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 93 comments

  1. Stuart gates

    Greetings from hong kong. I had it for about 2 months and i went 3 times a week to a foot massage place where the therapist used his knuckles and just worked in the problem area for an hour each time, also had acupuncture too and it did the trick, 100% curedand never any issue afterwards. The bare knuckle treatment really hurt but it definately did the trick.

  2. Andrew

    Having seen some of your shoe reviews, I would say stop using your low heel shoes and run only in shoes with a more traditional 10-12 mm differential, if that is what you most of your lifetime miles in. That worked for both me and my girlfriend, both long time high mileage runners with tight muscles who never got injuries until we tried longer mileage in flatter shoes.

    I have been a runner for 27 years, and have done some portion of my training in flatter shoes for at least a decade, but didn't have problems until about 4 years ago when I upped the proportion of mileage in them. I started having minor achilles, arch pain, or heel pain at intervals. At first I thought it was just because I was hitting middle age. You'd think that a decade long transition would help avoid any issues, but I think sometimes long time runners who have tight back of the leg muscles just cannot adapt. Instead of adapting, problems get worse the longer I tried staying with flatter/low differential shoes – and that was with very consistent eccentric strengthening exercises/stretches and night splits, etc. for a couple of years. I could still run about as much as I used to, but with little niggles here and there that I had to take care of with the exercises or stretches.

    Fall of last year, I decided to just get a nice pair of standard differential shoes (Puma Trailfox 4), and do all my running in them. I was immediately able to crank up my mileage to 100-120 miles per week, stopped doing the dumb exercises, stopped wearing the night splits and Strassburg socks, and all the aches and pains just went away. It was somewhat counterintuitive that I could crank up the mileage while still having some degree of plantar or achilles issues and have those issues finally fade away, but my body has memory of running maybe 50,000+ miles in 12 mm differential shoes. I guess that is what my body likes, even if the 4 mm differential shoe often feels smoother or better.

    My girlfriend had the exact same experience. She always made fun of my "trendy" or herd mentality of using other lighter shoes (though I pointed out I had worn flatter shoes at times since well before Born to Run), but she loved/got suckered into the feel of the LaSportiva X-Countrys with 5 mm differential. A year later, she was getting heel pain for the first time in her life, and had to look up stretches, borrow my night split, etc. A few months ago, she went back to her old favorite 12 mm ? differential shoe (Brooks Cascadia), and all the heel pain and niggles have faded away, just like mine did.

    Now I'm showing how stupid I can be by getting sucked back into the flat shoe thing. I tried out the Altra Superior and couldn't get over how much I loved the little toe room for my wide feet, so I got them thinking I would use heel lift pads in them for running and use them as non-running comfortable every day shoes. Well, they don't feel as good with heel lifts, so I run in them as is – and I am getting niggles in the right heel again, which go away if I limit the mileage in those shoes. I'm going to still run in them for the short runs, but I am prepared to do most of my mileage in my Puma Trailfox 4s.

  3. Andre Cruz

    Hugs from Brazil.

    Well, I have a post in my blog talking about it and the way I found to cure it.

    It´s simple and fast.

    If it worked with me it may work with you.
    http://www.96pes.net/2011/11/como-tratei-fascite-
    The words are in portuguese, but you can translate with google.

    But don´t care. Just follow the pictures.

    What is important is massage and stretching the plantar.

    Take care.

    Bye, André.

  4. Andy

    Total opposite of Andrew above: "cured" my PF by transitioning to minimal shoes over a period of like a year or more and (allegedly) strengthening the feet. Which goes to show that you're probably just as likely to benefit from a t-shirt and a good IPA. Or better yet, have the "healers" share their mescaline.

    Seriously, talk to AJW — seems to me he was suffering PF for a while and seems to have kicked it. Hang in there; it sucks but will get better … eventually …

  5. Shelby

    Bummer, Prez. Hope that your off-season gives you the time needed to heal. Maybe you can get some magic drugs that will also help grow you a beard and show Geoff & Co you’re no Baby Jones anymore.

    I recall your bday is near TNF50, so Happy Birthday, whenever it was (is?)…. Enjoy your double twos!

  6. Brett

    Look at Amy Palmiero-Winters – she has completed Badwater, Western States, and has even won 100 mile races outright…all with a prosthetic leg. So I say just cut the bitch off.

  7. David

    Another vote for minimal shoes – going to 0-4mm drop shoes (and thus a forefoot strike) cured my PF 3 years ago and it never came back. The higher drop shoes (Montrail) basically promote crashing on your heel where the tendon attachment is, duh. If your PF is really bad you may need support and rest; if it's not so bad then go barefoot as much as possible and do strength exercises – like picking up a golf ball with your toes. Good luck.

  8. Sam Winebaum

    You've had a fabulous season with dare I say an increase in "intensity"

    I got plantar's back in 2007 after running a mix paved road (mostly) muddy dirt road spring half in a worn out pair of Inov-8. I had been doing mostly nordic skiing that winter and was in great shape, so decent time. I almost immediately got plantar's. In 40 years of running never had it before. If I remember it took 6 months to lick.

    I got over it, it took awhile and wrote about the things I was trying here on my blog
    http://samwinebaum.blogspot.com/2008/05/relieving
    In the end in addition to running moderation including flatter terrain, some stretching, and lower drop shoes 2 things really licked it for me:

    I used a Pro-Tec Athletic Arch Support in my shoes and at night pretty much all the time, except running. Couldn't stand the pull your toes towards you knees socks more than a few hours at a time.

    In the end what licked it was… running. I ran the Mid Mountain Trail Marathon Park City in absolute plantar agony from the first step to the last. 2 days later plantar's was gone. Must have broken up the scar tissue but good!

  9. Tom

    The Cure

    Take the mescaline

    Put on an audio CD of Born to Run

    Cut your shoes up into one inch square pieces

    Discard the leather and rubber parts

    Have Scott Jurek come over and cook up the rest in a vegan dish

    Eat it

    Climb a local slab with Tony

    Chant to the gods of professional ultra trail running (the sponsors)

    Mention you need their money because you don't have a job

    Have Joe record this all on a video

    On his website it will be called Running Entrails

    When the mescaline wears off your foot will not be an issue

    1. Mike B

      Awesome! Everyone who's had PF has had a unique response to it (minimal shoes, cush shoes, no shoes, more mileage, less mileage, massage, PT, golf balls, etc.). At this point, do what works best for you. Like seeing the more light-hearted thoughts on PF issues than the serious, end-of-world, will I ever run pain-free again angst. Cheers!

  10. Rod

    After you have studied PF in detail you come to realize that saying you have PF is like saying you have a sore leg. It's likely to have many different routes to get to the party. Does it make sense to break PF down into subgroups based where in the foot the main issue appears to be? Medial heel,lateral heel,arch anterior or posterior?

  11. swimmons

    Speaking of golfballing, thats the answer. Roll your plantar over one 3 times a day. Then a couple times a day take your thumb and jam it into the part that hurts the worst and feels cracklely, dig around in there until your eyes water. Helps if you drink and put a stick in your mouth too. Goes away in a week.

  12. Bobby

    I take a particular interest in your statement regarding your inflexibility. I too, am extremely inflexible…and hate stretching. Having said that, the ONLY way I've been able to recover from and prevent injuries is with a regular stretching routine.

    To make it sane for me, I simply do a routine of some of the Wharton Active Isolated Stretches for about 10-15mins 4 times a week. If I don't do this…I will get PF issues, achilles issues, etc. I've come to believe everything in that lower section is tied together and most of my foot area issues are actually stemming from VERY tight hamstrings and less than adequate hip strength. Good luck dude, looking forward to hearing about you back at it!

  13. Ethan

    I expect given the number of 'here's what you shouldn do!!!' comments you're getting, you'll probably just give up at some point, but my two cents: 1 – regression to the mean is a real thing; just keep working trying stuff until something seems to work, as it will get better on its own anyway. Second, for my money I think the advocates of 'minimalist' or 'high drop' shoes are confused. PF, like many soft tissue problems encountered by runners, is a repetitive stress injury. This explains why advocates of both approaches improve when they switch – they've changed the stress they're applying. Your best bet is to lay in a supply of shoes with a range of stability, drop, and protection profiles, and vary your training between flat and hilly, fast and slow, rough and smooth. If you avoid beating on your body the same way every day, things should start to improve.

  14. Runner

    Well now you have 100s of people who will cure you. I can say, however, I have tried everything you mention. The night boot usually makes it about 3 hours before I take it off whilst still asleep.

    One thing that is working, finally, is Graston. Essentially, the therapist takes a piece of metal and scrapes the hell out of the adhesions on your foot. Often it becomes bruised (works on IT band, Hamstrings, calves, too). The scraping breaks up the adhesions and the bruising brings oxyegenated blood to the area for healing. I've been running for a year with this issue and after 4 weeks of Graston (www.grastontechnique.com) am finally seeing a difference.

    Lastly, I've gone back to those un-cool shoes that have some heel cushion and 10-12 mm of drop so that my Achilles and connective tissue is not strained daily with my minimalist shoes.

    Good Luck.

  15. Rob Y

    I suffered from PF (off and on to various degrees)for well over a decade starting, not surprisingly, after my first 100 miler in '96. I've tried just about everything you and others have mentioned in the comments. THE only thing that truly helped was staying in arch support ALL the time; not just while running. I bought a pair of Birkenstock sandals and when I'm not running or working I'm in them. When I'm working my shoes contain an off the shelf arch support (SuperFeet or Powerstep). When I'm running I've got another arch support in there. Keeping to this strategy has proven to the most effective treatment for me and now I've been PF free for a long time. The other thing to consider is where years of PF leads to. In my case I ended up having a HUGE bone spur right at the attachment point of the PF to the calcaneous. It was this vary spur that was causing most of my PF discomfort as the delicate tissue/fiber rubbed against this knife blade over and over! I totally believe now; after talking to multiple orthopedists that (at least in my case) running for so many years and so many miles that running w/o arch support lead to the development of this spur and my PF woes. So now I don't do anything w/o arch support! As a side note, I sustained a fall on my heel over a year ago that literally broke off the heel spur in my foot! After three months in a boot and no running (to allow the tissues, fiber and fasciaa to heal) the spur is gone and for once in my life since I started running ultras I can get out of bed in the morning and NOT feel a dull pain in my heel! It was like self induced heel spur surgery! (Not recommended!).

  16. Guy C.

    Wow, 14+ comments in and no one has mentioned the obvious:

    The All Fruit Diet.

    Sorry, man. It's a bummer. However, you did make me feel a little better about the knot in my calf.

  17. Bay Area Runner

    I second the Graston Technique. I've had PF for about 3 months, and had to stop running completely….in fact I could barey walk altogether. After Graston I noticed a huge difference after my first treatment. I am on #8 now, and its getting better and better. I ran my first mile today at the therapist's recommendation.

  18. Wyatt Hornsby

    Dakota: PF can be beaten. As you know, it's a ligament injury that requires time and some rest. Fortunately, this is a good time of year to take it easy. Wearing a night splint is crucial because it helps prevent reinjury when you take that first step in the morning. I had a very serious case of PF that made me think I'd never run (well) again. I blogged about how to beat PF here:

    http://nolimitsever.blogspot.com/2011/02/how-to-b

    Feel free e-mail me if I can be of any help.

    Good luck!

    Wyatt

  19. CJ

    Agree with Andrew here. I ran a tough 25k trail race back in September in Nike XC Waffle Racers which are 5oz each. Very bad choice, to say the least. Shortly after that, I began to have some PF pain which I had never experienced before. I'm not saying I'm immune from that issue but it caught me by surprise. Once I began running again for a few days in my supportive trainers, the issue cleared up and I haven't experienced it since.

  20. Jesse B

    I had a severe case of PF that lasted almost two years. It was the worst time period in my life. I could do almost no alternative exercises without pain, that includes swimming. I tried every available idea on the solution, from shoes, golf balls, ice, night splints, yoga, orthotics, you name it! Then I went and recieved Extracorporeal Shockwave Therapy, four sessions of five minutes and never pain again. I'm back to running competitively and have never looked back or had a problem. In my experience this worked for me, give it a try, it might work for you!

  21. Michael Kealy

    Mine surfaced by stepping up too quickly in mileage – I was able to keep trudging on for 3 months and then I sent both heels over the edge by racing downhill at Wasatch Steeplechase and that sealed my fate. From that point, the plantar hurt no matter what I did – wearing boots at night, standing of any type, sitting in a car or at my desk chair-it was horrendous. Ultimately after about 4 months, I was able to put it at bay with cortisone shots through each heel (brutal!) and then had to stop running for 16 months. The plantar all of a sudden was gone from both feet within a period of 12 hours of each other! Then I tried running in hokas and for the past 1.5 years I've been plantar-free. I raced a couple 50k's, was on track for NYC Marathon until canceled, and just signed up for Wasatch 100 next Sept.

    My take-away is that many folks suggested this and that but I feel it needs to play out over a shelf life of 8-20'ish months once it's at the sheer brutality stage. I know not what anyone wants to hear, but that was my story.

    1. ripvanracer

      "The plantar all of a sudden was gone from both feet within a period of 12 hours of each other!"

      I believe the sciatic nerve has a role in this injury because of cases like this. I don't know if I had what others call PF, but the muscle above the fascia in the arch in both feet would tighten or ball up. Before this happened, I remember pains shooting down my leg on a run. I got where I could actually feel the tightness coming and stretch a certain way with my back and it would feel better. All of my research about PF showed that nothing always cured it but most cases would eventually go away. The pain is your brain telling you there is damage somewhere and if you keep running it will get worse.

  22. Jonathan

    Sorry to hear about your running woes. I certainly hope things get better and that you are able to get back to running painfree. Look forward to seeing you in Squamish!

  23. oliver

    My spouse had a wicked case of PF.. she went to a doctor that zapped her PF with a machine that breaks up kidney stones. The pulsing machine goes internal and damages

    the facia, which promotes healing. It is a bitch to get rid of because there is no blood in the facia. This machine promotes blood to the area (because it essentially damages the facia), and gets it healing. Three treatments, one a week, and she was on the road to recovery.. never came back after 10 years. It is a machine that was originally designed to breakup kidney stones, and it sends a pulse or something into the bottom of your foot. Good luck.

  24. Ned Barrett

    Never had it, wouldn't have a clue what to do if I did. I've run in traditional shoes, low drop shoes, heavy monsters, lightweight trainers, currently love the Rogue Racers. Two constants in almost thirty years of running: I wear Spenco arch supports (the flexy kind, not the plastic kind)instead of the liners they come with. I don't get new ones very often, but the arch rise fits my feet really well. The other constant is that I roll my feet regularly. When I first started I used a tennis ball, then later a frozen water bottle, these days with the Stick.

  25. Ran Pergamin

    Dear Dakota,

    I truly feel for you. Recovering from PF myself just now I learned a couple of things.

    Above me (and maybe below me), you'll find many "how to" technique that worked for various people.

    The issue, as you already probably understood, is that each person has a different path to the holy grail of recovery from PF.

    My biggest tip to you would be this :

    – Try as many various things as possible, to know what is "working" for you.

    – How you know what is "working" for you ? That's the trick, and what I have found is when finding the "things" that work for me the relief was immediate & significant compared to all other attempts where I struggled to find hints that its leading me to recovery..

    It took me 3 month to discover that Birkenstock shoes enable me to be absolutely pain-free during none-running times & enable my fascia to recover. Once I put them on my feet, I knew I found a "home" for the recovery period.. This is after 3-4 month of ice, heat, ball rolling, stretching, etc..

    – The other thing that really made a difference for me is this exercise (ignore the trashi accent):

    http://www.youtube.com/watch?v=hvJ_KhrPN_8

    I do it 3 times a day x (3 x 1min).. It stretches the hell out of the fascia..

    The first time I did it, I thought I was going to die. Seconds after that 1min, I felt immediate relief.

    3 weeks into this, I feel that I am on the exit path.

    There are of course other things that do contribute to general health & recovery :

    – Stretching of calfs, soleos

    – Foam roller for trigger points (especially the posterior tibialis, which is a major TP on the Fascia)

    – Core training (back muscules, etc..)

    I do now intervals of walking/running, slowly increasing the periods of running, reducing walk.

    This works for me.

    Find the elements that work for you, it can be a long journey, but the moment you find that right element for you, you'll know it, that's my tip.

    If you want more info, feel free to email me.

    Best of luck with recovery

    Ran

  26. André Lambert

    Hey man,

    Do some of the massage people are talking about just because you can bother yourself to do it and buy some Hokas. You can't go wrong.

  27. Andrew

    "This explains why advocates of both approaches improve when they switch – they’ve changed the stress they’re applying."

    Changing the stress – variety, was not what I needed, and my example above was an attempt to advocate for less variety for runners who fit a particular profile. The bulk of my lifetime miles was in ~12 mm differential shoes, and that was injury free, ache free, maintenance exercise free over 20+ years. Introducing variety and different stresses by adding use of lower heeled shoes was what set off the aches and plantar and achilles issues in the first place, even though the "transition" was over a period of a decade and necessarily included the exercises to help the "transition". Byron might fit a profile similar to me and my girlfriend – tight muscles, high mileage runner for a long time with absolutely no repetitive stress injuries, probably been around long enough that he has done the bulk of his life miles in 12 mm differential shoes (which may have led to the tight muscles in the first place, but it might be a done deal).

    I'm saying that for someone of that profile, "transition" to lower heels might not be possible, even over a period of years with all those exercise to help "strengthen" and lengthen/stretch the lower legs/feet. Ramping up the "variety" had the opposite effect for me – lower legs/feet got weaker the more "variety". Going back to what was previously successful, with almost no variety, is what made all the injuries and aches go away. I'm back to the old traditional strategy (at least of those around my age) of using lower heeled shoes only for racing shorter races and for faster workouts, and maybe shorter runs.

    1. Andrew

      Oops on Dakota vs. Bryon. and another correction:

      Ramping up the “variety” had the opposite effect for me – lower legs/feet got weaker the more “variety” I ADDED.

      1. Ethan

        Andrew – if your previous approach was short and fast in low-drop shoes, and easy training in higher drop shoes, that qualifies as variation. Switching over to all low-drop would have the effect of limiting the difference in stresses your body experiences. That said, another good rule is "if it ain't broke, don't fix it." If you know something that works for you and you're happy with it, awesome. But if you're planning to continue running, farther, longer, harder, with increased mileage, then strength training, maintenance exercises like foam rolling, and variation in your footwear and daily routine will help you get there.

        1. Andrew

          Getting into way more detail than I intended, but my approach in the past was generally to use one pair of shoes at a time. I bought what was cheap or discounted and ran them until they almost couldn't stay on my feet (often several thousand miles per pair). I did have a racing shoes, but I sometimes didn't race for years at a time, and when I did, it was maybe only three 10K road races in a year. My racing shoes, the same pair for over a decade starting in the early 1990s, were uncomfortable, so I didn't actually use them faster training like I might have if they weren't awful. My spikes were used even less – the same pair I took over from my brother in 1986, I used infrequently in trail races into the early 2000s. The amount of use I put in race shoes was so low, I don't count it as variation. The exception was if my primary training shoe happened to be a race shoe – I remember using the Nike Thinclad as a training shoe because I got it off a clearance table, and it was the cheapest thing I could buy. I don't remember if it was low drop or not, just that it was on the thin side. I ran far (sometimes day after day of 20 milers, up to 145 mpw), fast (6 miles time trials in under 30 minutes, sometimes finished long runs with last miles under 4:40), never had repetitive stress injuries, never needed strengthening exercises. I had a 2 year bout with chronic fatigue in the 1990s, but I considered my legs pretty much injury proof.

          About 10-12 years ago, I started using lighter shoes like the Adidas Lightfoot and Adidas cross country spikeless shoes, then Nike Frees, Inov-8s, and Feelmaxes. This was the start of more real variation for me, and part of what I was calling a decade long (attempted) transition towards minimal. I gradually used more and more minimal shoes, mixed in with standard shoes, but always getting more minimal until August 2011. I remember getting a sharp arch pain during a short trail race in 2004(?) being totally surprised That type of pain was completely foreign to me up to then. I limited my running in that particular shoe, and the problem went away. In 2007 or 2008, I noticed achilles pain (and thickening)for the first time on one side. That led to the beginning of strengthening exercises, massage sticks, etc. Then the other achilles started having slight pain. Then arch pain or heel pain on one, then both feet. I was getting one lower leg/foot problem after another, and all this was while really consistently getting after those exercises (eccentric heel drops, etc.). After 2 or 3 years, it was obvious that while those exercises kept me running, they were not going to fix anything permanently. Adaptation to the variation was not happening.

          quote:"But if you’re planning to continue running, farther, longer, harder, with increased mileage, then strength training, maintenance exercises like foam rolling, and variation in your footwear and daily routine will help you get there."

          So after 2 or 3 years of that stuff, reading about how minimal shoes increases stresses in the lower legs and feet, and realizing that I've done all those things that minimalist say you need to do to adapt, and having done those things for 2 to 3 years, and also having a gradual build towards minimal for about 10 years, it still wasn't working. I got back on the one non-minimal shoe for all training in August 2012 and immediately stopped the maintenance exercises, and everything that years of those exercises couldn't fix healed up on their own. This past spring, after a winter of very limited running (<30 mpw), I jumped my mileage up to 120 miles my first week back, then continued at about 100+ mpw for most of the spring… back to the old bulletproof legs. And I had thought that I was getting old a few years back.

          1. Andrew

            Edit date in last paragraph: I got back on the one non-minimal shoe for all training in August 2011 and immediately stopped the maintenance exercises, and everything that years of those exercises couldn’t fix healed up on their own

  28. Andrew

    Even the minimalist advocates acknowledge that going to lower heeled shoes shifts the stresses towards more in the lower legs and feet, less higher up the leg. That might be a good thing for some runners, a bad thing for other runners.

    1. Meghan Hicks

      Andrew,

      Sorry if we confused you! You were probably one of our earliest-morning readers. When we first published the article, Bryon was erroneously listed as the author. We corrected our mistake and attributed the essay to Dakota just as soon as we realized it this morning. Again, sorry! :)

      1. Steve L

        Andrew,

        Thanks for sharing your experience with the lower drop shoe. I've been wrestling with the idea of switching back to a more traditional drop after a few months of problems, this was the push I needed.

  29. Gabriel contreras

    Hey, sad to hear of your PF. I have gone through two rounds of PF. The only thing that works is not streching the plantar, but let it heal. Strengthen the plantar by grasping a small ball nightly. Stay off of orthotics, I walk and run now in sandals 90%, NB 110 % on rocky, steep California trails. No PF. Checkout ; soc-doc.com he was very helpful. Good luck. Gabriel

  30. AJW

    Took me nine weeks to get over it. Then, when I came back to running I ramped up too quickly and jacked up my meniscus on the other side. Basically lost the whole year. But, I've been running solid since July so all is well.

    What worked for me was rolling my foot on a lax ball and then a golf ball, wearing the boot at night, taping my foot, getting good orthotics, stretching the crap out of my achilles tendons, and lots of Double IPA

    Good luck Young Money!

  31. mc

    Nothing worked for my PF either, until I got Dr. Ray's "Correct toes". My foot and lower legs have never felt better. Now I realize now narrow most of my shoes are!

  32. Andy

    Oh, yeah, and Voltaren (diclofenac) cream — I think that might have actually had some benefit. No one's mentioned KT tape either …

    And I'm sure others have said this above, but run through it. Unless the inflammation is extreme, rest does not help.

    Isn't it great to have hundreds of personal trainers and physicians all over the country, each with his/her own sure-fire treatment? How many ultra-runners does it take to change a light bulb?

  33. Dejan

    I would go with the alternative folks. Our feet are at the bottom of everything and after going to acupuncturist to sick another opinion he pointed out that I might have a bladder problem, since my PF was in the right foot. I am not familiar with the left foot PF.! So Dakota I think Boulder is the place to be.

  34. Kim Neill

    Just what Tommy S. said: it will go away in time. I ran with PF for 12 months leading up to Wasatch 100 (back in 90s when only clunky trail shoes were available). My PF disappeared by the end of the weekend that I completed Wasatch, never to return again (I get little hints of it and just roll the bottoms of my foot as prevention). Now I run in a variety of low-drop, high drop, light and heavy shoes. It will go away for you too!

    1. Brian

      Agree. I have it more in my heel and I smash the heck out of it every morning with a golf ball. Also put my arch supports back in. It has essentially disappeared. Also think you should climb more. I never had PF problems years ago when my feet were stronger from climbing all the time.

  35. Peter Andersson

    Olive oil applied through massage under the foot.

    That's how I cured my PF in just a few weeks.

    And I was sceduled for surgery a fem months down the road.

    That's how the person who gave me the tip cured his.

    That's how at least one person I've tipped cured his.

    Simple natural olive oil goes in to the tense tissue.

    Olive oil even goes through greaseproof kitchen papper.

    That's why it can be massaged in to the tensed tissue.

    Olive oil is often an ingredient in skin creams for this reason.

    Some would even say the "real" ingredient, but that's another story.

    Use olive oil and self-massage over the hurting area at least three times daily.

    Don't forget to put on a sock afterwards or you might slip on the floor and get other injuries. ;-)

  36. Andrew

    Just to be clear – I have pain in my right foot that I thought is PF but it is closer to the ball of my foot than my heel – is this something else?

    If it is PF of a different type, is the forward location cause by too much midfoot strike or what?

  37. Melanie

    LOL – you somehow made plantar fasciitis funny. Love the ultrasound analysis. And your comment on Hoka shoes. I look forward to following the progress of your overarching positive lifestyle changes ;-)

    Plantar fasciitis sucks, and sometimes the ultimate cure is to stop running (or run much less). (Getting old sucks, too, haha) I have plantar fasciitis that comes and goes, depending on use (or overuse). I sleep on my back, and I found the weight of the covers on my toes at night made the plantar fasciitis worse. Now I use a footeez to lift the covers off my feet, and my morning heel pain is much less. It won't cure your PF, but I think it helps minimize the shortening of the fascia tissue that leads to morning heel pain. Good luck!

  38. 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.

  39. 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

  40. 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?

  41. 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.

  42. 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.

  43. 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.

  44. 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.

  45. 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

  46. 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.

  47. 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 &frac12; 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.

  48. 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.

  49. 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!

  50. 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.

  51. 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

  52. 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)

  53. 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.

  54. 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!

  55. 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.

  56. 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. [broken link removed]

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