Monday, August 31, 2009

Dealing with plantar faciitis: an update--Post Doctor Visit

After six weeks of not running and following several recommendations to the "T" and still no progress on regaining a pain-free left foot, I finally went to a medical specialist this morning for my nagging case of plantar faciitis-- a common running injury that is hard to treat successfully. The graphic to the left that I got from the AAOS web site shows it's location.

I've been suffering from a worsening case of plantar faciitis on my left foot and a secondary injury of hip bursitas on my right side (which since has subsided since I stopped running about 2 months ago) and intermittent lower-back pain (sacrum area), since December 2008.

The injuries seemed to correlate with a sudden-I'm-so-dumb-to-do-this jump in running miles (more than 10% increase each week) and writing a research paper on the foodways of triathletes and runners for an anthropology class. My days in December were sleep-deprived generally and usually involved long hours of sitting at my computer, sitting in my car on the 101 Freeway or in class followed by a long Saturday road run with the gazelle-like Inside Track Running Club ultra and marathon runners. ("Who needs to gradually increase their mileage to train for a marathon? Not me!") Nine months is long time for me to be nursing an injury. Lately, I've been doing more mileage writing and reading about running, than actually doing it. I've been a runner who can't run.

Since I forgot to ask the good doctor's permission to blab about his advice to me online, his identity won't be revealed. However, I'm confident he knows what he is talking about. He's an orthopedic surgeon who specializes in the foot and ankle, is athletic himself (runs and surfs) and has been treating foot injuries for twenty-five years. Finally, two of my doctor-swimmer friends recommended him.

After the doctor reviewed my gait and stance, an x-ray of my foot, and the wear pattern on my old NB 1224 running shoes, according to him, I had no obvious mechanical problems with my gait. Both feet have good flexibility and perform well. I just have a very painful heal (pain located at the mid-point/center and front area on the sole). And, I have tight soleus muscles. Apparently tight calves strain the plantar facia & Achilles tendons by deprecating my gait efficiency which puts additional weight and pressure on the arch/heal area with each step.

Here are his recommendations (as I understood them) to treat my plantar faciitis:

1. Wear a foam heal-lift in my shoes to remove the constant strain on my plantar facia & Achilles tendon's attachment on the calcaneous (heal bone)

2. Stretch my soleus muscle (muscle below the gastronemius that is just above the heal) with a wall stretching technique three times a day; Web pages that show how to do the stretches properly are at and at the AAOS web site.

3. Use ice on my heal/arch for pain management within 30 minutes after an activity inflames it; massage with ice is okay if done gently

4. Lay off strength training for a while: it's too soon for me to engage in heal lifts or heal dips or walking around barefoot if the heal hurts or hurts afterwards; As the doctor said, "If it hurts, don't do it!"

5. No running of any kind until the pain/inflammation subsides; That means no barefoot walking or running and no up hill, forefoot, or beach walking or running for a few weeks

6. Go for a walk on flat ground with supportive shoes (Brooks T5 with Superfeet insoles & foam heal lifts or NB 1225 with Superfeet insoles and foam heal lift) for a mile; then progress to a 1/2 mile walk, 1/2 mile jog (no faster than 8 or 9mpm for jogging intervals); and work up the mileage if there is no pain (If there is pain, back off and go back to walking)

7. When I can run again, practice a mid-foot running style with a shorter stride and feet landing underneath my center of gravity--not in front of me, landing lightly on my mid-foot before rolling off. For more information about improving one's efficiency through running mechanics check out for a mid-foot running article that covers the many current running biomechanic trends and philosophies such as Chi Running, Evolution Running, Dr. Ramanov's Pose Technique, barefoot running, etc. I got this from Clynton at Running He posts informative articles on running and diet with cited sources, too.

8. Continue using the night splint; stretch the calf muscles before getting out of bed each morning

9. Cross-train (continue swimming, weight training & riding my bike to keep up my cardio)

10. Gentle self-massage of heal and facia of arch on the foot every day followed by ice only if needed for pain and inflammation; As the doctor told me, "Ice doesn't help this injury."

Even though I wasn't running earlier this summer my heal pain kept hurting while I was doing my six-week Born to Run- and Advice-from-Friends- inspired "Everything But the Kitchen Sink" and two-week "Kitchen Sink" Plantar Faciitis Treatment Program. According to the doctor, I kept straining my arch/heal facia by strength training too early (calf raises and dips, lunges and walking barefoot around the house and beach). These failed treatment programs culminated with two desperate (but enjoyable) barefoot jogs on the beach. Severe pain was the result of the final beach runs. It was only nagging pain before.

If this new treatment plan doesn't help then the doctor will consider putting my injured foot in a cast for 4 weeks to take the pressure off my Achilles/heal or plantar facia. That means I can't do my dawn open water swims, though. And the thought of riding a stationary bike to keep up my cardio really isn't appealing. I hope it doesn't come to that.

My doctor didn't talk about the barefoot running nor of the forefoot running discourse in the running community. That may be because either he was unfamiliar with the trend of training this way with barefoot-in-the-grass running drills and strength training. Or, it may have been because he ran out of time for my appointment. He emphasized only that the calf muscles of one's leg drives and supports one's foot. This is a paradigm shift for me: my calves are a part of of my feet. To fix my feet I must first fix my calves by frequent (at least 2x/day) stretching of my soleus muscles done with correct form.

For now I'm wearing my $8 foam heal lifts from Ventura Orthopedic in my lightweight and flexible Brooks T5 running shoes, $70-ish (it was last year's model on sale), I bought at Inside Track with my $35 Superfeet insoles (green ones for high arches) that I also picked up at Inside Track. My left foot aches a bit today. But is probably from yesterday's painful one mile forefoot running experiment on the treadmill. And, playing with the kids in the water at the beach yesterday--barefoot of course.

Thank you so much to those who have left me informative comments & encouragement!


  1. Wow, 9 months - like having a baby, but probably even more painful! I think you are indeed creating a new life, though, for yourself. You will get through this and be better for it.

    Interesting about the calf muscles being mentioned in the same breath as your foot problems. Makes sense, though, as everything's connected.

    Talking about the calf muscles makes me wonder (thinking out loud here) if running barefoot (or at least with a forefoot strike) might be worse at first, if your foot is inflamed at all. I say this because a forefoot/midfoot strike uses the calf muscle way more than a heal strike does. If the muscles are connected, maybe a forefoot strike isn't so good when you're foot's still hurting (and your calf muscles aren't yet used to that much work). Just a thought. I hope you are able to return to barefoot walking soon, though. After reading Born to Run and seeing the author Christopher McDougall, run so well now barefoot after suffering from the exact same problems (and being told he couldn't run by the best doctors in the country), I think there's an answer there for you as well.

    Trying to give your foot complete rest for a bit sounds like it might be a good idea.

    I really hope this works! Keep your spirits up.


    PS. Oh, and thanks for the link!

  2. You are correct about avoiding walking barefoot or jogging with a midfoot/forefront stike while the facia is painful and inflamed. That goes for calf/heel raises, too. Every other day during the first 8 weeks of my plantar facia treatment I did the calf/heel raises and walked barefoot a little. And, every other day I re-injured my foot!

    "As long as it hurts, don't do it" is my new plantar facia treatment plan motto. No walking barefoot, no calf/heel raises and no Chi, Evolution, or POSE running until the pain in my left heal goes away. However, long it takes...

  3. I copied this from another question I answered about achilles tendonitis. I don't know if you'll need heel lifts or not, but they take alot of stress off of the tendon and could give it some healing opportunity. Ice and ibuprofen are always recommended by doctors too. Good luck.

  4. When the arch of the tendon, the plantar fascia, becomes inflamed it is called plantar fasciitis. This is a trauma which may result from overuse and causes heel pain which can move throughout the foot. If you want to Best Shoes For Achilles Tendonitis visit our site


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