Plantar Fasciitis

Yeah, I’ve got it, alright? Plantar fasciitis. I’m not happy about it, and I’m even less happy about admitting it, but I can no longer pretend like I don’t have a running injury. This year cleared up two firsts for me: I lost my first toenail and I got my first running injury. But the toenail has grown back without issue, while the plantar fasciitis continues to vex me. The issue has become a lingering problem, lasting over a span of two months so far, never quite bad enough to stop doing anything, but always too much to do anything of note. So, naturally, I have been looking for a cure.

Plantar fasciitis, for the unaware, is problem with the “fascia” in the “plantar” area of the foot. The fascia is what’s called “connecting tissue” and brings together muscles and bones not just in the foot but all over the body, like Facebook for your body. Sometimes, as in the case of plantar fasciitis, the section of fascia running from the heel through the arch becomes inflamed, and this causes tightness and pain. I should make a note here that this is based on no research whatsoever beside my own experience with the problem. However, before you huff and puff and blow my argument away, I’d like to point out that the medical world doesn’t exactly have its stories straight on the issue either. This has become clear to me after several weeks of researching the issue both online and in conversation with other victims at our weekly, made-up “PF Sufferers Anonymous.”

Take, for example, the most common treatment: heat and ice. I’m not going to say these don’t work, but… I still have Plantar Fasciitis. Another common suggestion is flexibility, presumably based on the logic that if the fascia is tight, limbering up my body all over will reduce the tension. I’m very inflexible, so this could definitely be one of the problems, but couldn’t science give me a pill or something? I don’t want to work hard. In fact, that attitude is the reason I have done exactly three things to help my foot: ice, stretch and buy arch support to wear all the time. My enthusiasm for injuries is not very high.

From here the treatments descend from the reasonable to the wacky to the downright weird. I have been wearing a night brace on my foot, which is basically a splint that keeps the plantar flexed all night, thereby increasing flexibility and reducing stress on the foot after it has been relaxed for eight hours. Some people have suggested massage, both on the foot and on literally every other part of my body. Core strength is also supposed to help somehow, though how that could be true escapes my logic. We all know that a certain Boulder runner overcame plantar this year with the help of hyper-supportive shoes like Hokas, but even though I like running enough to try to fix this problem, I’m not sure if I like it that much. Ultrasound has been suggested to me at least twice, and I’m in favor of it. Not because I know what it is (I don’t, and it’s probably expensive anyway.), but because it’s called “ultrasound.” That sounds perfect for “ultrarunners,” right? It’s like one guy was really into music AND endurance, and one day was like, “what if I listened to music longer than the standard length of a song? It would be, like, ultrasound.” Sounds pretty progressive to me. And then, after all other treatments have failed, there’s surgery. No foot equals no pain, right?

Yesterday, at the behest of my Occupational-Therapist-Aunt Debbie, I volunteered to be a model for some of her alternative therapy friends in Boulder. Having no idea what was going on, nor what their numerous credentials meant, I acquiesced to lie down while they poked and prodded various parts of my body. According to them I have rock hard kidneys (thank you), no flexibility, an “interesting” pancreas and I don’t breathe through my belly right. They “listened” to my body and were drawn to areas such as my left abdomen (kidneys), lower back, forehead and left foot. I was told my lymph drainage system has poor flow. In fact, the only area they seemed to ignore in their analysis of my plantar fasciitis was the actual injury itself, in my right arch. When I pointed out this seeming incongruity, they dismissed without hesitation the idea that the issue came from my foot at all. Instead they insisted that my kidney’s and liver’s inability to process all of the toxins produced from exercise, as well as my poor diet, were causing issues that radiated throughout my body and manifested themselves in my foot, which is prone to weakness because I’m a runner and stress that area heavily and often. As I lay on the table wondering when they would start taking mescaline and chanting over my prone figure, they started to make sense. Perhaps the issue really isn’t directly in the foot, but more a manifestation of larger physical issues throughout my body that can be changed through overarching positive lifestyle changes. Then again, perhaps I’ve been in Boulder too long. Hard to say.

Having never suffered a running injury before, I never paid much attention to the problem. But now I understand that running injuries are a widespread – and totally unexpected – effect of running hundreds of miles on steep mountains. Who would expect their body to have trouble dealing with incessant blunt trauma like that? Not me! Anyway, to provide help to other unlucky souls like myself who get up every day and wish they could pummel themselves viciously in a desperate game of survival in the mountains (That’s what ultrarunning is about, right?), I’ve started an organization with the intent to… well, we sure won’t be able to cure anything. But we can keep you entertained. It’s called “iRunFar.com” – and I’m totally not being paid to say this – send them your money and they’ll keep supporting your addiction to “mud, mountains, miles, and more.” Bryon Powell will happily accept donations in the form of money, vehicles, small children and seats on your company’s board of directors. It’s the only way to save ultrarunning!

There are 94 comments

  1. Doug

    There's a saying in the medical community: The more solutions there are to a medical problem, the less likely any of them did anything.

    I've always said that plantar fasciitis arrives mysteriously, and it leaves the same way.

    Personally, I would explore Dr. Sarno's TMS, but, then again, I'd just be adding to the "solutions" list.

  2. Sean Olson

    Or you could try an insole like the New Balance NB405 or 425 made by Aetrex. Both have a metatarsal pad in them that help relieve the pain of plantar fasciitis

  3. Dan H

    Since no one else has mentioned it, I'll put in a vote for ultrasound. You can buy a personal ultrasound wand for about $50 on Amazon. Similar to the shockwave therapy, but a lot less extreme, it promotes blood flow in a place that doesn't get much.

    I also like massage for any kind of tissue recovery.

    I've only had brief, infrequent bouts of PF, so I'm no expert, but hey, maybe that means my methods are effective?

  4. geoff roes

    Dakota,

    At least you can take some solace in knowing that every other runner in the history of the world seems to have had PF as well. Or maybe that makes you feel not quite so special about yourself. don't let it get you down. you are special. heck, you even found my house on your first try, something no one has ever accomplished. As far as the PF goes, I think you just pretend you don't have it and then suddenly one day soon you won't.

  5. alison naney

    Just what you need is one more opinion. but i can't resist. I'm a massage therapist and ultrarunner and some serious deep tissue/myofascial work on your lower leg (tibialis posterior, soleus, tib. anterior) and possibly upper leg/hip will help. In my personal and clinical experience, you feel symptoms in the foot, but the lower leg is the underlying issue. Often hip weakness causes lower leg problems. If you're too tight above the foot, there's no give for the tension and you will inevitably get irritation in the plantar fascia. Sometimes just working the foot can give the lower leg (gastroc and soleus in particular since they fascially turn into the pf) more leverage to just get tighter. My three cents.

  6. Ben Nephew

    In terms of whether minimalist or traditional shoes are the cause and/or cure, both can be the correct answer. With low drop shoes, even going through a proper transition may not prevent PF issues; it may just be too stressful on connective tissue in the back of leg and the PF during hard training for some. With standard drop shoes, if the midsole is either too soft, there is a lack of sufficient arch support, or the midsole has a big cutout in the midfoot area, the PF is likely to be strained. Years ago Adidas trail shoes seemed to be designed to cause PF; huge cutouts in the midfoot. I've never had prolonged PF issues, possibly due to successful treatment early on. I've had some PF pain from stone impacts when trying to run in shoes that were too thin for technical trails, and also from overtraining in racing shoes without enough stretching.

    Switching to stiffer shoes with less of a drop for a while helped in both instances, in combination with stretching. The stretching that is most effective for me in terms of everything on the back of the leg is standing on an inclined board for 10-30 minutes each night, with incline enough to feel the stretch but not be painful. With icing, I always wonder how people are icing when they don't find it be useful. Using a gel pack wrapped in something may not be enough. My tactic is to get to point of frostbite, and then back off a few degrees. Feet are easy, bucket, water, ice, soak until your eyes water, remove, repeat as necessary. Having said that, the PF area doesn't have all that much blood flow.

  7. Aaron K

    Dakota, while I'm sure you appreciate the 50+ PF cures that have been presented here, I think the real question is, "what's your secret for achieving those impressive rock hard kidneys that we all aspire to?" Also, where are everyone's suggestions for better lymph system flow and for achieving a more boring pancreas? Also, you are a very serious guy and could probably benefit from developing a sense of humor. But not sarcasm- that's the lowest form of humor.

  8. Michael Wardian

    Dakota,

    Ah man, so sorry to hear this. I had the same reaction last winter when I got PF. I was like I don't have it and it can't stop me. The PF never really stopped me running but it just tried to suck the joy out of it. I dealt with PF most of 2012 until I got some other issues this past August. I am hoping the PF is gone and can't wait to get back out there in 2013. Good luck man and I can tell you that most of the people that I know/talk to about PF said it takes about a year to get over (I really don't know what that is based on) but I hope it is much faster for you. Have fun out there and good luck with everything. Cheers,

    Mike

  9. Speedgoatkarl

    I suggest seeing George Costanza's "Holistic Healer". He's in Boulder isn't he? Put some foam on your head and a triangle configuration….done. It'll get better, injuries always do, I have a new one daily…then it goes away again. :-) Wait till you're 45 years old. :-) Great writeup as always.

  10. hugh

    I began experiencing sensitivity in my PF in the summer of 2011 after switching from a neutral shoe (Adidas Supernova Sequence 2 with moderate medial support) to a minimal shoe (NB MT 101) and kicking up mileage and intensity. In November of that year I tore my right PF near the insertion at the calcaneous. There was minor swelling and enough pain it prevented me from running.

    Over the course of the next 2 ½ months, and under advisement from my podiatrist, I applied the following conservative treatments: icing, contrast therapy (hot/cold), massage, ultrasound, stretching, medial support via orthotics and night splints. Intermediate attempts to run were painful and ultimately resulted in the tearing of my left PF. Diagnostic images revealed PF in both feet were inflamed to twice their normal thickness with both micro tearing and larger 2-3 mm longitudinal tears.

    In March, my podiatrist casted my right lower leg and foot. After 5 weeks in the cast, the right foot was pain free. She ordered the cast on the left foot and 2 weeks into this immobilization my right PF began to hurt again.

    A friend related she had heard of someone curing their PF by using a tennis ball to massage the fascia. I removed the cast and while at work ground my foot into the tennis ball for 8-10 hours a day. 3 days later I was back running again for the first time in months. I continued the tennis ball therapy for several months until there was no longer any sensitivity in the fascia. During this time I increased my mileage up to 50-70 miles a week doing continuous runs up to 43 miles. And one year after I tore the right PF, I competed in a 50 mile race (marathon split = 3:18) with not so much a whisper from the fascia.

    Theory on why a $2 tennis ball was able to do what $5,000 of podiatry could not:

    1. The trauma caused by grinding my foot into the tennis ball for 8-10 hours a day caused a massive immune response to the damaged collagen fibers. Where the body had previously given up the fight because of continual abuse, the ball trauma was the tipping point that marshaled reconstruction.

    2. The deep tissue massage broke up the scar tissue and allowed the disorganized collagen fibers to realign. Increased blood floor adjacent to the avascular collagen tissues resulted in greater protein delivery and dead/damaged cell replacement.

    3. 30 hours of pressure over the course of several days stretched the fibers thereby reducing the tension throughout. This was the most immediate and tangible benefit as I was able to run relatively pain free.

    The takeaway: there are a number of conservative and invasive therapies used to treat PF. The effective result may be permanent cure but not before the ATM…er…patient has paid off the good doctor’s boat. Save yourself the time, energy and grief and use the tennis ball to get you back up to speed.

    1. Vegan Trail Runner

      +1 for the tennis ball. I didn't give it 8-10 hours a day but I rolled it for as long as I was at the computer or watching TV. Hope your PF clears up soon.

  11. PH

    Dakota: 1) Straussberg Sock; 2) roll your foot on a golf ball with as much pressure as you can handle- these 2 steps have saved my running life.

  12. ShaneT

    I will stick my neck, er, I mean arches out in favor of the tennis ball type approach. My collegiate running career was ended by PF in both arches in 1986. At that time there was little in the way of actual PT, but I tried the general treatment suggested (same as you received) to no avail. Numerous attempts to restart running failed over a three year period. Surgery was suggested and I cowered away from all clinics.

    I knew that the PF hurt the most in the morning (hence your boot thingy). Massage before I stepped out of bed helped a LOT, but working behind a chemist's lab bench caused excruciating pain by mid-afternoon.

    So, I began after work icing by rolling a frozen bottle of water under my arches – with pressure. After the pressured icing to reduce inflammation I rolled my arch over a tennis ball and/or massaged the arches HARD with my fingers. Within days of starting this regimen I resumed running. Now, the only time I have any PF issues is immediately after a 50- or 100-mile mountain event. That might have something to do with my 15-20 mpw training schedule. Maybe.

    Best wishes Dakota!

  13. oscar

    Google Soc-Doc for running injuries, by far THE BEST running injury prevention site (free, I might add) online! His advice has fixed me up many times, including PF.

  14. Alincb

    Dakota,

    Uh…good luck with that. I got a good case of the PF this Spring for the first time in 10years. No tellin wht brought it on. Perhaps it was the running on pavement in Mexico on early season feet and legs. Maybe it was the 9 miles I ran in Ski Boots 2 weeks before in the Grand Traverse. All I know is that I felt it coming on and did everything in my power to ward it off. Stretched the calf muscle prior to, during and after any run. Kept the strap by my bed and pulled my toes back up to my navel prior to getting out of bed… nuthin helped…still got it. Tried the night brace…hated it. Trained right up to the Lake City 50 with the crud and wondered whether running it was a good idea. Ran it anyway. Didn't quite have the enthusiasm to pound the thing into submission but the good news is…once it gets warmed up….running seemed to be pretty pain free.

    Good and Bad news…It's gone…and I mean gone. Don't even remember the first time I didn't want to crawl to the toilet. One day, I just realized it was gone.

    No voodoo, no weaning my self off of and back onto running…just kept running. One day. No pain. I have no idea wht did the trick.

    One thing I know is that I always have good arch supports in my shoes…maybe that helps??? Dunno…just know it went away. Yours will too. Time Mt Hopper.

    One of the most memorable quotes in my ultra career….."Dude, don't worry about it. About mile 35 you'll have so many issues going on you'll forget all about it."

    Always has held true. Good Luck!

    AH

  15. korey

    I've got that crap. Must be going around. I've found that some weeks it's awful and others it's almost as if it's not there. I ran a 50 miler last Sunday and it was fine. 3 nights before I was standing at work for a couple hours and it was killing me.
    I just ignore it. I've tried everything besides the sleeping boot. I'd venture to say the only thing that helps is time. (And possibly magical healers/profits)

  16. Brian

    I had great luck with acupuncture the first time I had PF. Five years later, less luck. But a tennis ball or golf ball (I keep mine in the freezer) has been helping a lot lately.

    Thing is, it's probably not a problem in the foot, as you intimated. For me, it's from tight calves — others might have unbalanced hamstrings/quads. Massage to break up the scar tissue — in feet, calves, wherever — helps spur healing for sure. I've also improved with some temporary inserts to take pressure off the fascia will it repairs.

  17. Pes Cavus Jim

    I am an avid runner who also happens to suffer from Pes Cavus, otherwise known as an extremely high arch. I have orthotic inserts that help to relieve the pressure and even out the landing however it's a pretty rough existence. I have recently been diagnosed with plantar fasciitis as well. should have chosen a different hobby! I love it so there's nothing that's going to stop me now. Your article is an inspiration and it's nice to hear that I'm not alone with this pain! keep it up!

  18. kay

    I solved my plantar f. with magnesium. I actually started taking it for migraines which helps some acc. to clinical trials, but did not help my headaches. Instead, suddenly my p.f. disappeared and so did my sciatica! I just took cheap stuff from the grocery store. You know if you have taken too much because it will give you diarrhea if you overdo it. I take about 120% of daily need whenever I feel a twinge and all is good!

  19. Robert Ebisch

    As a plantar fasciitis sufferer, I’ve taken my interest to create a little plantar fasciitis section on my hobby Web site. One curious aspect of plantar fasciitis has intrigued me: how plantar-fasciitis-afflicted NBA players like Pau Gasol and Joakim Noah can get back on the floor so fast while the rest of us struggle for a cure. I talked with Dr. Jeffrey Ross, Associate Clinical Professor in the Baylor College of Medicine, who works with pro athletes, and he has an interesting and instructive outlook. In case his outlook might be of interest to others who are afflicted, I wrote it up in a little article, "Plantar Fasciitis – Fast Bounce Back in the NBA," at
    http://www.bobbingforanswers.com/plantar-fasciiti
    I hope Dr. Ross’s perspectives and advice help others as it has helped me.

  20. Kimberly1evans

    Great stuff on Plantar fasciitis. I had it three years ago and was dealing with the pain for most of the three years. I tried the cold water bottle thing it is effective for some relief just as well as other products and tips that I have found online, but I wanted the pain to be completely gone, especially in the morning. There is a site that I invested about $40 in and I was pain free after 2 weeks on implementing it. I encourage anyone who is dealing with the pain to have a look at this site. http:///www.howtocureplantarfasciitis.org

Post Your Thoughts