Tuesday, February 22, 2011

How to Beat Plantar Fasciitis

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.

Rest
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.

13 comments:

  1. Running Man,

    This is by far the best info I have seen by a non-foot professional with regards to treating PF. I am a Canadian Certified Pedorthist and see feet everyday for a living. All of the info that you posted here is the stuff I tell all of my patients. Great job!

    If interested: follow me on Twitter: @Pedorthist_NS
    Cheers.

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  2. Thanks for the feedback! My plantar fasciitis continues to improve and right now I'm at the point where I think the worst is way behind me. But I continue to be cognizant of the fact that it can return. I wear my orthotics and try to keep up with my stretches. It is a very misunderstood injury. Thanks again!

    Wyatt

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  3. Thank you so much for this. I to am a runner who recently experienced PF after being free from it for over 8 years. I immediately started PT, icing, massaging as well as taking a break from running for 3 weeks. I have now resumed running and also recently taken up yoga. I have found it works very well and is extremely beneficial for me. I also find the downward facing dog very good for stretching the muscles aroung the foot.

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  4. Great article. I have one question. After taking time off, I am not sure how to start again. In my case I could easily run 20k at any time. Now I've barely run in 2 months. Do you know how I should start again. Such as, how long should my longest running be and how many miles should I do in a week?

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  5. Thanks! Great Article! I have a question. After taking time off to recover, how many miles should you do per day and week when you start up again?

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  6. Tom: Plantar has varying degrees. It was without question the worst injury I have ever had as a runner. Not until I got into orthotics (which I've since transitioned out of...after 1 solid year in them) was I able to run and regain what I'd lost. Even today I still occasionally "feel" my PF. My advice is to come back slowly and make sure you have the support your foot needs. You are dealing with a damaged ligament, which takes time to heal. There is no formula for mileage after dealing with PF. Don't push it while your foot heals...and maybe consider custom orthotics. For over-the-counters, I think Sole brand inserts are very good.

    Wyatt

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  7. Thanks for posting this information. I want to mention how I inadvertently cured myself of plantar fascitis. I went hiking with some friends, and was forced to trudge through stagnant water. The water produced an infection on the skin of my feet. Because of this, I had to wear some thick-soled AB-------IE brand beach thongs, in order to keep my feet well aired. After about two weeks, my P.F. was suddenly gone - after a year of battles. My theory is that the soft inch-thick beach thong sole compressed to match the natural shape, and curvature, of my foot. As a result, the tendon in the foot was never stretched any further, as happens when one stands directly on a hardwood floor, and the arch flattens. At this point, I am convinced that many problems arise from the surfaces that we run on. Many Kenyans run barefoot. But, they also run on soft dirt - not on hard concrete.

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  8. I've heard it all before....all podiatrists want to do is inject your foot with cortisone or do surgery. Someone needs to come up with a solution that keeps runners running at least just a little without us falling prey to all the gimmicks out there and being taken advantage of by running shoe stores. If anyone knows a truly sports-minded podiatrist that helps runners continue to run a little through the healing process, that info would be priceless.

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  9. Thanks heaps, brilliant information from someone who has been there.... I have suffered with this for about the last 3 yrs and just have had my first cortisone. The drs never really said what the deal was after, so really helpful to hear you say REST for at least another month, cause you are right, it's feeling the best it has in ages!!!

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  10. Good Job! An excellent post on PF treatement...100% agree!
    A question on Cortisone shot..I'm reading on the web it could weaken the fascia (I mean you gain a short term quick recovery but you risk in the long term).
    What did the doc say to you on this?

    Thanks again for your help but I'm litterally fighting with this bad PF!

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  11. Great post! I felt signs of PF 5 days ago. It was in full swing for the next 3 days. I went to a doc who performed ART on my foot and calf and I laid off running- still did intervals on my spin bike, though. Yesterday the pain was almost gone and today I don't feel it at all! How much longer should I lay off running so long as my foot continues to feel fine. I realize it may FEEL fine but still need to heal a bit... How long do you think that should be?

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  12. Wyatt, I just want to say thank you so much for your input in regards to PF. I have been dealing with this for months and was an avid runner. My doctor thought I might also be suffering from a stress fracture as most of my pain was at the end of my day and not so much first thing in the morning. We tried a steroid injection cortisone injection yesterday morning. (Still waiting on that relief everyone talks about) if that does not feel better in about a week I guess the next step is a scan since stress fractures don't always show up on X-ray. Really hoping the shot kicks in and works soon!!! I have since put running on hiatus for a while and started cycling which I enjoy and does not interfere with PF. Thanks again Wyatt:)

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