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 SportsInjuryClinic.net 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 RunningTimes.com 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 Quest.net. 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!

Foodways of Runners & Triathletes Fall'08 survey results

Last fall I wanted to find out about the cultures of triathetes and marathon runners for a course I was taking that studied the anthropology of food from a multiple perspectives: functional, economic, materialist and semiotics or structuralist view points. I've always been interested in how triathletes and long-distance runners seem to have different ways of viewing the world and doing things than the average person since I started racing in the late Eighties. Things have changed since then, but much of what I experienced as an old school triathlete and marathoner– such as modifying my diet to feature more easily digestible carbs and staying hydrated (e.g. the dietary primacy of bananas, bagels, pasta and water) and eating on the run (literally)– are much the same.

The result was a 35-page research paper summarizing my findings from secondary and primary research sources.

Here's a few high lights:

• Each of the triathletes I interviewed told me they often ate alone and shared a meal only in the evening
• About 81% of surveyed marathon and ultra runners ate more often than three times a day (Appendix B: 18)
• When asked how they choose what to eat, “health and athletic performance benefits” was the most common response for both triathletes (70%) and marathon (34%) (Appendix A: 14; Appendix B:14).
• The categories of good foods and bad foods seem to get temporarily reversed once many of the athletes finished their race. What is normally a “bad food” is now a “reward” or a “treat” and consumed with gusto (Appendix A: 26; Appendix B: 26) after the race.
• Energy gels are consumed by 45.8% of the surveyed marathon runners “frequently”
• Of the triathlete respondents, 71% are professionals such as doctors, lawyers, accountants, environmental engineers, computer engineers, teachers, college professors, scientists, etc.
• Of the triathlete respondents, 42% have the leisure time to train 10 hours or more a week
• Of the marathon runner respondents, 81% are professionals such as doctors, lawyers, accountants, environmental engineers, computer engineers, teachers, college professors, scientists, etc.

To access the PDF form of my research paper titled Ideas, Beliefs and Rituals Regarding the Foodways of American Triathletes and Marathon Runners please click here >

This summer I hope to delve deeper into the sport sub-cultures of triathlon and running by looking at the bio-cultural processes at work just before an athlete competes in a race and just after he or she finishes. New runner- and triathlete-specific online surveys for this research will be posted at this blog soon.

By looking at the food ways of American triathletes and marathon runners—what they eat, when they eat, who they eat with, how they eat and their food-related rituals and beliefs—I hoped to explain some of commonalities and differences of each of these sport sub-cultures and how these sub-cultures supported the conservative norms of mass culture and its health and fitness trend by, in some ways, subverting them.

I utilized a materialist theoretical model using the social sciences concept of one’s unconscious habits, known as habitus, as developed by Pierre Bourdieu in order to describe the significance of their food ways as being influenced by their socio-economic class and ideals of the dominant American culture. Though one’s cultural habitus is unconscious it presupposes one's beliefs, identity and daily practice. Or, in the words of Pierre Bourdieu, “The habitus is necessity internalized and converted into a disposition that generates meaningful practices and meaning-giving perceptions” (Bourdieu 1984:170).

Methodology

For this research project I incorporated both primary and secondary research. I interviewed triathletes and marathon runners about their food ways during two episodes of participant-observation at a sprint distance triathlon and a Half-Marathon utilizing a semi-structured approach that included questions about their eating habits (where, when, how much, and to define good foods and bad foods) and their demographic profiles. I sent out an online survey for marathon and ultra runners to the memberships of two running clubs and a survey geared towards triathletes to one triathlon club where I live. My choice of respondents of my un-structured interviews of triathletes and marathon runners was based on their availability and their typicality from the demographic information from the online media kits for Triathlete and Runner’s World magazines (Triathlete 2008; Runners World 2008).

My participant-observations were at the Carpinteria Triathlon on September 28, 2008 and at the Santa Clarita Half-Marathon and Marathon on November 2, 2008. I documented the material culture of those two events through photography, detailed written descriptions of the race events and interviews of race participants immediately before and after they raced at the race venues. Also, as a part of my primary research on their material cultures, I reviewed food packaging of endurance athlete food supplements, online and printed articles in Triathlete, Runner’s World and Marathon and Beyond magazines and blog postings, and nutrition articles on Active.com.

I received 141 responses from my online surveys posted on surveymonkey.com. Of my online “Food Ways of Triathletes” survey that I sent out, I received 33 complete responses. Of my “Food ways of Marathon Runners” survey, I received 108 complete responses. I found the data from my surveys informative but, because they include only responses voluntarily given and a convenience sample, they may not be entirely representative of the two sport cultures. Please see Appendix A of the PDF file linked to this blog posting (pages 19-24) for my survey questions and summaries of responses from triathletes and Appendix B from the same PDF file (pages 25-31) for my survey questions and summaries of responses from surveyed marathon and ultra runners.

I found that the demographic and habitus information that I found in my online survey responses were in sync with the practices and beliefs of my interviewed athletes and their food practices from what I observed at the races and in their emails and blog postings. The printed online sources included athlete blog postings. Other printed sources included books, food manufacturers’ sports nutrition articles in newsletters and sports nutrition articles in both peer-reviewed research journals and popular triathlon and running magazines (Triathlete, Runner’s World and Marathon and Beyond).

To illustrate the semiotics of training and racing supplements and the influence of food marketing on the triathlon and running sport sub-cultures, I reviewed the food packaging of several popular energy gels consumed by triathletes and marathon runners.

For my research results, surveys I used and list of references Please click here for my research paper PDF titled Ideas, Beliefs and Rituals Regarding the Foodways of American Triathletes and Marathon Runners >

Resources

Bourdieu, Pierre
1984 Distinction: A Social Critique of the Judgment of Taste, Cambridge, MA: Harvard University Press, pp.200-230

Runner’s World
2008 “Media Kit: Demographic Profile, Runner’s World, retrieved on November 26, 2008, from http://www.runnersworld.com/mediakit/rw/audience/demos.html

Triathlete Magazine
2008 “Print Media Kit”, Triathlete Magazine, retrieved on September 25, 2008, from http://www.triathletemag.com/Assets/2008PrintMediaKit.pdf