Monday, October 26, 2009

Plantar Fasciitis update: I got my cast off but I can't run...yet

I got my cast off today. I posted a photo of my cast-freed atrophied leg on my Facebook page with the caption, "Yikes! The horror! The hair!" The leg is cleanly shaven and sterilized with antibacterial soap now. Thank goodness.

Here is a summary of what my orthopedic surgeon told me that I need to do in order to get back to running long. If you are suffering from plantar fasciitis, I will tell you right now, I don't have the answer on how to get you back to running again. After months of self-treating it, reading about it in both consumer and fry peer-reviewed articles in scientific journals, I only know this: what treatments didn't work for me, mistakes I've made that made it worse, and that there is no single cure or treatment that works for everyone.

This is the second time I've had plantar fasciitis so bad where I had to completely stop running for over three months. The first time was a flare up that happened a few months after I got Achilles Tendonitis in the last mile of the Chardonnay 10 mile race in 1995. (I think the micro-tears in my Achilles was from under-training in my running, not stretching before the race and having tight hamstrings from my long road rides and from wearing racing flats for the first time in a long time.) It took about four years and two non-running periods of third-trimester pregnancy to get rid of the plantar fasciitis the last time I had it. The Achilles tendinitis only lasted about six months.

"You still have plantar fasciitis," said the doctor.

So, that means to me that I still need to sleep in an awkward putty-colored scratchy night splint at night. And, I still need to wear my store-bought orthotics (Superfeet and Spenco), and I can't wear flip-flops or cute sandles, and I can't walk around barefoot--even to the bathroom or to the pool. *Sigh* My foot doctor wrote me a prescription for physical therapy, 3 times a week for 4 weeks. The doctor wanted me to wear the felt heal lift I got from his office, too. Unfortunately, it doesn't fit in my shoes with the arch supporting orthotics and my husband cut a hole in it. I asked him to cut a hole in it because the pressure of it was hurting the inflamed area on the front of my heal in September--before I got cast. So "no go" on the $58 felt heal lift thingy. Hopefully, that is crucial.

"It takes about 10 months to get rid of it."

Okay, so does that mean I count 10 months from my first blog posting about my plantar fasciitis injury? Or, when I stopped training with Inside Track Running Club, the day after a painful 8 mile run along the coast on a beautiful sunny Saturday morning on June 27th? Or does it mean I count from the day I finally stopped running all together, the day after the Carpinteria Triathlon on September 28th? The next day I could hardly put my left food down without a sharp ice pick-like stabbing pain in my left heal. It was also on that Monday I got the cast put on. If so...

Crap! That means I won't be back running at 100% until May 2010.

I'm going with the first blog posting date, August 6th, minus one month. That way, I will be back at 100% in March. That's not scientific but I'm an optimist. (That's me at the Carpinteria Triathlon in the photo above. Not in the photo is my son waving and my daughter yelling, "Mom! What the heck?! I thought you weren't going to run!" The ambulance in the photo is symbolic of the damage that I did to my foot that day. Next time I will listen to my kids. Photo by Christine Paone)


"Before you can run, you need to walk."

Here's my walk-to-run training regime per my doctor -- as I remembered it (I was still in shock at the time after he said, "it takes 10 months to heal...":

  • 1st month: I need to walk up to a 1/4 mile the this week, then the 1/2 mile the second week and by 4 weeks be able to walk 2 miles.
  • 2nd month: I need to then add 1/4 of slow jogging (8-10 mpm) then walk 1/4 mile and so on the second month. By 8 weeks, I should be able to jog 2 miles--pain free.

"This will get you running again but you won't be able to go back to doing 10 mile runs until March."

:(

"You need to strengthen your left leg."

But before that I need to do the calf/Achilles tendon stretching exercise several times a day. Here's how:

Stand facing the wall with feel comfortabley apart (8-10 inces) Put your left foot about one foot length away from the wall (about 10 inches), toes pointing straight towards the wall. Put your hands on the wall and push back so your weight goes on the left foot. Keeping your back straight, slowly bend your knees, keeping your weight on your left foot. Hold this position 30 seconds before slowly rising to a standing position. Switch to the other foot and repeat. (The image above is from the American Academy of Orthopedic Surgeons web site. The position shown is slightly different from my doctor's instructions. In his version, the feet need to be closer together with the back foot's toe just behind the front foot's heal. This web site has other helpful stretches to treat or prevent plantar facsiitis and a good description of the injury.)

Strengthening exercises:
  • Calf raises; You do this by standing facing a wall, about 24 inches away from it, and raising on your toes; do this while standing on one leg at a time and continue this exercise until you can do as many calf raises on your weak (injured) foot as you can on your strong foot
  • Wall hamstring strengthening exercise; We called this doing "The Torture Chair" when I was in Track and Cross-Country in High School. It involves leaning against a wall in the sitting position with your legs at a 90° angle and then sliding up the wall and back down to 90°. Try it. It's fun. ;)
  • Calf raises over steps; This exercise sounded a bit too similar to the Negative Calf Raises that aggravated my plantar fasciitis for two months last summer. I may do this exercise later when my foot gets stronger
  • Do leg extensions to strengthen the quads and hamstrings in the gym
"Your range of motion is much better after four weeks in a cast."

Apparently, my left Achilles tendon and calf muscles were so tight before he casted my foot into a 90° angle, that he could not dorseflex my foot (push my toes towards my knee) more than a few degrees. Now I can flex my foot up 10-15°. The cast apparently immobilized the injured tissue and helped helped to loosen a tight Achilles tendon that was causing me to repeatedly strain the plantar fascia. The night splint wasn't enough.

"You will be able to run again and do ultras and race triathlons again. No problem. Just stay positive. "

Actually, he didn't say that. But I wish he did.

1 comment:

  1. Plantar fasciitis can be difficult to treat but very seldom do my patients not improve with it. First, I would revisit the diagnosis.
    http://www.footcentersofnc.com/doctors.html

    ReplyDelete

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