle wrap and crutches. And that she didn't run for 2 weeks.

                    I knew from past experience that orthopedists do not have the proper training to deal with this, so I insisted she go to the physiotherapy clinic around the corner.

                    The PT immediately stated that her ankle was out of place, then did some work on it and put it back in place, this relieving my wife of her pain. Had my wife not gone yesterday to the PT her ankle would remain out of place and it would cause a big list of injuries down the line.

                     

                    I have personally had an online consultation about my dorsiflexion issues with https://coaches.vdoto2.com/blakedircksen and it was very useful. I'm sure there must be somebody near you, that vdoto2 has a good roster, but there's probably others that are also good.

                    Your preference would be a PT clinic that has more than one PT, and that has all of their timeslots mostly filled all the time, that is, they're constantly dealing with all kinds of injuries ALL the time.

                    PRs: 1500 4:54.1 2019 - 5K 17:53 2023 - 10K 37:55 2023 - HM 1:21:59 2021

                    Up next: some 800m race (or time trials) / Also place in the top 20% in a trail race

                    Tool to generate Strava weekly