Thursday, December 24, 2009

A Year of plantar fasciitis: 12 months of pain and recovery

I've had plantar fasciitis for about a year now. If you have plantar fasciitis and this is your first time, just know this: this running injury can take a very long time to heal. It can take "10 months" (as my orthopedic surgeon foot specialist told me) to two years to heal. Below is a review of the past year of my plantar fasciits pain and my slow road to recovery. I'm not back running yet, but at least the pain is gone--most days anyway.

December 2008:
I first got that nagging heel pain in my left foot just before Christmas last year but being me, ignored it and kept on running. Each day the pain in my heel was more acute when I stepped out of bed. Gradually, through the weeks, it did not disappear after my foot muscles loosened up after a morning run. The pain continued after Christmas during our annual "week in the snow" in Mt. Shasta. My beloved mountains runs combined the physical exultation of striving up hills in the thin cold mountain air with the gorgeous visual of mountain roads blanked in white snow lined by contrastingly dark trunks and snow covered bows of evergreens. the sky varied from gray clouds with misty white snow fall and fog to blindingly bright blue skies and fresh snow glistening in the sunlight. So ignoring the heel pain, I savored the mountain scenery and kept running.

January 2009:
The heel pain was joined by a partner in January from me favoring my "good" right foot: hip bursitis in January. I self-diagnosed the searing to aching pain on the top of my right hip bone. It made sense to me since I knew I was favoring my right side to keep pressure off my left foot with plantar fascia pain. Being stubborn I kept on running because (1) if I didn't get a good run in every day I got cranky and (2) See number one.

April 2009:
The pain got worse each week of running that by April I was limping and down to running only two to three times a week with a long run on Saturday's with a fun local running club. I resisted getting off my feet because I would miss my morning chats with fellow runners at the Inside Track Running Club. Running was more than just a work out for me--it was also the only way I could spend time with my busy running friends. To lesson the tenderness I was applying ice to the painful foot and hip and taking lot's of ibuprofen.

May 2009:
I started buying stuff to lesson the pain. I got over-the-counter arch supports, a heel sock that kept my foot in a dorsoflexed (toes pulled towards the knee) position while I slept at night and bought a great book on Amazon.com Injury Afoot: 30 things You Can Do to Relieve Heel Pain and Speed Healing of Plantar Faciitis by Patrick Hafner. I did every exercise in the book and found it helpful. However, I think my injury was too far gone. Also, I kept walking barefoot on the beach each week when I did my open water swims with my new swimming friends. The "ice pick in the heel" pain of the plantar fasciitis in my left foot persisted.

June 2009:
Finally, after six months of increasing heel and hip pain joined with lower back pain (!), I stopped running. I replaced my 4-6 day a week running habit with road cycling and doing more open water swims. I started seeing a Rolfer once a month who came highly recommended. The Rolfer helped me walk normally. I was pain free after each session which was great. But the plantar fasciits and hip pain returned a day or two after each session. By this time I was wearing a night splint (which keeps my arch stretched while sleeping) every night.

August 2009:
I bought arch supports such as SuperFeet and wore them all the time. I got a special bicycle shoe version for my road cleats. My workouts consisted of road biking 2-3 times a week and swimming 2-3 times a week. No running or long walks. I saw a doctor for the first time in August and my x-ray showed that at least my foot bones were normal. I stopped running totally per the doc's advice and stretched my calf muscles every day, several times a day. According the doctor, I had to loosen up my tight calves as they were pulling on my foot tendons and exacerbating my symptoms.

September 2009:
I didn't run at all this month until a test jog a few days before the Carpinteria Triathlon. This month I just swam and road biked. I did the Carpinteria Triathlon and think I did my fastest swim and bike ever. I ran the 5K run portion slowly in the triathlon and had a realy fun race and saw lot's of old tri-geek friends. Was it worth it? I don't know now. I think that 5K really messed up my plantar fascia. I got a cast put on my throbbing left foot the day after the triathlon.

October 2009:
The day after the Carpinteria Triathlon I got a cast put on my foot. I wore the cast for four weeks. The week before the cast was to be removed, I had no heel or hip bursitis pain at all. Then I did a fast hike, hop and jog up Romero Canyon with some ultra runner friends. I think I re-injured my left foot then. The next day my left heel was painful to the touch again when I got the cast removed. I got a prescription for physical therapy (PT). The cast did cure that nagging right hip pain from hip bursitis, though.

November 2009:
After I got the cast off my left foot it was still sore. The doctor gave me felt heel lifts for my shoes but my heel was too sore to use them. My left ankle and foot felt very weak and fragile after being in a cast for four weeks so the physical therapists started me with some gentile strength and stability exercises that still challenged me at the time. On my first PT session I was pessimistic about the treatment and not in a good mood with my left heal throbbing in pain. It felt about the same that it did a month earlier after the triathlon and before the cast. The heel pain on the diagnostic pain scale was about a 5 or 6. It just ached the first two weeks. I did two PT sessions each week through the month of November. Each 1 1/2 hour session went something like this (from my PT notes from the November 10th):
  • Stretch calves (2x 30 seconds each side)
  • Stretch hamstrings (2x 30 seconds each side)
  • BAPS aka the "Biomechanical Ankle Platform System" (this is an egg-shaped disk about the size of a large pizza with a screw-in half plastic sphere under it so I can rotate my foot 360 degrees)
  • Straight leg extensions, four directions by pulling surgical tubing (2x 30times each direction, each foot)
  • Foot/ankle stretches with a TheraBand #3
  • "Monster walk" (walk about 20 feet with a giant rubber band around my ankles and legs shoulder width a part: forwards, backwards, left and right-2x)
  • Ultrasound
  • Deep tissue massage
  • ice (1o minutes)
After a week the PT's added these exercises:
  • Stand on one foot on the squishy top of Bosa ball and try not to fall off (30 seconds, 2x)
  • Step up on top of a Bosa ball: forward and back, then side-to-side (2x)
  • "Horses Head" (stand on one foot and at the same time pull on the light green stretchy surgical tubing with my opposite side hand towards my hip while lifting my right knee to a 90 degree position; then bend forward, letting foot down and straightening arm so the surgical tubing slakens; Repeat 15 times, each leg 2x)
  • Stand on the flat bottom of a Bosa ball that is flipped upside down & do knee bends without falling off (about 30 seconds)
December 2009:
By December my heel hurt at about a 2 on the pain scale. This month, now that I'm officially "high functioning" according the PT staff they have me doing more strength and plyometric exercises in addition to the stability and core work. After each PT session I was sweating and my legs felt fatigued and shaky-- like Jell-O. Here is a typical routine of PT exercises after 6 weeks of treatment (from my PT notes from December 15 & 17):
  • Treadmill walk (10 minutes, 2.0 incline, 4 mph)
  • Stretch calves (2x 30 seconds each side)
  • Stretch hamstrings (2x 30 seconds each side)
  • Foot/ankle stretches with a TheraBand #3 (2x dorsal, medial, lateral for each foot)
  • "Horses Head" (stand on my left foot on a trampoline and at the same time pull on the stiff dark gray surgical tubing with my right hand towards my right hip while lifting my right knee to a 90 degree position; then bend forward, letting foot down and straightening arm so the surgical tubing slakens; Repeat 15 times, each leg 2x)
  • "Monster walk" (walk about 20 feet with a stiffer rubber band around my ankles and legs shoulder width a part: forwards, backwards, left and right-2x)
  • "False Starts" get into a track starting position with each foot on a furniture slider (flat thing with a slick plastic bottom that slides on the carpet and sticky rubber top surface where you put your foot) and go back and forth until "fatigue"--for me that's 50x--each side, 2x)
  • "Triple Threat" ( This is tough for me & I just look ridiculous so I try to get out of doing this exercise each session). Here is how it goes: lay flat on the ground with a giant beach ball (aka "balance ball") under your legs and lift up your pelvis so your legs are straight like a board. (That #1 of the "Triple Threat.") Bring the beach ball close to your butt by bending your knees and keeping your pelvis up (That is #2). With ball at your butt, lift your pelvis higher (That is #3). If I can get through 5 repetitions of these without shooting the ball across the room and hitting the ground with a thunk, it's been a good session for me. (2x5 repetitions)
  • "Wooden Steps" First I step forwards one leg at a time on the step like I'm doing some sort of traditional hat dance, Then I side-step up on the step and down the other side, both feet on top and on the floor for "two-beat" version, then I step side-to-side up and over the thing with only one foot on the step and the floor at a time for the "one-beat" version.
  • "The Matrix" This exercise is sick: As fast as you can do (1) 30 squats (butt out so as to not overload the knees); (2) 30 lunges (knee almost touching the ground); (3) 30 squat-jumps; (4) 30 lunge-jumps switching feet mid-air. Twice.
  • Leg press (30x 80 lbs--but now I do 2x 100 lbs, twice)
  • ice (1o minutes)
I have have been generally pain free from my left foot plantar fasciitis for two weeks now. I had a relapse earlier this week for two days after I had the amnesiatic and stupid idea to stroll around barefoot in the sunshine for about an hour on Saturday on a friend's deck-- but other than that, I'm recovering from this affliction. I still can't run. I can't walk barefoot. But, at least (for today anyway) my plantar fasciitis pain is gone.

My plan for January is to start running again. Slow-ly.

16 comments:

  1. Hey by the time I'm reading this Post you must be fine, healthy. It's now happening to me about 1 Year 2 Months ago i felt my first pain and 'being me I ignored it.'

    ReplyDelete
  2. You say that you have "pain in my foot, ankle and all the way to half my calf" What is important to know is what type of pain are you experiencing. Is is numbness and tingling, is it sharp, stabbing pain, or is it a dull aching pain? 
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  3. Thanks for sharing these exercises with us, so we can benefit from them as well. Using arch supports with flat shoes as you did should also help. I know that they certainly help to prevent injury with a lot of men and women.

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  9. Now I know I'm not alone. I've been having this pain for about 6 months now. Desperately need to lose weight for my wedding, but can't do running too :(( I think I better start seeing the doctor & do my stretches. Thanks dear for sharing!!

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