Discussion: Plantar Fasciitis

How many of you have had experience with plantar fasciitis? What have you done for it (therapies) and how did you train while it healed (if you did)? I'd like to hear from anyone who's had experience with this condition. I suspect many of you young folk have not had this problem.

I have it right now. I'm taking the month of November off from running to give it time to heal. I'm also doing some stretching. I think it is getting better. My arches are less stiff in the morning.

Had an incidence after a Hudson Highlander where I ran hard about 1-1/2 miles on pavement in spiked o-shoes (they had zero arch support). When I was thru it felt like someone was sticking an ice pick into the bottom of my arch.

I had good results with ice; specifically rolling a can of frozen orange juice concentrate back and forth under my arch for 15 minutes a couple times a day (then drink the oj). I also firmly taped the arch in a stirrup fashion -- thanks Peter G. This kept me running and competing for the 3 months it bothered me.

one thing that helped me was to make sure to not sleep with my toes pointed (lets the arch get tighter, then you re-pull it when you get up in the morning). if you sleep on your stomach, then you could just hang your ankles off the bed. this change was a big help to my recovery anyways.

I had this once or twice
The key to keeping it away and getting over it is arch support and a loose achilles tendon (in fact, whole back of leg muscles).
Buy some arch supports for your shoes, and use them when running and walking around. I could feel my supports pushing at my swollen arch at times, but they never got worse from then on.
To prevent further complications (achilles tendonitis), do the 2 back of leg stretches after you have warmed up running or walking awhile (5-10 minutes).
I assume you know these, lean forward stretching the back of each leg, one with knee bent, other with knee straight.
Wearing the style of shoes which raise your heel are definately detrimental as they shorten your achilles, thereby leading to increased tension and straining along the whole back of leg and under the foot.

Another thing to add to the "good shoes with good arch support".... wear them ALL THE TIME. When you wake in the night to visit the restroom, put on your shoes. When you get up in the morning to go shower, put on you shoes. When you get out of the shower, put on your shoes. DO NOT go barefoot. DO NOT stretch the bottom of the foot until you are pain free. While the underlying cause may be tightness in back of legs or elsewhere, the PF is due to tears and microtears in the tendon that can be slow to heal (less blood flow in tendons). When you get up at night your feet are "cold" and any healing that was done can be negated by walking w/o support. It is bothersome and takes discipline but shoes, or I should say support, "all the time" is important.

Thanks! I certainly appreciate all the responses to my inquiry. I'll have to get proper arch inserts for my shoes at some point; at the moment I'm using foam makeup applicator sponges to build up that area (under my shoe insoles) for support. I'm icing and massaging the arches, stretching the back-of-the-leg muscles whenever possible (while sitting and also before bed), and not running. I don't sleep on my stomach, however, so I'll have to try something else at night. I do try to flex my feet before getting out of bed to gently stretch the back of the lower leg. (I'm hoping my visit to the doctor tomorrow will result in a night splint paid for by insurance.)
I believe the primary cause of my problem was an ill-fitting pair of O-shoes (too long, narrow and NO arch support) that I used this fall. Folks with high arches should be reminded to use proper arch support in any shoes they wear running/orienteering to hopefully avoid this condition.

and don't wear sandals. they allow the cushy part of the heal to 'spread out' from its normal position and cause more pressure on the heel bone. a shoe will keep the pressure on the sides of the heel and create a thicker pad of skin and muscle covering the bone.
does that make sense?

I have a feeling this is what I have right now.
At the 24hr last weekend I thought I got a thorn in my bike shoe when I stood up on my heel a bit, but didn't find anything. Yesterday I was doing some core work, and stretching my leg straight while contracting my foot (Toe towards knee) caused the same stabbing pain in the medial part of my heel.

Probably from walking around in hard bike shoes, and seems fine when I run or bike right now. Not sure how an arch support would help here.

I had it. Wear something softer for a while, like sneakers, or at least put a softer sole in there, it should go away in couple of weeks. You can get the same thing after wearing worn out hard old O-shoes as well.

All I can say is that if it DOESN"T go away in 2-3 weeks, go see a professional. When people show up in my office and they have waited 6 months to see me, it takes at least 4 months to get rid of it at that point.
So dont just drag it for too long thinking it will go away by itself.

i had it for quite a few months in one heel and it was v. painful. I did a few things, and eventually it went away over the winter when there was so much snow i only went running a few times a week. But i did all these things, and they all help:-

A) wear 'night splint' for a few months (keeps foot in 90deg position, ie. not pointed toes). you can buy one but i had a homemade job that worked well.
B) dont run in O shoes or old shoes on hard ground, esp ashphelt
C) stretch you calves a LOT (helps to fix causative problem)
D) tape foot in special way for running/walking in daytime (see physio for taping technique). this really minimised any pain.

you have to be proactive, it doesnt go away by itself and the longer you leave it the worse it gets. good luck

I came down with PF (and heel spurs) after doing a 12 hr ROGAINE in O shoes. It took 6 months to resolve. I tried extended layoffs, icing, stretching, etc. but it was orthotics which finally did the trick. I continue to wear the orthotics and also try to do a lot of calf stretches to prevent a recurrence.

It's a very annoying injury but be patient, you will get over it eventually.

Squishy spenco heel cushions in my street shoes, and avoiding pounding to my heels during running completely fixed my symptoms, so---I'm with z-man.

I am going to add my 2 cents about the Spenco heel pads or any other type of cushioning. Even though they DO feel great, they are not solving the problem at all, only making it more comfortable while things are healing.
THere has been a lot of good advice dispensed on this site, but padding/cushioning the heel is the only one that will NOT help get rid of the problem but only mask the symptoms. If things get better with those pads, then it only means that whatever triggered the PF was temporary (like a rogaine, worn out shoes that you have gotten rid of...) and you are on the road to recovery. If it's not, then you need to address the cause - padding by itself will not help the healing.

Another piece of information: heel spurs are NOT the cause of any problem in the foot, but the result of a tight and tensed plantar fascia. THey only indicate that the tight plantarfascia keeps pulling on its attachment point and the bone is trying to cut it some slack by producing extra layers of bone, pushing the attachment point further. Even though a lot of aches and pains are blamed on those heel spurs, they usually are not the cause of the pain, it's the inflammation from the sore tendon that is. So don't worry about the spurs, 70% of the population has them and they are not a problem - most people don't even know they have them!

I'll add another vote for calf (and hamstring) stretching, that's what really made the difference for me in the end.

be careful about inserts with big arch supports, because the reason they feel better is that it keeps your facia from having to stretch out...good in the short term, bad in the long term.

OK, I've ramped up my calf and hamstring stretching, I'm walking around in Tevas or shoes at home instead of barefoot, and I'm seeing Thumbs-of-Death tomorrow.
I haven't gotten to a night splint yet, but the PF isn't bad in the morning.

It's a weird injury because it doen't bug me at all to walk, run or bike, only during certain stretches. I haven't taped so far, although Hammer sent me a link to great but complex taping instructions. I suspect the heavy duty taping is for PF that is painful to run on, no?

I had a really bad bout that I kept running through - stretching, heel pads, arch wraps, icing allowed me to keep training, but ended up making the situation worse.

After about a year, when I had reached constant pain walking or even just sitting still, I found a runner in the military medical establishment who really helped a lot. He made me plastic orthotics for my boots, which I could also run with - they had deep heel cups, supported my high arches, and went almost to the ball of my foot. I ran with them for almost 6 months before I didn't need them any more. I think custom orthotics are probably worth the price you pay.

He also recommended a night splint, which was a hassle but also the only thing that finally kept me stretched out enough to heal. If I had to use it again, I'd probably order a Strasburg Sock - same theory, looks more comfortable (google it).

I also took Naproxin for a month, bought only running shoes suited to my high arches and weight (at 150, I am considered heavy for a female runner - lightweight shoes are a disaster for me). My shift in focus to triathlon training probably didn't hurt either, since I could increase my training volume without overly stressing my feet. After about two years of moderate distance, I had no problem running a marathon training program in preparation for the White Mountains rogaine without needing orthotics, painkillers, or even any special stretching. For me, most important is not to increase my mileage too rapidly.

Good luck - PF is definitely no fun, especially if you want to be out running!

If you tape right, you hardly notice it while running. You can get some nasty blisters after a couple hours, though, especially if the tape gets wet. I'd strongly recommend a pre-tape like Tuf Skin.

Also, if you're not experiencing a lot of pain first thing in the morning, you probably have a pretty mild case. When it gets bad, the first step out of bed feels like you stepped on a hot spike. Light activity seems to make it feel better.

I think just about every high-mileage runner over the age of 22 gets this from time to time. Quick treatment is the key. If I feel even a hint of it, I lay off the long runs for a couple weeks and do my distance training on the bike instead. It usually goes away pretty quick if you catch it fast, but once it gets bad, it's a very tenacious injury. A buddy of mine has been fighting it for nearly a year.

I agree with ebuckley that if you don't feel it first thing in the morning, it's probably not a bad case of PF. Mine finally resolved about a year later; I use the Pro-Foot foam inserts that mold to the foot in my shoes and replace them when needed.

I recently went through an odd case of what sounds like what 'Bent is feeling... It started after West Point and the only time I felt pain in the heel was when I was stretching my hamstrings (straight leg, seated or standing). I could do everything I usually did EXCEPT stretch the hamstrings, and after 5 weeks the pain was gone.

Just to add one thing, mine hurts only on the medial aspect of the heel, not under the foot in any way. Bash has some Pro Foot partial insoles I think, and I'll have a look at them.

I found a pic online, and mine hurts just where the blue area is marked here, : http://www.myfootshop.com/images/photos/conditions...

but not where the red area is marked.

Looks more like an Achille's tendonitis to me then. Or a case of inflammed Sural nerve.

I finally found the text related to the blue area on the image:
"One entrapment that causes heel pain is an entrapment of the calcaneal branch of the posterior tibial nerve. The blue circle shows an area where the calcaneal branch of the posterior tibial nerve may be entrapped as it passes beneath the abductor hallucis muscle."

Is this similar to the Sural nerve?

Whops! wrong side of the foot for my diagnosis! If it's the inside (medial) then you are looking at tibial nerve, if lateral side, then sural nerve. I didn't look at the picture very carefully!
It's the same problem, just different side.
THe pain associated with this kind of injury is usually burning, sometimes stabbing. It may cause pins and needles or tingling as well, but an ache is much more unlikely.
Hope that helps!

Hey, we're getting pretty close. An amazing "feat" for an attackpoint discussion rather than physical exam.
So, what's the prevention/treatment for this type of thing?

The amazing thing is that a thread has gone this long without any mention of attack badgers.

... or the presence of a certain swampfox ;)

Swampfox does not concern himself with these afflictions of mere mortals. Injuries?

No, he has much more grave issues to worry about -- keeping the attack badgers at bay is at least as important as keeping the Vandals out of Rome.

Hey Bent,
I suspect that the nerve might not necessarily be trapped in the foot area. It's actually a branch of the sciatic nerve, and given that you feel it mainly when doing a certain stretch that the way you describe it would put tension on the sciatic, I would bet my money on that monkey.
THe best way to treat a nerve is to *floss* it. I am sending you a really good exercise to floss the nerve (there are 8 exercises on that page, but the important one is called Sciatic flossing). Let me know if you have any quesitons on that.

Well, if I can't floss it, who can? I'm looking forward to being on the receiving end of flossing instructions!

I swear it was not an intended pun!
Have you received it? I sent it right away.

Thanks Barbie, I got it.

I saw Thumbs-of-death.
He thinks it's part of the insertion of the achilles tendon, not nerve entrapment or PF.
He did some ART, and lent me a therapeutic laser to use over the weekend.

Looks like I don't need fancy taping, rest or orthotics just yet, but need to keep up my stretching and not walk around in those bike shoes.

lent me a therapeutic laser to use over the weekend

ummm... well, I can see how zapping a few people might be therapeutic for you... :)

Oh sure feet, you can laugh. At least you don't LIVE with the guy who is bringing home a "therapeutic" laser for the weekend.

Mwaaa haaa haaa! Bzzzt! Kapow!

I also recommend what ever insert/support you put in your running shoe, put the same in your work shoe. You typically wear what ever work shoes you have 4 times longer each day and even though the arches don't take the full compression of a runnng stride as you walk the added support helped me heal faster. Costs twice as much but you get 4 times the return.

Y'know, although there's indication above that some people believe Swampfox to be immune to such things, I believe he has been afflicted with plantar fasciitis in the past.