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.

5 Steps to heal plantar fasciitis: "cloud care" from running Twitter friends

I'm still hopping around on one foot. After more than a year of painful plantar fasciitis heel pain in my left foot (since December 2009) and months of not running (since June 2009) and medical care, this cursed injury has still not gone away.

It's hard to have an identity of "Runner" and not be able to run. Having a cheerful and fit ultra runner girl friend who moved in across the street recently just put salt in the would.

Me: "How did your 50K training run go in San Diego last weekend?"
Ms. Ultra Runner: "Oh fine. I'm really not very sore at all. *laughs * It was a tough run though. The wheels came off at about mile 20 but I managed to get it together and finish..."

Dang! I so wanted to be her. Dang! She's so happy and looks so fit...Dang! I want to run again...Dang! Dang! Dang! (Can you tell I'm missing my daily running fix? :/ )

So, out of frustration (and desperation) I looked for some sports injury advice from my @MultisportMama followers on Twitter. Here's their advice in a nutshell:

5 Steps to Get Rid of Plantar Fasciitis That Worked

1. Stretch (gastrosoleus/calves/hamstrings), wear night splint to take load off foot tendons/fascia
2. Strength train (heal raises, towel pulling with toes, core workouts, etc)
3. Increase circulation with deep tissue massage, ultrasound or rolling foot on tennis ball
4. Wear custom orthotics (I'm waiting for a pair to get finished now)
5. Swim or bike (Don't run and cross-train instead)

How is that for some open source "cloud care"? It was free. It actually worked for other runners. It's based on first person evidence. It's current (meaning it is not based on some study done 20 years ago or a book). And, there is no financial incentive for them to sell me over-priced products and services that don't work.

To give credit where credit is due, here are some of running Twitter friends who kindly gave me the advice (and agreed to share their tweet names in time for this post):

@boulderrunner
@dogbert10
@rundigger
@SoloRunner 
@Wesley_K

Do you remember those $700 toilet seats from back in the 90s? That's how I feel about the insurance-inflated prices for stuff I have in my medical system. The $250 co-pay for the MRI, the $40 co-pay ($150-$212 cost to insurance) for "therapeutic exercises and ultrasound therapy" twice a week, the $20 ($53 cost to insurance) felt heel pad shoe inserts, and waiting 10 weeks for Anthem to approve the MRI so I was getting the wrong kind of treatment for months (getting PT for plantar fasciitis and not a stress fracture).  I think our medical system has some inherent conflicts of interest. I mean when my orthopedic surgeon foot specialist is part-owner of the medical and physical therapy clinic providing me with advice, products and physical therapy, it benefits him financially when I buy as much care as my insurance will approve. So, for example, the stress fracture in my heel-- the "calcaneal contusion"--that didn't show up in my X-Ray-- went untreated for three months before the doctor requested an MRI. Then it took 10 more weeks for the MRI to get approved (thanks Anthem). In the meantime I'm continuing with the same regime of physical therapy for plantar fasciitis and asked to walk on my foot--even though I had a stress fracture.

The current medical system is a game based on wrangling profit from the patients by both the care providers and the insurance companies.  In this system I only get as much care as my insurance company allows my doctor to proscribe. My doctor only proscribes as much care that the insurance company will approve to pay. That care is not based on needs of my running injury. It's based on what each side can get away with. That is not good outcome-orientated care. That is not good medical care. That is crappy care.

At this stage of the game, I'm sticking with my running Twitter friends' advice (see above). As far as I'm concerned, it's outcome-orientated care devoid from any profit incentive or conflict or interest.  I will do another blog post about their collective "5 Tips to Get Ride of Plantar Fasciitis That Worked" in mid-May. It will be a status report on how my new social media/sports injury "cloud care" system is working. If those "5 Tips..." actually worked for me.

Hopefully, by then I won't have to hop on one foot anymore.

Happy Trails!

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