Thursday, August 29, 2013

Killing My Plantar Fasciitis Beast

[This seems to be my most popular post, so I'll try to keep it updated as I learn more techniques for battling and defeating the monster. Happy running! -Scott]

So, you have plantar fasciitis (PF). Me too. Sucks doesn't it? In fact, I would say it's one of the most evil injuries that can afflict a runner. Pulled muscles heal in a month or two. Tendinitis can be managed while continuing to train. Even broken bones heal in 8 to 16 weeks.

Plantar fasciitis can last for many months. Or years. Or forever. It's evil. Pure evil.

I've had PF before, in my right foot. I tried all sorts of remedies and therapies but not much worked. Some things would help, but only temporarily. The PF always returned. Over the course of a year, I eventually worked out a seemingly effective treatment strategy.

Note: I am not a doctor, nor do I claim to be one. I'm just another knuckle-head runner with a blog. This recovery regimen worked for me, but don't blame me if it doesn't work for you. Your mileage may vary. Take with water before bedtime. Do not operate heavy equipment under the influence of this therapy. May cause hair loss and extreme boredom. Do not attempt these therapies if you do not have PF or if you have no feet. These statements have not been evaluated by the FDA, the FBI, or the CIA. The NSA denies the very existence of PF.

Calm The Beast
First, I had to get my PF beast to calm down and stop thrashing about it's cage. Here's what I did.
  1. Stop running. Don't panic! It wasn't a long break. I gave my foot about 2 weeks to recover from the inflammatory injury cycle (i.e. running) that I had been putting it through.
  2. No, really, stop running. Yeah, you saw me out there, limping along. OK, I'll head back to step 1.
  3. Reduce the inflammation. This is tricky. Inflammation is required in the body's feedback loop of healing, so I didn't want to eliminate it entirely. But I wanted to reduce the pain and inflammation enough to begin the actual recovery exercises. I didn't go on a 2400mg per day regimen of ibuprofen in an attempt to be pain free. That wasn't the goal. Actually, I just avoid NSAIDs like ibuprofen entirely when possible, mostly because I value my colon (don't ask). Topical anti-inflammatory creams worked, but I had to use a lot since the skin on my feet was fairly thick.
Herd The Beast
Second, I began herding the beast towards the slaughter house. I followed these steps on a daily basis until I was pain free.
  1. Deep massage. If you've had PF for a while, you probably have a nice little build up of scar tissue. I sure did. Deep massage using my thumb helped break up the scar tissue and started realigning the collagen fibers of the fascia. Think of the injury site as a pile of collagen fiber spaghetti with scar tissue meatballs. Deep massage started breaking up the meatballs and aligning the spaghetti strands. I massaged from my heel towards to my toes, just because that was easier. Warning: In the beginning this hurt! You will likely feel (and possibly hear!) crunchy areas along the fascia as you run your thumb along the tissue. However, the pain will become more tolerable after a few sessions, and the crunchy bits should slowly disappear. Another more advanced massage technique I tried was rolling a hard ball under my foot, back and forth across the plantar fascia (from heel to toe and toe to heel). I used a pool cue ball, but a golf ball or something similar would probably work just as well. This provided both massage and stretching of the plantar fascia. And speaking of stretching...
  2. Gentle stretching. There are several ways to gently stretch the plantar fascia, but I had a favorite. I sat in a chair and crossed my afflicted leg on top of the other leg. I placed the ankle of my crossed leg on top of my knee, allowing the foot with PF to hang slightly to the side. I held my heel in the palm of one hand and wrapped my other hand over my toes and around the ball of my foot. Then I pulled the ball of my foot towards the knee while bracing the heel with my other hand. When I did it correctly, I felt a gentle stretch in the arch of my foot. Go here for another description and to see the source of this picture. 

  3. Ice Is for Drinks. A lot of people will tell you to ice the fascia as part of recovery, but I disagree with this approach. Icing can indeed help to reduce the inflammation early in the recovery process, but it won't help you heal the damage, unless it is coupled with heat. That's right, heat is what you need! Increasing blood flow will help with healing and nothing beats the cooling and heating technique for increasing blood flow. My technique is to use a frozen water bottle (plastic) as a sort of roller. Roll it under your foot until you have achieved a nice cold foot (wear a sock to prevent frostbite!), then switch to heat. I used a heating pad for the warming stage, but rolling with a bottle of hot water would work just as well. Alternate the cooling and heating as often as you can throughout the day.
  4. Strengthen the feet. Believe it or not there are muscles in your feet, and they can be strengthened. My favorite strengthening exercise was the foot "scrunch". I did this while sitting (easier) or standing (harder). The idea is to scrunch the foot by pulling the toes and ball of the foot towards the heel using only the muscles of the feet. I started in a seated position with my foot flat on a towel which was lying on the floor. I then attempted to scrunch up the towel using only the scrunching motion of my foot. Once I was able to do that proficiently, I wore a sock and performed the same foot scrunch while standing on a smooth floor (no towel required since I had learned the proper form from the sitting scrunches). Three sets of 10 scrunches a couple times a day really helped me after a week or two.
  5. Wear a boot or a sock. I was very reluctant to wear a boot at night. I didn't think I needed something so drastic. But the boot seems to help the fascia heal in a more neutral position, so I eventually got a boot and wore it to bed every night. I regretted not doing it sooner because my foot felt much better almost immediately once I started wearing the boot. Don't worry, I didn't wear it forever. Every few weeks, I would sleep without it for a few days. Each morning I would see if I could take a pain free step out of the bed. Once I had a pain free week without wearing the boot, it went into the closet. If you can't stand the boot, give the strassburg sock a shot. It's much easier to sleep while wearing the sock and it keeps your foot in same position, with the added benefit of putting a slight stretch on the fascia

Kill The Beast
OK, it's been pretty standard protocol up to this point. Now we get to the hard parts, and some would say the controversial parts - lifestyle changes. Yeah, sorry, but the only way I was able to truly kill the PF beast was to change some aspects of the way I live and exercise.
  1. No arch support. Yeah, seems counter intuitive, but believe me, I wasn't doing my plantar fascia any favors by perpetually propping it up on top of arch supports. Using arch support, my plantar fascia would heal, and I was even been able to run again, but it never became strong and PF resistant (PF came back regularly). The only way to ensure development of a strong, healthy plantar fascia was by actually using it as intended (as part of the spring complex in my foot's arch).
  2. Run barefoot. I wanted strong feet, so I sucked it up and ran barefoot. I don't care if you think it's hippy trippy dippy crap. It worked for me! I'm not saying I ran exclusively barefoot. I just added some barefoot running (or even walking, but preferably running) to my normal training. I ran barefoot once every week or so, not more than a mile or two. It didn't take much barefooting since I was gaining foot strength by running without arch support, but it did seem to be necessary to get back to 100% foot health, at least for me.
  3. Stand up. Aside from the other health benefits of getting off your arse, standing is good for the feet and legs. I started using a standing desk at work and spent most days on my feet. I would stand and balance on each foot for several minutes at a time during the day. If I got tired, I sat down, but I tried to spend more time standing than sitting. Sitting is nearly as evil as PF.
  4. Roll the calf muscles. Yes, really. Tight calf muscles (or muscles with painful spots/knots) put persistent pressure on my achilles tendon, which put persistent pressure on my plantar fascia. I bought a foam roller and went after the tight spots in my calf muscles. If you are a masochist, you will really enjoy a "fun" session of rolling out the knots in your calf muscles.
  5. Get Stronger! Not that I'm calling you a weakling, but you likely have PF because something in your rear chain of running muscles wasn't balanced, or you increased intensity too quickly and your strength levels were insufficient. Either problem would result in what I (and many others) would call "calf running", where your calf muscles and feet are overloaded because your hamstrings and glutes are on vacation or are overwhelmed. So, hit the weights! Yeah, I know, you're a runner, not a weight lifter. But you are now an injured runner, so just get in there and work on strengthening your hamstrings and especially your glutes. My favorite weight lift for rear chain strengthening is something called the "good morning squat". 
My right foot has been PF free for a couple of years now. I expect to kill the beast in my left foot in short order.

Update! I did indeed kill my PF, but it took longer than expected, due mainly to the fact that I had partially torn the fascia near my heel (don't run a marathon if you are already hobbling around with PF!). This required 6-8 weeks of absolutely no impact training and a boatload of patience on my part. After the healing period, it was a long slow road to recovery using the techniques described above, but I did indeed finally beat the PF. Being mindful of my feet and maintaining more balance (see Get Stronger! above) has been of very important in maintaining foot health. My foot has been great since defeating PF, and has held up just fine in 17, 20 and marathon length trail races.

If  you too have PF, best of luck to you in your quest to kill the beast! I'll be cheering you on.