For a few weeks now I've been wanting to write a post on how to beat plantar fasciitis but, honestly, I didn't want to jinx myself. Well, at the risk of a jinx, here goes.
I'm no doctor, but my understanding of plantar fasciitis is that it's basically a torn ligament in your foot. Specifically, it's a tear to the fascia under your foot. It starts with a dull pain in your heal, especially when you wake up in the morning. Oftentimes the pain gets better as the day wears on. But if you're a runner who ignores the signs and keeps pounding out the miles without attention to your injury, you are setting youself up for a nasty, long-term battle. I know runners who've battled PF for years.
Let me say it again. Plantar fasciitis is a torn ligament in your foot! When you look at PF in that light, it seems kind of ill-advised to think one can run through it. It takes rest and therapy.
Here are some tips for dealing with plantar fasciitis, based on my own experience with PF.
At the first sign of suspected plantar fasciitis pain, reduce your mileage and, ideally, take at least 2 weeks off from running. Cross-train instead. Most of the time, you cannot run through PF. If you try to run through it without proper management, you are in effect playing with fire. If you refuse to shut down, at least avoid hills, reduce your mileage, avoid fast stuff for a little while, ice your foot daily, massage the heel and arch, and investigate over-the-counter inserts that support your arch and heel. Do NOT overstretch the injured foot! Would you ever stretch a torn ligament?
Seek Medical Evaluation and Treatment
If the pain doesn't go away after 2 weeks of rest, see a doctor--preferably a sports medicine or foot specialist. He or she will examine your foot; do X-rays to rule out a stress fracture, heel spur, etc.; and, if indeed you do have PF, prescribe treatment--usually a night splint, perhaps an orthotic, maybe physical therapy, possibly a cortisone shot, or all of the above. Prescribed rest will likely be in the mix, too. Don't fight it. Submit to your doctor's course of treatment, but do be informed, ask questions and express any concerns you may have. Above all, set expectations. I told my doctor up front: "Dr. Ng, I run 4,000 miles a year and have big plans in 2011. I want to be able to run again. What can we do to get there?" He heard me, understood where I was coming from, and helped me get back to running. (Click on the link above or here for Dr. Ng's info. He is an excellent doctor and I also send huge props to Rob Marchant at Physiotherapy Associates. He's an Ironman triathlete and very supportive and expert.)
If Your Doctor Gives You a Cortisone Shot....
A cortisone shot is your golden opportunity to get better. But it's where I made a critical mistake that set me back several months. If your doctor gives you a cortisone shot, REST FOR 3-4 WEEKS! Do not resume your training just because your foot feels fantastic from the cortisone. The cortisone quickly reduces the swelling and boosts healing. Allow it to work and rest while it works. I didn't and I paid for it. After the cortisone wore off and my foot was painful again, I was back to square one. You cannot get multiple cortisone shots in your heel or else you risk fat pad atrophy, a rupture to your fascia, and other complications. It is a one-shot deal, but a very effective treatment--so allow it to work and don't be stupid like I was.
Get a Night Splint
When you get out of bed in the morning and feel that terrible pain in your foot, you are in effect re-injuring the fascia. You must prevent re-injury. And the best way to do this is to get a night splint. A splint will keep your foot stretched out while you sleep, allowing the fascia to properly heal. As a result of a night splint, you will notice that your foot hurts less in the morning--a good thing because it means you're not re-injuring the fascia every time you get out of bed. I tried the Strassburg Sock and hated it. It was incredibly uncomfortable and clumsy, but maybe it'll work for you. What has really worked for me is a more sturdy, robust night splint given to me by my foot specialist. I had to pay for it out of pocket ($85) since my insurance provider wouldn't cover it. Whatever you do for a night splint, be sure to massage and gently stretch your foot before you get out of bed.
Go to PT and be Patient
If your doctor prescribes physical therapy, do it. Unfortunately, I have a $1,000 deductible for PT, and so the 6 or 7 appointments I had were basically out of pocket. But it was well worth it. Through PT, I was able to access dexamethasone treatments, ultrasound therapy, electrical stimulation, deep-tissue massage, stretches, strengthening exercises and good old-fashioned moral support that made a huge difference. You have to be patient with PT. As my therapist told me, many folks with PF conclude their course of physical therapy still hurting, but in a few weeks or months they are much better. PF takes a lot of time to heal and physical therapy isn't an overnight remedy.
If You have a Serious Case, Get Custom Orthotics
I resisted custom orthotics for a long time because I have pretty anatomically sound feet and am a mid-foot striker--all good things. My PF wasn't from a structural flaw or poor gait; it was from an acute injury to the fascia or perhaps overuse. Everyone who examined my feet told me how sound they were. And so, with that thinking, I resisted orthotics because I didn't like the thought of a device "realigning" my feet. But I ultimately got the orthotics, shelling out a few hundred bucks, and I wear them at all times EXCEPT for on my runs. I know that sounds crazy. I've found that my Sole-brand inserts work well for runs and the custom orthotics are perfect for my work and casual shoes. I refuse to allow my orthotics to be a permanent solution; they are temporary and my goal is to be out of them in a year or less. That said, if you're prescribed custom orthotics, do what works for you. You may need them 100% of the time. I do think first checking out Sole-brand inserts is worth it, though. (Update: I now wear my custom orthotics on all runs and they're great!)
Do NOT Go Barefoot
Going barefoot or just in socks around the house, especially if you have hardwood floors or tile, is incredibly damaging to a foot with PF. Wear supportive sandals or shoes, but do not go barefoot...ever...until your foot is 100% healed.
Practice Self Treatment
Stick with your physical therapy regiment and also do some self treatments at home. I have found that massaging my heel and arch makes a big difference in keeping the foot loose and breaking up inflamed tissue. I have also found that the downward dog yoga stretch is wonderful for keeping the calves loose and my foot stretched. I would not recommend the downward dog stretch until you start seeing big improvement with your PF. Do NOT over-stretch the foot when you're still in the early stages of pain.
If You're Willing to Go the Medical Route, Be Ready to Shell Out a Lot of Money
I had to spend a lot of money to get better. Between my physical therapy, orthotics and night splint, the costs added up. I'd do it all over again. If you asked me, "Wyatt, I can only afford one treatment. What should I do?" I'd recommend a cortisone shot and 4 weeks of rest--as in no running at all. If you can't see a doctor, then I'd recommend a night splint and rest. Cycling, elliptical, etc. will have to do and, really, some time off will do your body some good.
The Biggest Lesson I Learned
I waited too long to get treatment. My PF manifested in July when I was at the height of my Leadville 100 training, knocking off 100-110 miles per week. I trained through it and even finished Leadville, but in the process I developed a chronic injury that would take 7 months to begin to heal. The key to beating PF is managing the injury at first sign. Rest. See a doctor if rest doesn't work. Wear a night splint. But do not try to run through it. You have a torn ligament. Face that fact and put your ambitious race plans on hold for a while. If you don't, you could literally end your "career" as a runner. There were days when I thought the party was over.
I know plantar fasciitis is a hot topic with many runners, and a difficult injury to manage. So please let me know if you have any questions.