(Almost) Happy Feet: Steps for plantar fasciitis recovery & good shoes

I still have plantar fasciitis (PF) in my left foot but I'm finally seeing progress again. This is since the disasters earlier this year that have pushed back the healing process.  In January I tried running a few miles (2 to 4) per my doctor's okay after having my PF foot immobilized in a cast for a month (in October'09) followed by three months of physical therapy and a cortisone shot (November thru December'09). I ended up with a calcaneal contusion (bone bruise in my heel) and plantar fasciitis all over again. While riding my road bike in May, I got hit by a van and between the road rash, an infected abrasion on my ankle, bashed up hand, and whip lash from hitting the pavement that day, I wasn't able to train or do the PT exercises for about 8 weeks. Argh! So, 2010 will not be my fondest year.  After doing core and strength workouts in the gym with an athletic trainer beginning in July and getting the foot treated by running injury specialist chiropractor once a week in mid-October this year, the PF is finally getting better. And, I'm finally starting to much feel better physically and mentally.

If you are suffering from plantar fasciitis, I have a lot of empathy for you. Don't ignore that heel pain! I did two years ago and that is how I got into this situation. I've had to deal with this running injury off and on since December 2008. Finally, it's starting to go away. Here is what is working for me...

Plantar Fasciitis Recovery Steps That Seem to Be Working –Finally:

1. Sleeping with a Strassburg Sock night splint on my PF foot; By keeping the foot stretched in a dorsaflexed position, it allows the damaged fascia tendons to heal in a stretched position that prevents re-tearing every time my arch flexes down when I walk or run (Earlier this year I wore the Swede-O Thermoskin night splint with good results but had to stop after a bike accident since its thick ankle strap irritated the road rash on my left ankle) - every night
2. Stretching the Achille's tendon every day (and calves and hamstrings) for 30 seconds each day- 1x/day
3. Core and strength training (upper and lower body) in the gym to develop better running posture and prevent re-injury - 2x/week
4. Foot strength training with toe-towel pull and other exercises from recommended by my physical therapists, chiropractor and the book Injury Afoot by Patrick Hafner* - 2x/week
5. Increasing circulation to damaged fasia tendons to expedite healing and optimal tissue alignment (while breaking up the twisted scar tissue) with deep tissue massage, ultrasound or rolling my foot on tennis ball (followed by 10min ice treatment) - 3-4x/week
6. Cardio workouts in the pool, on an elliptical machine or on my road bike - 2x/week
7. Good chiropractic therapy by a sports injury specialist at Wilson Chiropractic Clinic in Ventura. This place was recommended to me by someone who had plantar fasciitis and recovered from it (I don't receive a benefit by mentioning this place and haven't told my chiropractor about this post) - 1x/week
8. Think positive thoughts (thinking positively lowers one's stress hormone levels which enables healing)
9. Eat highly nutritious foods: A fresh organic fruit smoothie on most mornings followed by a low-processed carbohydrate diet mostly nutrition-rich whole foods (fruits, vegetables, dairy and nuts)  in meals I prepare for my family at home from our local grocery store and CSA farm basket from Ojai 
10. Wear good shoes: I wear my regular shoes with custom orthotics or the anatomically designed comfortable Kuru shoes** or stylish FitFlops (Both of these footwear companies make shoes that come with anatomically supportive arch supports and heel pads, and they are, honestly, the most comfortable shoes I have ever worn.* ) I had to get rid of all my sandals and flip flops that didn't have arch supports.:(
    
    

Weekly Workout Time: Those ten steps translate into a half hour to one hour workout per day– about 5 hours a week. That should be do-able for most people. As a busy parent, who is in a graduate program and who works part-time, this is all I have time for now. This is about half to a third of the time I normally would like to workout each week (10 - 15 hours). Wouldn't that be nice.

Motivation: I try to workout first thing in the morning before I take the kids to school. Also, I register each workout on my free  DailyMile.com account. Stressing about staying on track with my workouts on dailymile.com is self-motivating and allows me to see progress and trends with workouts the past year.

Full Disclosure:

I promoted several products in this post. For full disclosure, below are the details about my experiences with the two products that I have received free for this review and my relationship each.

*You can find plantar fasciitis recovery and strengthening exercises in the book Injury Afoot: 30 things You Can Do to Relieve Heel Pain and Speed Healing of Plantar Fasciitis by Patrick Hafner. The book is clearly written and features photos of every stretch and strength training exercise recommended by podatrists to recover from plantar fasciits. The author has a degree in kinesiology and has recovered from PF himself. I bought my first copy on Amazon.com and reviewed it earlier this year on a post about minimal shoe and barefoot running. The author Mr. Hafner contacted me after reading my post and offered to send me a free copy. The exercises in the Injury Afoot book worked for me except that I put off wearing good shoes and a custom orthotic the first year. Now, I know better.

**Kuru Shoes sent me a pair of their Halcyon model in October to review on this blog. I wore them at our kids cross-country meets for a few weekends and they are the most comfortable shoes that I have ever worn. They were even more comfortable on my feet than my running shoes with my custom orthotics. I asked a few parent friends what they thought about my free comfy Kurus and here is what they said:

"They look funky...With shoes I don't care what they look like. It's all about comfort for me." ~ Physician and mother of two very speedy little girls on the cross-country team.

"Well, they're earthy looking. I'm not a real earthy person." ~ Local race director and multisport retail store owner

"They're, uh, kind of funny looking. But I like 'em!" ~ Local catering business owner

"You didn't buy those, did you?" ~ Hubby

Oh well, so the particular model they sent me won't be found in a fashion magazine but at least they allow me to walk pain free and are good for my PF recovery.

When recovering from chronic plantar fasciitis (or "plantar fasciosis" as one of the several foot specialists I've seen has called my particular chronic case), the key is doing something every day to help the healing and prevent re-injury. After spending hundreds of dollars on medical care for this running injury, what seems to be finally working is doing basic stuff consistently: Deep tissue work followed by ice treatment, daily stretching, wearing a night splint each night, cross-training and wearing good shoes.

Sadly, I can't walk around barefoot anymore. And running in minimal shoes--at least in the near future-- is out of the question. But I really don't care. I would wear clown shoes if I thought it would help me run again...Really!

5 Steps to heal plantar fasciitis (after getting hit by a car)

It's been exactly two and a half months since my last blog post about treating plantar fasciitis and it is with great disapointment that I must report that MY HEEL STILL HURTS. And, you know that really sucks and I'm tired of blogging about it and it's not entirely my fault (or my heel's fault) and I wish to God that I could blog about being CURED of plantar fasciitis, instead.

(Sorry about the all-caps words. I just wanted to get my point across that if you are tired about this topic of mine, I am very, very tired of it.

If you are new to plantar fasciitis and are looking for treatments that work, please see my earlier post: "5 Steps to Heal Plantar Fasciitis: Cloud Care from Running Twitter Friends" or go see a physical therapist or athletic trainer who specializes in healing running injuries – or a podiatrist– with good references from runners. If I learned anything from this year of chronic plantar fasciitis pain is that getting a good reference from a runner is key. I didn't a year ago. And, I still have plantar fasciitis.

The reason why I haven't written earlier is two-fold and related:

1. I got hit by a car while riding my road bike on May 15, 2010
2. I had to stop doing my "5 Steps to Heal Plantar Fasciitis" after the accident

Because of the accident I have not been able to follow the "5 Steps..." for the past eight months. Before the accident, according to my orthopedic surgeon foot specialist on my last visit in mid-February, I had a calcaneal contusion and still had plantar fasciitis – but it was going away. I was getting better and was advised to keep doing what I was doing and to gradually build up my running mileage from jogging a block, to a mile, to two miles, etc. Two months of doing this, on my first road ride since December,  I got hit by a car. :(

However, I believe my "cloud care" steps to get rid of plantar fascitis came from real people who really recovered from plantar fasciitis.  I found them at my Twitter account @MultisportMama by posting a tweet: "How did you recover from plantar fasciitis?"

So, that being said, here are the 5 Steps to Heal Plantar Fasciitis that worked for other people*:

1. Stretch (gastrosoleus/calves/hamstrings): Increase flexibility by daily stretches and by wearing night splint when sleeping
   
   (From the accident I had road rash on my legs and elbow from hitting the pavement and a puncture wound that got infected on my left ankle. That means I could not wear a night splint. Consequently, my arch stiffened up while sleeping and I experienced heel and arch pain with the first foot step out of bed each morning. Sound familiar? The night splint was really helping me keep the fascia loose before the accident.)
   
   
2. Strength train: Heal raises, towel pulling with toes, core workouts, etc
   
   (After the accident I had to stop weight training for about 6 weeks because of my right strained wrist and hand, a wicked cervical (neck) strain from my helmet hitting the pavement, and a strained left shoulder. I couldn't carry anything in my right hand for weeks and, doing push-ups, pull-ups and using free weights were just not possible.)
   
   
3. Increase circulation: Get deep tissue massage, Rolfing, ultrasound in the affected area or by rolling your foot on tennis or golf ball each day
   
   (With a banged up body trying to heal itself, the idea of causing more muscular and tendon pain with deep tissue work seemed like a bad idea the first few weeks after the accident.)
   
   
4. Wear custom orthotics
   
   (Yay! The one thing I could do consistently-- except that week when my foot swelled up with an infection from the heel wound--was wear my new custom othotics. They relieved some of the pressure on my arch but I can honestly, say that used alone without the other four healing methods, didn't work.)
   
   
5. Cross-train: Swim or bike
   
   (My bike was trashed and I'm still waiting for the insurance settlement to get it fixed. With the road rash and a seeping icky infected punture wound on my left heel at that, swimming was out of the question for a while.)

Now, it's eight weeks since the bike accident.  I've made an appointment with a podiatrist recommended by a running friend. In the meantime, I will be back at the "5 Steps to Heal Plantar Fasciitis" again (with the exception #1's "wear a night splint" since the abrasion on my heel is still sore and number 5's "bike"). Barring any other ridiculous miss-fortune (with my luck lately, who knows?), I will post a status report on the results of the 5 Steps to Recover from Plantar Fasciitis. Believe me, I'm motivated get running again. :)

QUESTION: How did you recover from plantar fasciitis? Please let me know by posting a comment. I may try it. If it works for me I will happily sing your (or the product or services you used) praises right here. Please, only first person experiences.

Best wishes and health and have a great injury-free summer!

:) A

*The 5 Steps To Heal Plantar Fasciitis methods have been validated by peer-reviewed medical research that I have access to as a graduate student. The latest research suggests increasing flexibility, circulation and using orthotics and anti-inflammatories to help that crummy little fascia tendon heal itself. The medical research and Runner's World running experts also suggest supporting the arch during the healing process. They also recommend  s-l-o-w-l-y working up to barefoot or minimalist running if you are injury free. However, with plantar fasciitis, barefoot and minimalist running like a Tarahumara (as mentioned in the book Born to Run by Chris McDougall), running in minimalist shoes like Vibrams and running on the beach are definite no-nos. It puts additional strain on an already strained arch.

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.

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.

Dealing with Plantar Faciitis: Trying a cast to heal the cursed thing

I have had more kind words of advice to help me recover from plantar faciitis these past few months than I can count from friends, family, Twitter, Facebook and blog followers and even complete strangers.

I've been battling this affliction off and on since 1995 when it first reared it's evil head after I finished the Santa Barbara Chardonnay 10 mile race and got micro-tears in my Achilles tendon. (I still remember that awful popping sensation in my right Achilles tendon just above my heal in the last mile of the race.) I PR'd that day but I paid a terrible price. After limping into the finishers area my running would never be the same. The Achilles tendinitis forced me to drop out of Canadian Ironman and eventually, I developed a case of plantar faciitis on my left foot--my "good" foot--while trying to recover from it. The Achilles tendinitis healed completely after a few months or so of no running. However, the plantar faciitis wouldn't go away until I got pregnant with my first child and stopped running completely for about 5 months.

But then the plantar faciitis came back again after I did the Catalina Marathon in March 2000. To combat it I wore my own homemade arch supports, eschewed wearing flip-flops, got deep tissue sports massage and cross-trained for a few months. It really didn't go away for another year. Later, I was able to train for and completed several more marathons, including the heinously fun Big Sur Trail Marathon in 2003, and later qualified for Boston. My last long, 15+ miles, run was the Boston Marathon in 2004.

To date, my current case of plantar faciitis began after I increased my running mileage too quickly in Dec'08 after joining a local running club. I was working, being mom and juggling writing a difficult research paper then, so I had very little time to train. I was doing the long running club road runs on the weekends (10-14 miles) while only running 2-3x during the week (5 miles). In hindsight this was stupid and I knew better. The pain got worse and by six months later I couldn't run a step without pain. I also had two secondary injuries: hip bursitis (right side) and lower back pain. I tried changing running shoes: first buying a new pair of my usual cushioned and structured New Balance running shoes, the NB 1224, then when my heal still hurt, I went for less structure and switched to Brooks Cascadia trail shoes. I also bought a running video of a running technique developed by Ken Mierke called Evolution Running that was mentioned by Christopher McDougal as one of the curatives for his own case of chronic plantar faciitis and Achilles tendonitis in the recent published best selling book, Born to Run. Nothing worked.

What I have tried

This past summer, to treat my plantar faciitis, I've did just about "everything but the kitchen sink". Beginning in June:

• I stopped running
• Cross-trained in swimming, bicycling and weight training.
• I bought a pair of last year's racing flats on sale, Brooks T5s, and used those to walk around in with Superfeet orthotics (the green high arch model) most of the time and as soon as I got out of bed in the morning.
• I got the book Injury Afoot by Patrick Hafner on how to treat my plantar faciitis iinjury and tried everything in the book. (Sponsorship disclosure: After I reviewed Injury Afoot, the author kindly sent me a free copy as well as some advise on good stretches for plantar faciitis sufferers on his blog "Heal Your Heel Pain".) In hindsight, I was was doing some of the stretching exercises too early, re-injuring the facia. I also wasn't diligent in obeying the book's advise to never walk barefoot. I was re-injuring the facia as soon as I got out of bed in the morning when I walked barefoot into the bathroom and three times a week when I walked barefoot from my car to the beach for my open water swims or from the locker room to the pool at our local fitness club.
• I actively treated the the plantar faciitis stiffness and pain in my left foot with monthly Rolfing sessions (if you try this, bring a piece of wood to chew on, it's deep tissue work and can get uncomfortable)
• Iced my heal and arch 1-2x/day (10-15 min each time)
• Took Advil (2-4x/day, 400mg each time, as needed for pain
• Slept with a night splint (so sexy...not!)
• My husband administered deep tissue work on the injured foot once a week during the last month
• I saw an orthopedic surgeon foot specialist finally
• After the doctors visit, I wore Superfeet orthotics or the over-priced ($58 but $8 to me with insurance) heal lift given to me by my orthopedic surgeon in my shoes

During my summer of plantar faciitis, at about every 3 or 4 weeks, I would do something stupid and re-injure it. In desperation, one beautiful dawn morning while visiting Leucadia, a north county San Diego Meca for old school triathletes, I tried jogging barefoot on the hard packed sand of Moonlight beach for 30 minutes while my husband coached me on my gait for less heal striking. Another morning, I tried jogging in my socks on a treadmill (only 1 mile) after being inspired by the barefoot running tweets and articles I have been reading. Both times had disappointing and painful results. (At least the beach run was pretty.)

Nothing I have done has worked for longer than a day or so. Even the deep tissue massage and Rolfing didn't work for longer than two days. Sure, my foot felt great afterward (my whole body felt great), but the classic symptoms of tendon tightness in my arch, a hard swelling from the adhesion at the front of my heal and sharp pain (like an ice pick jabbing violently in my heal) returned after a day or so of tentative painfree bliss.

What I have not tried

I had not tried aqua-jogging, acupuncture, cortisone shots, surgery, seeing a shaman, praying to the Virgin Mary, taking supplements, meditation or wearing a cast. For now, I am trying the cast method. And, to I'm eating mostly fruits and vegetables to boost my antioxidant intake and to maintain my weight. I hope that by immobilizing my foot in a cast for 4 weeks and keeping all pressure off my plantar facia, it will be able to finally get better.

Someday I hope to be able walk and eventually run long distances again without that ice-pick-stabbing-in-the-heal debilitating pain.

If those Tarahumara that Chris McDougal wrote about in his book Born to Run can kick ass in their forties, fifties and sixties running twenty, fifty or hundred miles on mountainous trails wearing nothing but homemade tire sandals, there must be some way to recover from this affliction. I'm open to just about any suggestions people may have who have recovered from plantar faciitis.

For now, I just hope the cast and the diet of mostly fruits and veggies work.

Dealing with plantar faciitis: an update

After six weeks of following my Everything-but-the-kitchen sink Plantar Faciitis Treatment Plan my foot still hurts.

This is a real bummer.

Briefly, my six week Everything-but-the-kitchen sink Plantar Faciitis Treatment Plan was:

• Ice pack treatment 2x/day (no longer than 10 minutes each per my doctor friend)
• Ibuprofen when there's arch/heel pain/inflammation (per my retired PT friend)
• Wearing shoes with arch supports such as SuperFeet all the time--even at the beach
• Calf strengthening exercises: positive heal rises 3 sets of 20 and negative (off a step) to exhaustion, for each leg every other day
• Stretching my calves, hamstrings, glutes--everyday
• Cross-training everyday by either swimming, road cycling, or 30 minutes on the elliptical machine with weight training of my upper body everyday
• Survive a pain and straight-talk session once a month with my gifted and no-nonsense Rolfer who keeps repeating "Don't run for two months!"
• Wearing a night splint (which keeps my arch stretched while sleeping), etc.
• Complain about it and my inability to do my favorite athlete past time ever: run

So, six weeks later, my heal wasn't hurting at all and I found myself with an hour to myself on Santa Cruz Island at the bottom of my very favorite running trail that meandered to the top of the bluffs. This beautiful trail gives a 360 degree view of the island's windswept hills, sea lion and seabird nesting areas on the rocks below, it's still native chapparel-covered peaks, and a soaring view of the mainland across the Santa Barbara Channel and open ocean with seagulls and pelicans flying by.

I jogged up the hill.

Thirty-five minutes later back at the bottom of the trail, my heal hurt. A lot. Damn.

The soreness went away a few days later so when I found myself at Moonlight Beach, site of my very first full triathlon (Bud Light Series, Olympic Distance, 1988) I thought that a barefoot run on the hard packed sand might be good for it.

I was wrong. After thirty minutes of trying to jog like a Kenyan or Tarahumara (landing on the forefoot, heals flicking up and faster turnover), my heal hurt. A lot. Again.

Damn.

Okay, so here's my new Kitchen Sink Plantar Faciitis Treatment Plan:

• See an orthopedic surgeon who specializes in feet, has been recommended by a former patient or medical doctor and who is athletic; the appointment is tomorrow and I'm anticipating it with both hope and fear (What if he can't do anything for me or recommends expensive options such as custom-made insoles that don't work?)
• Ice pack treatment 2x/day (longer than 10 minutes each per myself)
• Take two Advil when there's arch/heel pain/inflammation
• Wear my new Brooks T5 Racing Flats (last year's model to this year's "T6" that I got on sale) with the disco shoelaces with a pair of SuperFeet high arch (green) insoles when I'm not icing my feet, showering, swimming, riding my bike or dreaming.
• Do calf strengthening exercises every other day (positive heal rises 3 sets of 20 and negative (off a step) to exhaustion, for each leg)
• Stretch everyday (calves, hamstrings, quads, glutes, lowerback)
• Cross-train everyday (Swim, bike or do 30 minutes on the elliptical machine with some free weight training of my upper body)
• Wear a night splint (which keeps my arch stretched while sleeping)
• Avoid wearing flip-flops, shoes with no arch support or walking barefoot whenever possible
• Tweet about my Plantar Faciitis woes on Twitter in hopes that some one can offer me some good advice, encouragement or at the very least, commiserate (misery loves company)
  

Since I've been complaining about my running injury on Twitter, a lot of people have kindly shared advise or words of encouragement. So many people have tweeted me that I am really feeling good right now. My heal still hurts but everything feels great. Especially my heart.

Here's some of the Tweets I've received about treating Plantar Faciitis or offering encouragement:

"@Superfeet@multisportmama Hoping you get some relief – if we can be of any help, please let us know! 1.888.355.3338"

"@RaceSpeed@multisportmama Let me know what you find with your PF. Swimming seems to be good. Enjoy."

"@trijd@multisportmama Hope you get rid of it soon."

"How is the foot? Been able to do any BF running? Would love your thoughts on new post http://bit.ly/HPlxg" (Direct Message)

"@RaceSpeed@multisportmama Be careful with this type of injury. Here is a link to wikipedia write-up http://bit.ly/UnMD They say time is best cure."

"@RaceSpeed@multisportmama At bottom of this article is more links to exercises that help RT @faceurfears: Top 10 Sports Injuries - http://shar.es/qxtU"

"Thanks for the follow. Have you tried Active Release Therapy on your calves for your Plantar Faciitis? Worked instant wonders for my wife." (Direct Message)

"@kchealy@multisportmama you're welcome. I hope your PF resolves soon...it's a pesky injury!"

"@RaceSpeed@multisportmama Two points, bear with me. 1) If going on for 6 weeks without running, I worry and definitely worth Drs visit."

"@RaceSpeed@multisportmama 2nd point, I found video claims good for all foot related weakness injuries. http://bit.ly/15Srde Worth a look at."

"@kchealy@multisportmama the thing that helped me with PF was massage. Very painful but effective."

"@boulderrunner@multisportmama in my experience it [visit to a podiatrist] can be [a waste of money]. They love custom footbeds. Don't underestimate rolling on a golf ball and rest"

"@michaelsally@multisportmama well, depends on the dr. Most traditional drs like drugs or the cut & burn approach. Neither solve the cause."

"@runnrgrl@multisportmama pf sucks. Are you getting orthotics. After 3 mths of finetuning, mine helped! Still no more pf since-2 yrs of relief so far"

"@donna_de@multisportmama I'm reading Chi Running on the same topic [barefoot running]!"

"@ajrizza@multisportmama I see runners all time with PF we do foot and ankle exercises, EPAT (check out link) and Orthotics from Foot Management ..."

"@wildcelticrose@multisportmama the story of the accident-shows that an athlete can overcome anything http://wildcelticrose.net/l..."

"@the17thman@multisportmama @FootPursuita You should try Aqua Aerobics http://bit.ly/eldVE"

"@behindtherabbit@multisportmama thinking a lot about adopting 'less shoe is better' - slowly, to avoid injury. starting with light trainers, then mayB VFFs?"

"@dnorton@multisportmama I will go out on a limb to say a little barefoot running may actually help your PT. It has with mine... YMMV."

"@bmolloy@multisportmama I had PF last year for the first time and it took 3 months to be gone completely. heat moldable orthotics were my cure."

"@RunningQuest@multisportmama That's great! Remember to take it slow, to give yr muscles time to awaken. Good news is they do so pretty quickly."

"@healthyashley@multisportmama I'm sorry about the news (and pain!)... Good luck with your alternative exercises! Can you bike?"

"@turtlescanrun@multisportmama I guess you are with us on that list...It is so hard sometimes..I'm always injured or recovering lately :S"

"@ultrarunnergirl@multisportmama best advice 4 PF i know: keep supportive shoes on all the time, never go barefoot, esp getting up in a.m. or @ nite 2 pee."

"@DCrunnergrrl@multisportmama I know how you feel! Contemplating one of my 1st runs "back" tonite, and trying to make sure I don't jump the gun. So hard!"

"@ncjack@multisportmama awesome! How's the PF??"

"@misb@multisportmama how's the PF? Hope it's settling down! Orthotics, ART, & the night splint cured my chronic case."

"@misb@multisportmama it's Active Release Technique http://bit.ly/7xB4V & http://bit.ly/ZVzis ; really helps with soft tissue/fascia issues"

"@chicrunner@multisportmama gosh! get better soon. I am stretching as I type ha ha :)"

"@IronmanLongRunr@multisportmama I say tape it strong and give her a go"

Thank you everyone. Just knowing that there are people out there (fellow runners, parents, triathletes, non-athletes--people) who care enough to take a minute to Tweet me a word of encouragement or healing advice for my plantar faciitis really rocks.

It makes me feel better.

:) A