Plantar fasciitis

Discussion in 'Ask the Docs' started by fmagic, Jul 11, 2011.

  1. fmagic

    fmagic Chapter Presidents
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    I just started running in April of 2010 and I started with Vibram FiveFingers. I moved on to Merrell Trail Gloves when they were released later in the year. I started off consistently running 3-5 miles with no problems. I let my sister talk me into running the Broad Street 10-miler on May 1, 2011, and my training leading up to that obviously included increased mileage. I was diagnosed with some kind of tendonitus in my left foot in August (2010) and treated that with significant quantities of stretching and accupuncture/massage and it went away. Fast forward to April/May (2011) and I started to develop a significant pain in my right heel. The pain was never sharp, and never occurred while running. I only noticed it after waking in the morning, and after sitting for a while (such as at work). I saw a podiatrist in June (2011) and after taking x-rays (to check for any obvious fractures or other problems) he diagnosed me with plantar fasciitis and recommended supportive footwear, specifically with arch supports. I was recommended to wear the supportive shoes as much as possible, from work to exercise, and then to use a night splint while sleeping. I had no supportive footwear so I had to go out and buy new work shoes and I picked up a couple pairs of more traditional running shoes so I could use arch supports (such as Superfeet). I have been wearing these supportive shoes for a few weeks now, but I still go barefoot at home, and I still take my Merrell Trail Gloves out for a short run at least once a week. I am looking for advice on what is best... after doing a lot of reading, there seem to be two camps on this--those who recommend wearing supportive shoes all the time and never going barefoot, and those who recommend going barefoot to let things stretch and strengthen. What should I be doing? I really dislike the supportive shoes, and want to get back to full-time minimalist running, but I do not want the plantar fasciitis to get any worse. My current treatment is a lot of calf stretching, icing and rolling (various balls, iced bottles, etc.) and I am using the night split for a few hours a night (can't stand it for long as it gets hot.) I would say the PF is not getting worse, and maybe it is getting a little better, but it is definitely still there. I do not really notice stiffness after sitting any more, but I always notice it first thing in the morning (although I think even that is getting better.) I am surprised I do not see more posts on plantar fasciitis here, but maybe I am just missing them. Any thoughts on this?
     
  2. dunetraveller

    dunetraveller Barefooters
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    I know the docs would say to

    I know the docs would say to find out what is happening with your form that led to the PF in the first place. Treatment is the easy part, preventing it from recurring is the real work. Seems to be the answer to any running related injury actually.

    As far as threads about PF.. No, there do not seem to be a lot of them, but they are here... like this one

    Hope you conquer it!

    John T.
     

  3. Dr. Mark

    Dr. Mark Barefooters
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    Mike,This is a great

    Mike,

    This is a great question and one where there is no precise answer that can be generalized for all.



    That being said I am a proponent of strengthening the foot and the intrinsic muscles as well as restore normal plantar fascia and lower extremity mobility.



    Here is a post I wrote for Toesalad on the topic

    http://www.toesalad.com/articles/plantar-fasciitis



    Also this recent post on our site by running guru Jay Dicharry goes through the self evaluation process…it is a MUST READ.

    http://naturalrunningcenter.com/2011/07/09/ask-the-experts-how-much-time-do-i-need-to-transition-to-minimalist-footwear/



    The process to restore the strength and mobility in this area is a long one…up to a year.

    My feet are now way thinker and wider than they were when I wore shoes all day and I can safely say my odds of Plantar Fasciitis is now near zero.



    Progress gradually with a plan.



    Dr. Mark
     
  4. migangelo

    migangelo Chapter Presidents
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    Mike, The semi-famous Dr

    Mike,



    The semi-famous Dr Mark just replied to you. saying pretty much what i planned to say. You need to strengthen the foot. Wearing supports will immobilize your feet and not allow the muscles to work. It relieves the pain but won't fix the problem. I know first hand how it feels. My doc told me to never go bf and always wear something on my feet.

    After a year and a half of bf/minimalist i don't suffer the pain that i used to. I still have some pain because i have to wear shoes to work. It's nowhere near as bad as it used to be as i just know its there now and it's not always screaming at me for attention.

    There has been lots of talk about PF here, it's just buried now. It takes time and patience and if you run bf or in vff, which are more flexible than TG, it will help a lot faster.



    Good luck,



    Mike
     

  5. HobbitFeet

    HobbitFeet Barefooters
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    I'm no doc, but I'll share my

    I'm no doc, but I'll share my experiences. I developed a case of PF in my right foot after the 2010 Marine Corps Marathon. From what I gather it wasn't a "bad" case but it was pretty unpleasant. Well I'm pretty bad about treating injuries, so I didn't do much as far as icing, stretching or any of that. That race was last october, and I'd say it only went away completely about a month ago. I also noticed it was worse in the morning, so the one thing I did do was try to do some stretches and ankle turns before I got out of bed. That seemed to loosen it up a bit which also seemed to help it heal.

    So to answer your question yes it can take a while to heal, even if you're doing all that good preventative stuff. As for shoes/no shoes, I was always told that the most common cause of PF was heel slippage in running shoes, so I'm inclined to think if you don't have shoes on you can't have heel slippage. :)
     
  6. Dr. Nirenberg

    Dr. Nirenberg Barefooters
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    Hi - the post by Dr. Mark is

    Hi - the post by Dr. Mark is superb; great advice. Essentially, you strengthen underused muscles to help lessen strain on the fascia.
     
  7. Jesse James

    Jesse James Barefooters
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    Hi FMagic,I am a little late

    Hi FMagic,

    I am a little late showing up for this discussion, but wanted to give you some self treatment advice that will help you get through the acute pain phase of plantar fasciitis.



    This blog is specific to plantar fasciitis and other foot pain injuries.

    http://tao-fit.com/self-treatment-for-plantar-fasciitis



    This blog is a general massage program to help prevent over training inuries.

    http://tao-fit.com/foam-roller-therapy-for-beginners



    And definitely follow the sage advice of the guys that posted above me. Good luck.

    Jesse James Retherford

    http://www.tao-fit.com
     
  8. Warren Dickey

    Warren Dickey Chapter Presidents
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    FMagic,I too had a

    FMagic,

    I too had a horrendous case of PF after running the 2009 Disney marathon. I had never had it before but it was extreme after that marathon. It took me a year of shots in the feet, stretching, ice, and orthotics to finally get any relief whatsoever. I still had a mild case of PF when I began BF running in 2010 but within two months it was completely gone. Since then I've run as far as 32 miles in a single run with no hint of PF whatsoever.

    Since I noticed you started running in minimalist shoes and not barefoot I wonder if you are somehow still hitting on your heel more than you should and don't quite realize it. I notice when I instruct people in BF running they develop great form MUCH faster when they start out with small distances yet go completely barefoot. That's also what I did. At this point I run barefoot/shod in the proportion of about 60/40. It largely depends on the terrain and time of day. Florida in particular gets foot-burning hot in the early afternoon, so many times I've got to go with minimalist shoes. I would suggest you really focus on your form and start doing some shorter runs barefoot if the terrain in the area you live in allows it at all. Fortunately I'm blessed with miles of flat, smooth concrete in my neighborhood so it's a BF runner's heaven. If you live in a big city or an area without much in they way of sidewalks you might be out of luck.

    Good luck.

    Semper Fi,

    Warren
     
  9. DNEchris

    DNEchris Barefooters
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    I watched Lee Saxby film a

    I watched Lee Saxby film a guy last week. First shod, then barefoot. No specific instruction was given. The videos were then played back side by side. The runner went from being a typical heel-striker, in Altra Instincts, to a fine mid-foot strike in 30 seconds flat!

    Lose the shoes good people - lose the shoes!
     
  10. fmagic

    fmagic Chapter Presidents
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    When I started, I did try

    When I started, I did try some running completely barefoot. There are not really many places around here that I feel comfortable staying barefoot, but I did it anyway just to give it a try and see how it felt. I have run completely barefoot up to a mile or two on paved surfaces and up to 3 miles on a local cross country course (mostly flat with a lot of grass and smooth trail). I was doing this during my training earlier this year, but have not done so recently. I have been using Brooks Cascadia 6's on trails and Mizuno Precision 11's for paved trails and roads. I have only been wearing my minimalist shoes for walking and hiking. I feel this mix is helping me get through things right now, and am still hesitant to go back to completely minimalist since things are working (symptoms still there, but improving.) Fun stuff. At least I am still running!
     
  11. scott.undefined

    scott.undefined Barefooters
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    Hey Mike,I'm glad to hear

    Hey Mike,

    I'm glad to hear you are still running. I had PF pretty bad many years ago and all the supportive stuff really aggravated it for me. I wore flip-flops and apparently the tightening of the toes when walking inadvertently strengthens the toes. Just a thought! Good luck!
     
  12. Dr. Andrew Klein

    Dr. Andrew Klein Barefooters
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    If I could add my two cents

    If I could add my two cents as well, I would suggest more barefoot (not minimalist) walking, while practicing a forefoot landing. Dr. Nirenberg said it above, and Dr. Mark's toesalad article hits it on the head. You have to strengthen those feet up while the PF heals. Scrunching up a towel with your toes, picking things up with your toes, and barefoot walking are keys to strengthening. I really like the exercise of picking things up with your toes because it makes you balance on the other foot/leg and you get some strengthening there too. I also have patients progress to barefoot hops in place as well, practicing a balanced foot strike (forefoot, then heels and toes together). Strengthening was the only thing missing from the treatment in your original post.

    Your original post also mentioned icing. By this point icing should be un-necessary and it may actually be slowing healing if you are doing it regularly.
     
  13. Barefoot TJ

    Barefoot TJ Administrator
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    Let me tell you what I've

    Let me tell you what I've noticed about having PF. Background first: The last time I developed PF was while healing from cryosurgery in both feet for Morton's Neuroma (a condition directly caused by the types of shoes I used to wear). The reason I got PF was because after the surgery, I was walking around on my heels for 3 monthsish trying to avoid putting any pressure or weight on the balls of my feet where the cryoprobes were inserted; it was that painful. Now that I am running barefoot about every other day, my PF is getting better and better and better each time I do. The reason is because I am restrenghtening my arch muscles.

    I watched a video where Dr. Irene Davis was explaining what happens with PF and why it is so painful. She said that when our arch muscles are weak or injured, the plantar fascia has to do all the work in bearing the load. This is not the plantar fascia's job; that job is supposed to be the muscles' job, but if they are inadequate for whatever reason, the plantar fascia ends up doing all the work, and since this is not its job, it becomes injured. The only way to recover from this is to strengthen the muscles in the arch and feet. Once the muscles are strong enough to bear the weight, then the plantar fascia can start to heal.

    So it would make sense that running barefoot (or in something so minimal that it does not atrophy the muscles of the feet) would strengthen the muscles of the feet and prevent you from developing PF in the future, as long as the feet stay strong and healthy. And it would make sense that so many people who run shod do get PF because the shoes are weakening/atrophying their arch muscles.

    So keep building up those arch muscles, and your PF will go away, like mine is.

    More history. The first time I got PF (in my right foot) was when I was wearing ASICS Kayanos, it took two months to overcome because I was still "transitioning away from them," to bare feet, meaning sometimes still wearing them. The second time I got PF was when I had not been wearing the ASICS for a long while, then I put them on to go get my race packet, since it was raining, and I did not want to get my VFFs wet, since I would be running the half in them the next day. I took two steps in the ASICS, and the PF in my right foot felt like it had exploded. I went completely barefoot after that, and the PF was gone within a month. The third time I got PF, I mentioned above, has not gone away yet, and it's been over a year now. It's also in both feet. It was aggravated by what I think was a bad reaction to some antibiotics I had taken for an unrelated reason, which set me back for weeks and weeks. (Some of you might remember that mess while I was going through it.) My feet weren't the only thing affected though. My left wrist, my arm, and into my left armpit and chest and my tailbone were also afftected. My PF felt like a bad sunburn on the inside of my skin. Only after stopping the antibiotics did I start to improve. At that point, a doctor prescribed both Voltaren pills and Voltaren gel, and finally, the pain became manageable. I still take the Voltaren pills, and I had found that when I stopped, the pain would increase and the sunburn feeling would come back, but I think I am at a point now that I can stop taking them to see what happens, meaning the PF pain may now be manageable without them, whereas it wasn't before. Don't forget though, I've been barefoot for 98% of the time over the past three years, only wearing flip-flops, huaraches, on occasion, so I have barefoot activity and strengthening every day. I understand from talking to others that PF is something that can take months and months to get over, so just don't give up. I am getting better all the time. I haven't stopped running, and in fact, I believe that each time I run barefoot, my feet are getting stronger. I just have had a very, very bad case of PF this last time, and it's going to take some time. Stick with it.
     
  14. Dr James Stoxen DC

    Dr James Stoxen DC Barefooters
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    PLANTAR FASCIITIS come from too much chronic STRESS in the plantar fascia of the foot. It starts with inflammation that turns into scar tissue that later calcifies.
    The question is... What is the cause of this chronic stress in your foot?
    In walking or running as you know there is simplistically the "take off" and the "landing". We all know the majority of STRESS injuries occur in the landings.
    Like a plane, the human body has a landing gear, spring-loaded shock absorbing mechanism built into the arch complex as well as the muscles that allow the foot to impact like a spring and not a bang.
    Foot Cuff: http://teamdoctorsblog.com/wp-content/uploads/2012/06/Suspension_Muscles_Bottom.jpg
    Foot Spring Suspension Muscles: http://teamdoctorsblog.com/wp-content/uploads/2012/06/Spring-Suspension-system-muscles.jpg
    The key is to
    · release the muscle spasms around the 33 joints of the foot, so they can move better. That allows the impact to be moe evenly distributed across the foot like a spring load instead of a bang.
    · Stretch the foot in a 3 dimensional plane so it is flexible to absorb the impacts of walking
    · strengthen the suspension system muscles or the pronation supination cuff muscles that suspend the arch so it works like a spring to spring you off the ground rather than bang you into the ground
    Here are some simple stretches and massage techniques you may find helpful:
    Scissor Stretching Of The Feet
    http://teamdoctorsblog.com/2011/08/05/video-tutorial-84-dr-james-stoxen-dc-demonstrates-scissor-stretching-of-the-feet/

    Deep Tissue Treatment Under The Big Toe And Second Toe
    http://teamdoctorsblog.com/2011/08/03/video-tutorial-82-dr-james-stoxen-dc-demonstrates-self-help-deep-tissue-treatment-under-the-big-toe-and-second-toe/

    Video Tutorial #80 Dr James Stoxen DC Demonstrates How To Self-Help Deep Tissue Treatment Of The Subtalar Joint Of The Ankle On The Inside.
    http://teamdoctorsblog.com/2011/08/01/video-tutorial-80-dr-james-stoxen-dc-demonstrates-how-to-self-help-deep-tissue-treatment-of-the-subtalar-joint-of-the-ankle/

    Video Tutorial #81 Dr James Stoxen DC Demonstrates How To Self-Help Deep Tissue Treatment Of The Ankle (Subtalar Joint Outside)
    http://teamdoctorsblog.com/2011/08/03/video-tutorial-81-dr-james-stoxen-dc-demonstrates-how-to-self-help-deep-tissue-treatment-of-the-subtalar-joint-of-the-ankle/

    Video Tutorial #87 Dr James Stoxen DC Demonstrates Self-Help Deep Tissue Of The Ankle Mortise
    http://teamdoctorsblog.com/2011/08/10/video-tutorial-87-dr-james-stoxen-dc-demonstrates-self-help-deep-tissue-of-the-ankle-mortise/


    Here are my last two articles you might find helpful:

    How Does The Body Spring Back Safely From Impacts Of Running and Walking?
    http://teamdoctorsblog.com/2012/06/13/video-tutorial-12-is-running-bad-for-knees-how-the-body-springs-back-safely-from-impacts-of-running/

    Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running
    http://teamdoctorsblog.com/2012/06/18/video-tutorial-28-the-impact-absorbing-landing-muscles-of-the-human-spring-mechanism-testing-and-training-the-spring-suspension-muscles/

    Dr James Stoxen DC, President, Team Doctors The Barefoot Running Doctor
     
  15. fmagic

    fmagic Chapter Presidents
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    I just wanted to update everyone that I seem to be doing okay with my battle with PF. I am still running. Lately it's been a 25/75 mix of barefoot and minimalist miles, with a lot less pain. I have noticed some tightness in my Achilles area on my right foot, but it has not put me out of commission. I still have leftover heel pain, but it is so minimal any more. I have been forgetting to do my foot strengthening and rolling, which is probably not helping. I have been able to get runs in up to 5 miles barefoot (on trails) and up to 2 miles (on pavement). I really feel great when running completely bare, so I suspect my form is definitely in need of tweaking. I am pretty sure I start to land on my heels when in the minimalist shoes, especially towards the end of my longer runs. Right now, I am dealing with a calf muscle pull/strain, and went back to barefoot to force myself to keep my runs short and so far, so good. I want to take a moment to thank all of the doctors and participants in this thread as all of the information was definitely useful.
     
  16. Barefoot TJ

    Barefoot TJ Administrator
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    Good to know, Mike! Thanks for checking in.
     
  17. Dr. Gangemi_SockDoc

    Dr. Gangemi_SockDoc Barefooters

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    I saw plantar fasciitis and night splints in the first post. The first (PF) leads me to share this SD post/video: http://sock-doc.com/2011/03/plantar-fasciitis/
    and the second, "night splints" make me cringe because I think that is possibly the worse thing you can do for PF.
     
  18. PB Junkie

    PB Junkie Barefooters
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    I can't say enough good things about the video Sock Doc posted. I was beginning to have PF symptoms and got really bummed. Started using the trigger point release in my calves from his video and it went away very quickly, in a couple of days. Mine was just starting to get cranky and wasn't chronic by any means, but wow! what a difference in a very short time!

    THANKS, SOCK DOC!!
     

  19. Dr. Gangemi_SockDoc

    Dr. Gangemi_SockDoc Barefooters

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    Sweet; great to hear. Thanks.
     
  20. migangelo

    migangelo Chapter Presidents
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    mike, good to hear it's getting better.

    i followed Dr Stoxen's advice. i learned to hit the knots in my feet and other trigger points in my legs. i broke up the knot in my left arch and it now feels like bubble wrap when i work on it. i've had pf for 10 years and am finally getting it to go away with all the work. it is work. sometimes it wears me out more than running. keep at it and take all the dr's advice.
     

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