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, review of article about barefoot running & less is more running shoes

"Barefoot Running: Not just for bums and hippies", is a well-researched blog article found at runningquest.net. It's an excellent source of news about the new discourse in the running community about the benefits of running barefoot or with "less is more" minimal running shoes.

The trend seems to be inspired by the book Born to Run by Christopher McDougal that came out earlier this year. The book documents the author's search for a cure for his nagging running injuries including the dreaded plantar faciitis (PF) that has ended running for many. The "Barefoot Running..." article's author Clynton expounds on the McDougal's findings about barefoot running, the running shoe industry marketing shoes known to be bad for running efficiency, and current articles. He also, very nicely and responsibly, cites his sources. (I love that!)

According to Clynton the benefits of running barefoot are these:
1. Shock absorption: Barefoot running makes you run using the body's natural shock absorption system by landing mid-foot while conventional running shoes force you to land on your heals which is damaging [my paraphrase]
2. Lighter Strike: Landing more lightly on your feet happens naturally barefoot [my paraphrase]
3. Muscle Strength: Your feet become stronger and more resilient to injury when running barefoot [my paraphrase]

What I also found useful were his several reviews of minimalist running shoes such as the Nike Free racing flats and Vibram Five Fingers shoes.

I used to run barefoot on the beach in my twenties as an undergrad at SDSU. I felt better, more free, and lighter running barefoot than plodding along on the concrete bike along the beach in my big running shoes. I had sore calves after my barefoot runs, but that was it.

Flash forward 20 years with 2 kids, 2 great careers (one in sales, other in web design) and current grad student & PT web designer ...

Bare with me on this, but I believe that our occupation, which effect the movements we do every day habitually, is directly connected to our fitness. My occupation, unfortunately, requires me to sit on my butt for hours--all day sometimes--and that is not conducive to being physically fit.

I'm not running now because of a nagging case of the dreaded plantar faciitis injury. The facia, a tendon that acts as a shock absorbing and flexible band runs from my heal to my forefoot, is badly strained and inflamed. (See drawing at the left of the Plantar Fascia from the American Academy of Orthopedic Surgeons helpful web site.) This is the the same injury that prompted author Christopher McDougal to write his book Born to Run.

To figure out how to recover from this cursed injury, my research included the above mentioned web site, several other web sites I found via Google, and two peer-reviewed articles written by physicians (that I found online via CSUN's library with my student access), and this very helpful little book that I found on Amazon.com: Injury Afoot: 30 things You Can Do to Relieve Heel Pain and Speed Healing of Plantar Faciitis by Patrick Hafner. It seems that my case of plantar faciitis comes from a combination of variables:

1. Weak feet. At the time of injury I was sitting all day and doing short "maintenance" jogs 3-4x week--no more than 45 minutes long each.
2. Wearing heavily structured and cushioned running shoes; In my case it was the NB 1223) during my sleep-deprived grad school semesters (sleep deprivation inhibits tissue repair, etc)
2. Tight calves from inadequate stretching (because I was always in a hurry to get my run in),
3. Weak abdominal muscles (probably from sitting hunched over a compooper all day (miss-spelling of "computer" is intentional!)
4. Walking around in stiff/arch-free flipflops all day (we live at the beach) which further caused my foot muscles to atrophy
5. A dramatic increase in my weekend long runs in a couple of weeks (from 5 miles to 14 miles--more than double) when I joined our local running club in November 2008.
6. Ignoring the nagging pain in my left foot PF for months, favoring my right foot which did two things: (1) made my injury worse and (2) gave me another injury: hip bursitis on my right side. This was probably caused by subtly shifting my weight off my left injured foot to my right foot. So, I came down with two injuries by December 2008 and by May 2009 I could not walk without extreme pain, on both sides of my body and suffered from lower back pain. How dumb is that? See where ignoring the obvious gets you? Don't do what I did!

So, unlike Clynton's article implies, my case of PF is due to more than atrophied foot muscles and tendons caused by over-structured expensive running shoes, it was my lifestyle too. However, I believe those shoes contributed my weaker arches in general and, eventually, plantar faciitis. But not by themselves.

I thought my years of racing and "muscle memory" could carry me through the jump in miles. I've done 20 marathons and used to train mostly on hilly trails. As an out of shape and older grad student, road runner and web developer, my "old school" attitude that training intelligently was for beginners, got a rude smack down by the reality of my current state of fitness. I had forgotten the miles and months it used to take me to get in good running shape when I was younger.

Right now I'm walking (not running) around in a new pair of NB 1224s with Superfeet insoles for high arches nearly all my waking hours. Even with dresses. Not very flattering but I figure it's my version of foot cast. It allows the plantar facia to heal and, unfortunately, atrophy. I'm no longer in pain with I walk but the tenderness is there and I have to be very careful and slow with my feet strengthening exercises and walking barefoot right now--or I'm back to square one.

(1) My Everything-but-the-kitchen sink Plantar Faciitis Treatment Plan:

• 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 archsupports such as SuperFeet all the time--even at the beach (this really was not fun at the Hurley US Open Surf Championship two weeks ago!)--per my graduate adviser at CSUN who suffered from PF
• Heal rises: positive 3 sets of 20 and negative (off a step) to exhaustion, every other day
• Stretching my calves, hamstrings, glutes--everything every day
• Cross-training once or twice (if I'm lucky) a day by swimming, cycling, core workouts, elliptical workout, or weight training
• 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!" (I just repeat his words over and over again when I'm tempted to skip..errr... I really mean run... down the beach a bit after an open water swim or when I'm with the kids).
• Wearing a night splint (which keeps my arch stretched while sleeping), etc.

If you suffer from Plantar Faciitis, the book Injury Afoot: 30 things You Can Do to Relieve Heel Pain and Speed Healing of Plantar Faciitis may help you with it's plan to get rid of it. So far, when I follow that little book's steps for healing and strengthening exercises, my foot is pain-free.

(2) As soon as my PF is healed, the plan is for me to return to barefoot running on the beach to strengthen my feet. Gradually--just mile or two at first. I've come to realize, during this injury, that my body needs more than muscle memory to get conditioned, especially at my age.

That being said, my footwear plan:

(1) I will get a pair of Vibram FFs. They fit my feet fine and the weird factor is kinda cool in my book. I like them. They crack me up! Also, I think Barefoot Ted (from book Born to Run) is on to something.

(2) For road running I also have a pair of Brooks Cascadia 4 trail running shoes that I got just before my PF injury got too painful to run. I like them, too, and I feel that my foot can flex more naturally while wearing them. I heard that Scott Jurek designed them. Maybe he added some magical running powers to their design. I need it.

(3) I don't think I will go back to wearing conventional running shoes. But, then when marathon training on concrete and asfault I'm not sure if the Vibrams and trail running shoes will adequately protect my feet from injury. I'm waiting to hear more and may purchase a pair of racing flats for this reason in the future. I was considering the Nike Free or a NB racing flat (if they have one) but I'm kinda pissed off at Nike and coventional running shoe companies right now for inventing and marketing the over-structured/padded running shoes that contributed to my running injury in the first place. I still don't know what to get.

Please comment and keep me updated on your own barefoot running or "less is more" running experiences! And, feel free to offer any "less is more" running shoe tips.

:)