Sunday, April 22, 2018

Getting Over Plantar Fasciitis

I ran 283 miles in May 2017, which is when my PF first started appearing.

I first did whatever treatments I could find on my own, like one-legged heel dips on the edge of a stair, and massage, and stretching. This got me through the training leading up to Tahoe Rim Trail 100 (race report), and I had no problems at all with my heel in that race. But two weeks later, I raced the Devil's Slide Half Marathon (race report), and I think that worsened the injury.

This was July, 2017. Runs for the month: about 215 miles.

Again, I tried first to cure myself, and I was taking more and more time off from running, but I wasn't getting better. Overall, I was getting worse. Previously, the PF hurt in the morning and I would stretch it out, but now, it was hurting throughout the day, like after sitting for a while. Also, I developed another probably related problem with a hip/butt/groin muscle tightness on the same leg that had PF. I was getting sad at losing so much hard-earned physical fitness, too, and my weight was climbing up.

Nov. 7 -- I met with a podiatrist, Dr. Krisdakumtorn, aka, Dr. Kris. We agreed to try the least invasive treatments first. Here are the instructions I received.
You have been diagnosed with Plantar Fascitis. The following recommendations for treatment have been given:

1. Ice massage the area 1-2 times per day for 15 minutes at a time. This works best by rolling your arch and heel over a frozen water bottle with firm pressure.

2. Stretch your Achilles tendon and plantar fascia 1-2 times per day especially with the first steps in the morning or after rest (i.e. sleep, sitting, etc.) You may elect to do 3 sets of 15-20 seconds each or one longer set of 60 seconds. Each stretch is meant to be done slowly without any quick, sudden movements.
 a. While lying down with a straight knee, use a towel around the forefoot to pull and stretch the calf
 b. Runner's stretch #1: Lean forward with one foot in front of the other, an extended or straight back knee, heel on the ground and toes pointed straight ahead or intoed. You should feel a stretch in the upper calf area if done correctly.
 c. Runner's stretch #2: Similar to above but with a flexed or bent back knee. You should feel the lower calf stretch if done correctly.
 d. Place the bent toes on a wall or vertical surface with the heel on the ground and then bring the knee/leg forward until the leg is parallel with the wall.

3. Shoes should be supportive and replaced regularly especially if doing a lot of mileage. The shoes should have a firm heel counter, bend only at the level of the big toe joint area and not be overly flexible.  Running and/or walking shoes should be replaced every 350-400 miles of running/walking. While treating your plantar fascitis, you should avoid any barefoot walking and using any overly flexible shoes like slippers, flip flop type sandals, old shoes, etc. For running shoes, you may want to consider such brands as New Balance, Asics, Brooks, Mizuno, etc. For dress shoes, you may want to consider Rockport, Ecco, Munro Sport, Clarks, SAS, etc. It should be noted that there isn't one specific brand that is perfect for everyone. You should select a store with a good selection and try on several different brands/styles at the end of the day when your feet are most swollen and/or tender.

4. Supportive devices are often helpful in treating plantar fascitis. You may elect to try a generic OTC device such as Superfeet or Birkobalance. In most cases, this is sufficient to help alleviate the pain and prevent its recurrence when used regularly.  In some cases, a prescriptive custom foot orthosis will be necessary.

5. Night splints can be a helpful treatment modality for the morning pain if used appropriately. These can be found at Footwear Etc. or online at There are various types which range from a rigid type to a sock type. The biggest issue with these consistent use as patients sometimes find it difficult to sleep with the splints on overnight.

6. Plantar fascitis can often be treated successfully with the above mentioned program. Should symptoms recur or fail to improve satisfactorily, you may need other treatment modalities such as a steroid injection, night splint, physical therapy, custom orthotics, extracorpeal shockwave treatment or surgery.

7. Schedule a follow-up if your symptoms do not improve by 50% in 4-6 weeks.

I bought the inserts the same day. (Superfeet Carbon.) I borrowed the night-splint from a friend. I wore shoes all the time. I did the stretches. It didn't seem to get any better.

November runs: 79 miles.

12/13, 12/20, and 12/27 -- Shockwave Therapy
I went back to Dr. Kris and began three treatments of shockwave therapy, once a week for three weeks. This involved him identifying the most tender and painful spot on the bottom of my heel, and then using an electric jack-hammer-like device to administer 3000 pulses. This device rapidly hammered my heel with a small steel cylinder. This hurt like nothing I had ever experienced before; it was excruciating, but kept telling myself that I was making myself better. The first treatment was the worst but the 2nd and 3rd weren't as bad. There was no bruising and very little swelling from the treatment, and I was able to walk out of the office just fine.

The theory behind the shockwave treatment was that it would break up scar tissue, and that after three or four weeks, I could expect to see results as the fascia healed.

December runs: 16 miles. :-(  (There's a chance that I missed a short run or two from being recorded by Garmin.)

January, 2018 -- I could barely run 5 slow (10-11 minutes per mile) flat miles. I'm at my all-time worst since I began running regularly in 2004. My heel is bothering me still, but the main limitation is now this groin/hip/butt tightness, where it starts to hurt and then eventually spasms and cramps. The PF would hurt in the mornings and would interfere with driving (because it's my right heel). I tried to avoid any driving over a half hour. But throughout this month, the PF was getting better and my hip/groin/butt problem was becoming the limiting factor.

January 30 -- first day of physical therapy.
I met with Meghan Taff (I highly recommend her) and she taped my foot and gave me some exercises.
The taping seemed to provide immediate PF relief. She used Rocktape H2O which can stay on for 3 or 4 days, even with a long run and showers. The technique she used was to apply two strips from the forefoot to the heel, to be applied while you bend the foot upwards (toes towards the shin). The theory she gave me was that when the foot was relaxed, the tape would pull away from the heel and increase blood flow to heal the damage.

I met her once or twice a week up through the end of March and she gave me various exercises.for PF:
* One-legged heel dips on the edge of a stair, 20 times slowly on each side, twice a day.
* Stretching and massage, especially first thing in the morning.
* Using a roller on the heel.
* A kind of foot scrunch.

I stopped using the night splint because I couldn't detect any improvement from it and it was annoying.

January runs: 99 miles.

February (137 miles) and March (183 miles) -- I finally am seeing huge improvements. I build up my mileage in preparation for the Boston Marathon. My goal is just to finish the race reasonably comfortably. My fitness and speed are significantly worse than a year ago. The PF is "pretty much" gone. I still feel it lightly sometimes, but it is far better.

April 16 -- Boston Marathon. (Race report.) It's the slowest I've ever raced a road marathon, but my heel doesn't bother me at all.

June, 2018 -- I think my PF is 98% cured. I get lazy with the exercises and I mostly stopped taping my heel, and I still feel it slightly in the mornings.

So, what were the keys to getting cured? Probably the shockwave therapy was #1 followed by the physical therapy. That's my best guess of what worked for me.

Hope this helps!

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