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.


22 comments:

  1. I have been dealing with this for 3 months now. The pain is faint and not there some days and the next day is back. I stretch, I roll with tennis ball , stopped running for 3 months now, my calf is tight and tough to deal with. I sleep with a splint( both feet) I changed my shoes to clark's etc. Surprisingly? If I wear crock's I have zero pain( instant relief ) I don't know what else to do. I am considering the shot

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    1. Sorry to hear about your PF problems anon. Recovering from PF can be a long, frustrating process. My first bout with PF took nearly 1 and a half years to finally disappear. My current PF is still with me (4+ months at this point), even though I'm running again for short distances. Personally, I wouldn't get a shot of cortisone. It's at best a short term solution for pain relief, but it won't help with healing and recovery (actually will weaken the tissue). If the squishy crocs work for you, by all means, wear them! Do what works for your particular issue. If the crocs stop working, stop wearing them. One thing I've learned about PF is that it's nature changes as it progresses (hopefully towards being healed), so adapt to make positive progress. Best of luck to you!

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  2. Came upon this post because my PF came back this morning just as I was hitting my stride in my training plan (which I had to restart 2 months ago because of PF!!) You are right. PF is SOOOOOO EVIL. I hate it I hate it I hate it I hate it. I finally took the seemingly drastic measure and purchased a boot today and hopefully it will relieve some of the pain in the morning. I've had recurring PF for the past 2 years and I am so sick and tired of it!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Your post is over a year old but still rings true.

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    1. Sorry to hear it! My last bout was severe and took nearly a year to recover from. I had to totally stop running for 12 weeks to let it heal and settle down. Then slowly work my way back into running. I'm happy to say that even though it took nearly a year, my PF finally healed.

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  3. I had PF pretty bad for about 2-3 months and I nailed it hard with ice and ibuprofen for about 3 weeks w/o running, lots of deep foot massages and calf stretches. When I felt it was "gone" I restarted a routine that only included elliptical and walking for about a month, then slowly running again. Yes it was very disappointing and it includes some time consuming routines. For me the pain reached a point that it was causing my sub-7 minute miles to dip into the 9 minute mile territory and finally I said, ENOUGH. I stuck to my regimen and it disappeared without returning for about 4 years. Sadly, I just got it again about a week ago. I had taken about 2 months off from running because I moved and then went out thinking I was Michael Wardian. It's no where near as bad as the first time so there is some hope. I'm about a week into the same healing routine I did last time but being 4 years older seriously doesn't help. I suspect it will be a slow healing process.

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    1. Sorry to hear it. Sudden changes in workout intensity are usually what gets me as well.

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  4. My only criticism of your post is that you really should have included a warning early on about drinking water while reading it. I had to dry out my keyboard before I could comment. This:"Do not attempt these therapies if you do not have PF or if you have no feet." is perhaps the funniest thing I've read in forever. Thank you for that! And thanks for the info as I battle PF for the 5th or 6th time in 10 years.

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    1. Glad you enjoyed the post, Jennie! And best of luck in our battle with PF. I finally got over my left foot PF, but it took a long time. I've been PF free for over a year now (knocking madly on my wooden desk!).

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  5. Did you still run with PF after you "calmed" the beast? I haven't run in a month, and I am going crazy! I have been told not to run until it fully heals but I am running out of patience. Great advice on here!

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    1. Yes, I ran with PF, but not until it was at a very low level of pain. You need to start back very slowly (very short runs) and be willing to back off running totally for a short time (a week or more) if it flares up after you start running again. Concentrate on strengthening and balancing before you go back out and run again. If you return to running as a more balanced and stronger runner, PF will be less likely to return.

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  6. Thank you for your post. It was encouraging to read that you did indeed kill the beast! Quick question regarding deep tissue massage. I have been aggressively attacking the bottom of my right foot with massage of all sorts. I can feel small hard bump/crunch in the arch. It is very sore after I deeply press on it/massage it. Should I continue doing so until it goes away or is this a sign of something else?

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    1. That sounds like the same crunchy mess that was in my foot. I kept at mine until it went away, but when it was especially painful or sore, I let it rest a day or two in between aggressive massage sessions. Best of luck!

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    2. I have the exact same problem. It seems like the more I massage with a golf ball and my hands, it goes away little by little.

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  7. I've been battling mine for almost a year now and just ordered a boot and pf compression sock...i use a ball and massage and do stretches but either im not doing it enough or right or consistently or i just dont know..all i know is im VERY frustrated of hobbling like an old woman. I know i need to lose weight and it doesnt help not being able to run anymore either...i try walking but all it does it aggravate the foot again and i need days of foot rest to feel well enough to not hobble so badly. Thanks for your post and suggestions. I'm really hoping to kick this PF in the arse soon..so tired of not being active like i want.

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    1. The sock/boot and some deep tissue massage will hopefully help you on your way. Best of luck!

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  8. I want to know how compression sock are helpful for Plantar Fasciitis issues.

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    1. They probably provide some temporary comfort. They provide a small amount of support by restricting the movement of the arch, which may reduce the stress on the injury in the short term. I view them the same way as orthotics - they are a brace for the injury. Not a permanent solution, unless you want to wear the orthotic or compression sock the rest of your life.

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  9. Thanks for this post. I am an avid runner - dealing w PF for 7 months and diagnosed w a PF tear 7.5 weeks ago. What was your timeline to being able to walk? Did you have to deal with that bruised heel feeling but walked through it? I've read that ) within 8 weeks the tear is usually mostly healed bug what's left us the scar tissue....I've been instructed not to walk much so I'm wondering if that's baking things better or worse? I'm also battling the orthotics - strong arch supports seem to bruise my heel more...

    I roll my foot many times a day, sleep with boot, do deep tissue massage....

    Any ideas and encouragement most appreciated!

    Julie

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    1. Hi Julie. Walking wasn't a problem for me, as long as I didn't walk too much. Walking a mile resulted in a very sore foot, but walking around the house didn't seem to do too much to make it worse. 7 months is a long time and I feel your pain (mine lasted over a year), but hang in there. That scar tissue takes time to sort out. Keep up the deep tissue massage as long as it doesn't seem to make it worse and use heat to increase blood flow. I tried arch supports for a few days, but it made mine even worse, so I trashed them. If you start having some good days, where you get out of bed nearly pain free and have a few hours of normalcy, then you know you are on the right track. Even if you have flare ups in that same day, just back off a bit and let it settle down (for like a day or so), then start back with your therapy routines. Patience is key, but you probably know that since it's been 7 months.

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    2. What was your timeline to recovery once you had the tear?

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    3. My PF started in May of one year, followed by a tear in October during a marathon (stupid me). My foot wasn't totally recovered until August of the following year. It was a long, long haul...

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