Plantar aspects of foot, varying depths (superficial to deep) (Photo credit: Wikipedia)
I’ve been meaning to write this post for a long time. However, I’ve been holding off because I wanted to be sure that I have in fact won my battle with persistent heel pain. I’m finally at a point where I think my war with plantar fasciitis is officially over.
As a runner, I’ve been very lucky in that I have not succumbed to any significant running-related injuries. In fact, the only injury that kept me from running for more than a few days occurred as a result of running a second marathon in a month’s time in a new pair of racing flats (my first marathon in flats). I developed a case of peroneal tendonitis that stopped me cold on a few subsequent runs and sent me limping back to my house. Given the stupidity of my approach to that race, I deserved to get hurt, but even then I missed less than a week of running.
For the most part, my body seems to repair itself pretty quickly. Aches and pains pop up, and usually within a few days they go away. I’m usually good at listening to my body, and I’ve developed strategies for attacking aches that seem to be very effective for me (e.g., mixing up shoes). However, the one pain that appeared and simply did not want to go away began in late 2010.
I can’t remember exactly when my heel pain started, but I think it was shortly after the above-mentioned race in which I injured myself. I know that the pain was in full force in January 2011, and it lingered for well over a year. The symptoms pointed to a classic case of plantar fasciitis. Pain, sometimes intense, upon first waking up in the morning, just below my left heel. It hurt to put any kind of pressure on my heel for the first few steps after getting out of bed. After a bit of walking the pain would ease off, and on most days it would go away such that it wasn’t a big deal. Sometimes it would hurt on runs, most often not, and it was never bad enough to keep me from running (I didn’t miss a single day of running due to heel pain). I couldn’t find any pattern linking my footwear choices to the appearance of the pain, except that shoes with hard heels made it hurt when I walked (e.g., Merrell Trail Glove and Vibram Trek Sport), and I recall one memorably painful run in the Saucony Guide 5 (talk about shoes that have little in common!).
Until summer 2011, the pain was isolated to my left foot. That summer I ran a 5K in Vibram Fivefingers just to see how fast I could go in a barefoot-style shoe, and though the race went well, I strained the insertion of my abductor hallucis muscle on the inner side of my right heel. The insertion was tender, and not long after that pain appeared underneath my right heel as well. I had what I self-diagnosed to be bilateral plantar fasciitis (I may or may not have had a bit of assistance from Dr. Google, perhaps you know him?).
I was never particularly aggressive in trying to treat the pain, mainly because it was never much more than a first-thing-in-the-morning nuisance. A bit of calf stretching, both straight legged and bent-knee to target the soleus muscle, seemed to do the trick. Being in zero drop shoes at work all day seemed to keep things loose and stretched out (particularly my calves), which I think helped prevent progression to a more severe case, and on most days I’d forget that I even had a problem. But the pain was still there every morning, both under the heels on each side and at the abductor hallucis insertion on the right side. By early 2012 I realized that when something painful lingers for over a year, it might be worth getting it checked out (yes, I am sometimes stubborn). My wife had been seeing a chiropractor friend (Brett Coapland of Performance Health Spine and Sport Therapy) who specializes in treating athletes (she’s had nagging hip issues since the birth of our daughter), and I decided to let him have a go at fixing my feet.
Brett has great manual therapy skills, and he did some active release work and Graston on my feet and calves. He also did a bit of dry needling – not sure if it helped, but it sure felt interesting. He also gave me some exercises and stretches to loosen up my posterior chain – my hamstrings and calves were wickedly tight after years of neglect. We talked a lot about trigger points (I had some really tender spots in my lower legs), and he had me doing regular foam rolling of my calves, particularly my soleus in the lower calf.
The first foam rolling sessions were intensely painful, even worse-so when I used the Rumble Roller, which may as well be a medieval torture device! I remember on one occasion my 2yo son taking the roller away and putting it out in the hall because I was screaming out while rolling my legs. In addition to stretching my hams and calves, I also regularly worked my foot over a rubber bouncy ball (stolen from my kids – they’re a great source of improvised self-therapy devices) and a Foot Rubz ball.
Over the following weeks I noticed my hamstring mobility improving – I actually reached a point where I could touch my toes with locked knees – never been able to do that in my life! Un-weighted, stiff-legged deadlifts in front of a wall seemed to really help stretch out my hams. Foam rolling got progressively less painful, and I became a strong believer that it does actually accomplish something beneficial – it seemed to really work away some of the angry spots in my calves. It’s really hard to say for sure, but the heel pain did seem to subside a bit as I headed into Spring 2012.
Another thing worth mentioning is that in January of this year I started taking Taekwondo classes with my kids. Taekwondo is great for improving flexibility and strengthening the feet and legs. It’s also great for improving balance. We always practice barefoot, and much of the class involves standing on one foot. Again, I don’t know if this helped, but it’s a factor worth mentioning. I also played around a bit with using Therabands for foot strengthening, as well as an AFX Foot Strengthener, which is an interesting device. I’m really lousy when it comes to following through on home strength work though, and given that Taekwondo was a scheduled class twice per week, that was my most consistent outlet for strengthening exercise.
Move the calendar forward to July 2012, and I embarked on the two most intense months of running I have ever undertaken (monthly mileage PR’s in both July and August). And, rather surprisingly, my increase in mileage coincided with a complete cessation of my foot pain. My feet still felt a bit tight when I first woke up (and they still do), but no pain to speak of, and nothing at all during the day or on runs. The lingering pain at the insertion of my right abductor hallucis muscle disappeared as well.Three months later and that’s where I am now – pain free and still not quite sure how I got here.
Lots of people will claim to have the answer to curing plantar fasciitis. I will make no such claim. All I can say is that the diminishment and ultimate cessation of my pain seemed to coincide with three things – starting Taekwondo in January, being treated by Brett and following his advice in the winter through early Spring (mostly for calf work after the initial few appointments), and ramping up my mileage from Spring into summer (2011 was a low for me running-wise – many weeks with only 10-15 miles max). I don’t know which of these factors, if any, was most important in fixing me (or if all played a role), but let me wildly speculate for a minute (this is, after all, a blog and not a medical journal, so I’m allowed to wave my hands around a bit here).
Here’s what I think happened. I started running minimalist in 2009. As it does for most people, moving to low drop shoes, particularly zero drop, non-cushioned shoes, resulted in a lot of initial calf soreness for me. I had sore calves for a long time, and I never did anything to take care of them. No stretching, no foam rolling, nothing. I think that as I accumulated more and more miles in flat shoes my calves got progressively tighter and tighter. Then, I ran a hard marathon training cycle in late 2010, with two hard-effort marathons in late 2010. I think the progressive battering of my calves for over a year combined with those races (and the preceding intense training) may have triggered the pain in my feet. I continued to do nothing to take care of my legs through 2011 (short of being in flat shoes all day to keep my calves from shortening up), and my mileage diminished considerably so there was less positive stimulus for repair. The pain lingered.
As I moved into 2012 I began doing intensive strengthening and flexibility work on my feet and legs in Taekwondo, then added to that by seeing my chiropractor and following his treatment plan. The calf foam rolling worked wonders, and continued flexibility work helped as well. As my calves loosened up, they pulled up less on my calcaneus on each side and eased some of the strain on the plantar fascia below (the tissues are all interconnected). My calves no longer seem to get sore when I run zero drop now, so that is an added bonus. Then, as I increased my mileage I kept a good positive repair stimulus going and kept the blood flowing well to the damaged regions of my feet. Repair occurred, and the pain went away.
The above story sounds good, but it’s just my speculation about what worked. One of my goals in the future is really to dig into the literature on specific running injuries and summarize what we do and don’t know (I hope it doesn’t lead to another book…).
If I had to give advice to anyone dealing with chronic plantar fasciitis it would be to not focus solely on the feet. Consider your calves, as well as regions higher up in the leg. The pain in your foot may simply be a reaction to a problem somewhere else (e.g., incredibly tight calves from going minimalist without any attempt to maintain tissue quality in transition – I’m a disciple of Jay Dicharry in this line of thinking, read his book!).
If you have tight calves, get a foam roller – I really have become a believer in what they can do with regular use. I’ve come to believe that a foam roller should be mandatory equipment for anyone planning to go minimalist, particularly if your goal is to go zero drop. You need to take care of those legs in transition! Do as I say, not as I did – I hope people can learn from my mistake :)
I also think that being in zero drop shoes almost full time prevented progression of my pain into something more severe. Pain occurred for me immediately after any time I relaxed my calves for an extended period of time – at night while sleeping, in the evening on the couch, etc. Wearing flat shoes all day helped to keep my calves fully lengthened while standing and walking, whereas a heel lift would have shortened their working range during the day.
And don’t think that treating pain always requires rest – my pain went away in concert with the biggest ramp-up of mileage in my life! Rest can definitely be helpful in overcoming acute pain, but it doesn’t necessarily resolve the underlying cause – you need to get at the root of the problem if you want long term resolution of the issue. Again, for more on this read Jay Dicharry’s book.
Most importantly, don’t despair – my heel pain, though never acute, lasted for upwards of 16 months. But it’s now gone, and I just ran a half-marathon PR last weekend. There is a light at the end of the sometimes very dark plantar fasciitis tunnel!
About Peter Larson
“Plantar fasciitis is caused by weak feet”, a scientist we both know once told me. Sounds very consistent with your experience and resolution.
I had a similar experience, but it went away on its own, without intervention from a foam roller. But I did do a bit of stretching and constantly wore minimalist shoes. Running up hills also seems to help a lot, I suspect, as you note, because it stretches the calves and hamstrings.
Tuck,
I agree, I think the key point is to not focus only on the location of the pain, but also higher up the chain.
I used to suffer from plantar fasciitis for around 10 years so I can relate to people who have it. No medications or treatments ever really did anything for me (I tried them all haha) but I was actually able to completely cure plantar fasciitis naturally after countless hours of online research. What worked for me:
1. Roll a frozen water bottle under the arch for immediate pain relief, though this is more of a pain reduction rather than a treatment.
2. Follow every step in the free video & in the guide seen at http://curehealthproblem.com/plantarfasciitis to get to the root of the problem in a NATURAL way. This is the important bit!
3. Take Bromeliad supplements. Bromelain should be used in place of nonsteroidal anti-inflammatory medications during the post-acute phase of plantar fasciitis to help reduce any inflammation. Before taking bromelain for your plantar fascia pain, meet with your doctor to discuss possible side effects and proper dosage.
Try all those three steps together and hopefully you will get as much luck with getting rid of plantar fasciitis as i did. Just stay confident as this condition does not have to be permanent. Sorry if I rambled but hopefully my comment will be of use to others
Hi Asian girl in the comments below (sorry I don’t know to say your name), I just wanted to reply to give you a massive thanks for your advice on this post! I went ahead and followed the full guide that you linked to at http://curehealthproblem.com/plantarfasciitis and in less than a month my plantar fasciitis has almost completely disappeared. I wanted to show my gratitude for your comment as I have been suffering with plantar fasciitis persistently for many years and I never would have known I would be able to get relief from my condition as much as I have done already
Sounds alot like my experience. First when I started to massage the calves – especially Tibalis Posterior and Soleus – did the pain in the foot become better. Agree 100% with your conclusions.
Pete, I found this article interesting. Some of the symptoms, vis-a-vis tight calves, parallel my experience since going to the Kinvara 3s. I also now wear a second pair of Kinvara 3s as my general “walk around” shoe, which I think has helped, as compared to wearing a more traditional running shoe when not training.
I get 90 minute deep tissue massages every two weeks, which focus the majority of time on upper legs and calves. We are members at Massage Envy, so the cost is acceptable and those seem to be helpful.
I also started using a firm OPTP foam roller a few weeks ago to aid in between the massages and that is also helping.
Time will tell, I suppose, if this generally gets better as my body accommodates the training and whether or not I experience a similar transition if I shift to the Virrata when it become available early next year.
Thanks!
Well this helps answer many questions for me, but none about Plantar Fasciitis :) I have been running short distances for the last 6 months in a more minimalist style of shoes. I had an achilles problem that I couldn’t seem to shake so I decided to give this route a try. Good news has been no Achilles issues, but my calves have been sore, very sore. I assumed it had something to do with the lower drop in footwear, but wasn’t certain. After last week I was so tight that I had my wife roll out my calves. That was quite painful by the way. This week I head out on on my first good run in quite some time. I hadn’t yet put two and two together, but with hearing your feedback on what has helped you I will keep the calf rolling on a regular schedule.
Pete,
I had the same problem three years ago. I solved with physiotherapy and also rumble roller at home. In my case, however, I was able to isolate the cause, in terms of shoe pattern. It happened when I used to wear Nike Vomero. I sold all my pairs, started to use a (almost) zero drop shoe, a forefoot strike and the problem almost dissapeared. Now it just happens sometimes because of the shoe I use to work (kind of a derby shoe). In any case I just use the rumble roller and in the next day I am OK.. Incredible the power it has in my case. I am happy in that the problem has not prevented me from running in the last 3 years.
I am happy that you were able to solve your problem. Incredible how any case is different from another. It is difficult to create a pattern to study. All that our cases have in common is the use of the ramble roller to help solve them.
rgds
Sergio (Brazil)
I had very similar experiences. One thing I’d like to add is that high weight leg presses also helped strengthen the whole posterior chain.
You mention you wear zero drop shoes at work. What do you wear? I am a big fan of Vivobarefoot Ras.
I can get away with running shoes most days, so I have a lot of options, but for dressier attire I go with wither the Merrell Tough Glove or Vivobarefoot Aqua. Also have a pair of the Merrell Edge Glove, but not sure if they still sell those. I’ve heard good things about the Ra, need to get a pair.
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
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Thanks! I’ll give them a look. The Ras are great with a sportcoat, button-down oxford and chinos (my usual work clothes).
I had low level PF for almost 2 years, never bad enough to keep me from running, but certainly uncomfortable in the mornings (especially mornings after races). I was doing the full spectrum of rolling, stretching, massaging to keep it at a low level. And then earlier this year, I got lazy. I stopped doing anything specific for the PF, and it didn’t seem to get any worse. Like you I did ramp to bigger volumes earlier this Summer (started running more back to back days and more days per week). And somehow, like magic, the PF just melted away. I’ve been pain free for several months now. Was it the volume increase? Or just adaptation over time (it had been almost 2 years after all)? I’ve been running in moccasins and barefoot for the past 2 years, so I thought my feet were pretty strong. Maybe not. It’s a big mystery to me. I’ve been meaning to write my own blog post about it. Maybe I will soon.
I had also Plantar fasciitis for a year (more or less) in my right foot, and I didn´t get any massages or did special stretches, with or without foam roller. I´ve never gone to a doctor (because I was hopping it would disappear by itself but it didn´t). Reading about barefoot, I discovered a way, not only to mitigate the pain when i get up in the morning, but a way to drop the pain. The solution for me were in the tip of the toes. This is what I did (what I do): when I was in pain, I shrank the toes. When I walked, I pressed the toes against the ground, in order to take the main friction with them. I made the toes actives actors of the motion of the foot. That really helped me. It´s not magical; it didn´t work promptly, but it worked.
Prove it. And forgive my English.
Saludos.
Sounds like this may achieve a similar goal as the towel scrunch exercise: http://www.youtube.com/watch?v…. Thanks for sharing your story!
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
Facebook: https://www.facebook.com/Runbl…
Great post, Pete! I have had the same pain many times (this morning, for example). The return of the the pain corresponds to my complete failure to do any kind of strength and rehab in the last few weeks.
For getting rid of it, I find that balancing on tiptoes and walking like that a bit can be helpful.
Are you familiar with slacklining? It’s an easier version of walking a tight rope. I haven’t tried it yet, but a lot of elite ultra/trail runners do it for crosstraining. It would obviously benefit strength and balance.
Have you ever tried the Healthy Toes toe stretchers? I read about the product in 4 hour Body by Tim Ferriss. The product claims to help with plantar fasciitis, among other running-related injuries. What do you think about the merits of this product?
Haven’t heard of those unfortunately.
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
Facebook: https://www.facebook.com/Runbl…
Great post Pete. You certainly do exhaust all the science behind equipment and injuries. I have certainly come to realize the merits of foam rolling and trigger point therapy in these and other injuries that seem to affect athletes like us, especially as we age :-). Flexibility decreases and we become more injury prone. For me the plantar fascitis and post tib tendonitis is also weight related as it comes whenever I venture over 200 lbs. Below that my body just feels better. Great job on the research and explanations.
Thanks! Didn’t even think about the weight issue – lost almost ten pounds this summer, so wonder if that had an effect as well…
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
Facebook: https://www.facebook.com/Runbl…
Pete, what do you think about the theory linking plantar fasciitis with the narrow shape shoes force our forefoot into? I believe a doctor on Running Times has written about it. The theory goes that narrow shoes, and the resulting change in foot shape restricts blood flow. Perhaps there are many factors and affecting different people differently. PF is the one pain I have not experienced over many years and marathons (knock on wood, knock on wood!!). (btw: I have the forefoot of a duck – wide like flippers!)
Lots of people have theories about what causes things like PF – my guess is there can be multiple causes leading to the same set of symptoms. I doubt this was the case for me since I had been in wide shoes for over a year before the pain started. But that’s not to say it couldn’t explain things in someone else.
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
Facebook: https://www.facebook.com/Runbl…
Pete, loved your story. I have exactly the same kind of heel pain on the right side for about 6 months now. I don’t miss any of my runnings -including the weekly long runs- because of it but still I’d be happy if it goes away. I have a broken ankle above that heel and I think it has lost some range of mobility. I run mostly in Altra Intuition and Nike Free 3. I’ve been going minimalist since end of 2010 but this pain has appeared only recently. However, I already do regular self massage to my calf and my foot, I do Ashtanga Yoga 5-6 days a week which really works very well as a strength&flexibility tool for all my body, but I cannot say that I win the battle with my heel pain yet. I hope that one day it’ll happen. I will follow your advices.
Thanks for the post!
Plantar “fasciitis” is a tricky thing. The pain may result from different sources in different people, and in some cases may actually be entirely unrelated to the plantar fascia. I avoided discussing this in the initial post to prevent it from getting too long and complex, but plan to discuss more going forward.
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
Facebook: https://www.facebook.com/Runbl…
Happy to hear your running feels so much better now. Nice, interesting and honest post. Now hold on to that. Jacky (Thjeko)
BTW; By “hold on to that, I meant injury free running of course (-;.
Hi Pete, your experiences with PF sound similar to mine with Achilles tendinitis. While I think moving a bit quickly to lower drop shoes was a cause of the tendinitis, I soon found that spending a lot of time barefoot felt better than walking around in traditional shoes. After returning to running, I then found that 4mm drop shoes felt better than 10mm drop shoes, and my calf strength continued to grow. Active isolated stretching and foam rolling were also critical, and my chiropractor told me that increased mileage would help thicken the tendons and make the damage less impactful. This is a great article that I’ll definitely bookmark to share with my clients; I already promote calf-strengthening exercises when they face PF symptoms.
Thanks Greg!
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
Facebook: https://www.facebook.com/Runbl…
I was hoping that you’d post about PF. I have only had PF for nine weeks now and like you have been able to continue training but have generally been more conservative with my training to avoid making them worse. The fact that you’ve upped your training load and injury has got better is encouraging, but of course judging which side of training enough to get better but not so much as to cause further injury is going to be a very personal balance to strike.
On the support side for training more approach, I’ve now down two marathons since developing PF, one early one – about week into having PF, and one just yesterday. On both occasions my PF was sore during and directly after the marathon, enough that I worried that I had made the injury worse, but in subsequent days found less problems that before the marathons. This make me wonder if breaking down scar tissue in the plantar fascia or calves might an important part to healing the injury.
On the tight calves front I believe that in the previous two years I had far more problems with tight and knotted calves but no PF problems at all. This year my calves have largely calmed down, have been supple and have retained a good amount of flexibility.
What seemed to tip me over the edge seems to be running a hill race without any hard hill runs before hand, I think the ascents running uphill entirely on toes for tens of minutes followed by 5 min/mile descents down stony trails just overloaded by calves and in particular my feet. The PF didn’t appear properly till a few days later, but right after the race my feet were generally sore but once I loosed the laces on my shoes the pain went away so I thought I had got away with it. Running races over open hills requires lacing up shoes pretty tight to avoid slipping within the shoe over the broken ground.
I too have been using a foam roller on my calves any time they feel tight and knotted and I believe it has helped. On a recent visit to my Physio she recommend that I don’t use the roller if I’ve just pulled a muscle, instead wait a couple of days for the body to start knitting the muscle tears back together. She said the repair process involves a temporary shortening of the muscle fibers around the damage area to protect and allow it heal, trying to over massage the region right away would interfere with this process. So short term tightness/knotting right after a pull one should hold back on the foam roller, but after a few days one can start introducing it to stimulate blood flow/ease off muscle fascia/break down scar tissue.
Hi Pete – I’m a new follower, and really enjoyed your post on PF. I’ve had a chronic case of PF for many years, and just recently overcame it with lots of stretching of calves and hamstrings. I agree with you that stretching out the entire leg is critical for resolving it. Thanks for the great information!
Congrats on battling through! PF is a tough one to get rid of.
Thanks Pete for the timely message. Your story is incredibly similar to mine, except when my kids go to Tae Kwon Do, I go to run more at the track:)
I am in the middle of treatment now that involved a cortisone shot followed by PT. The PT work is starting to pay off. Especially doing front and side lunges on the Bosu ball.
On Friday, I am going for some analysis with a trainer that did a Dartfish analysis- slow-motion video from 4 angles. Will let you know when I get some good still images of my foot. In the problem foot, I land on the outside edge of the foot and roll extremely inward, while the other foot lands flat.
I was wearing minimal footwear since 2010 (Kinvaras). I never had a problem, but now that you mention it, calves were always really sore to the touch. I also think one of the major contributors might be that I have really high arches, and my right (PF) foot is smaller than the left. I always feel the right foot smashing around the shoe.
I have shifted to wearing a higher drop shoe NB 1400, and that has seemed to help. I also have been using off the shelf orthotics that are heat moldable, but only in my non-running times. These inserts produce improvement from the first wearing.
I have not completely tackled this problem yet, but believe I am on the way. I am hoping to run a marathon in Maine this weekend hopefully mostly pain free.
i highly recommend that every person living or at least a family buy Clare Davies “Self Trigger Point Therapy Manual 2nd Ed.” i used that a long with Dr Stoxen’s techniques on getting rid of my PF. you’ll also get more bang for your buck if you go to a big box store and buy a 4″x24″ pipe instead of a foam roller. you can get one for about $10.
Pete, glad to hear you won the battle. You hit many of the areas I would treat on my patients. I would also recommend getting a FMS done by a certified movement specialist and thesock.com. I have all my plantarfasciitis, Achilles patients wear them at night.
I just attended an FMS certification workshop, good suggestion!
Sent from my iPad
What was your score? You didn’t get the sock? It’s a very effective treatment for heel pain.
I think I scored a 17. Not bad. No sock for me, never felt it really warranted that.
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
Facebook: https://www.facebook.com/Runbl…
Pete, is there a particular type of foam roller? I hear people talk about them all the time, but I’ve never thought of getting one. I have very tight calves but havent had any PF issues yet. Maybe I should get one just for good measure… @Oblinkin:disqus
Not, any firm, cyndrical structure will do. I’ve even used a kitchen rolling pin before getting the roller to roll out my calves. A large PVC pipe can also work. I need to shoot some picture is my technique.
Sent from my iPad
It is interesting that you say your pain decreased as you increased your mileage. I had a similar thing happen with an injured hamstring (a cycling injury) and as I increased mileage on the bike, among other things, it improved much quicker and I was able to complete my 1/2 IM race injury free. Great article.
Thanks, I’m starting to see more and more people moving away from the rest is best mentality for some injuries. The old “RICE” acronym is being replaced in some professional circles by “POLICE,” where the OL replaces R and means optimal loading instead of rest.
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
Facebook: https://www.facebook.com/Runbl…
Pete.. some thoughts that may or may not be of value. I am currently in the middle of a study into plantar heel pain, and there have been some interesting developments. We tend to regard the pathology as being similar to tendinopathy,i.e, at biopsy of presumed cases of plantar fasciitis, there is no inflammation, so it cannot be plantar “facsiitis”. Many are suggesting the condition be renamed plantar heel pain syndrome or something similar. There have been some MRI studies showing bone marrow oedema, which raise interesting questions about what this condition really IS. The assuption has always been that this is a traction injury, with the fascia pulling on the enthesis (attachment into the calcaneus), under load, and this being especially exacerbated if the foot is pronated. This has little support in the literature. In fact there seems to be little evidence that either arch profile or a pronated foot plays a part in the genesis of the condition, but strong support that these two issues may exacerbate the condition once it is present. Whatever, it seems very clear that traction is not the key issue, and that compression and shear are at least as, or more important. Intriguingly, the role of the plantar fat pad is now being explored, and there is strong evidence that the energy dissipation ratio (EDR) of the plantar fat pad is reduced in plantar heel pain sufferer, and this may be an issue. The EDR is determined via ultrasonography, and it is important to clarify that we are not talking a change to the thickness of the plantar fad pad, but a change to the way it attenuates impact. This fits in with the demographic for PHP.. fifth decade plus (which you do not fit), where the material properties of the plantar fat pad would change through loss of H2O in the ground substance of cells. Anyway.. this presents interesting prospects for how the condition should be treated, with very few of the “recognised” treatments having evidence via an RCT. De Guiliani’s method of stretching the plantar fascia by dorsiflexing the hallux is one of the few that does have such evidence.
Bottom line is that of all the risk factors for “plantar fasciitis”, you have only one: Distance running, so it is entirely possible that the diagnosis is not actually “plantar fasciitis, but something else. This would depend a lot on the symptoms, but a simple ultrasound study would probably have put it to bed.
I agree with your assertion that it is wise to “lift the eyes” from the foot. This was demonstrated to me years ago when I had a fellow in with “plantar fasciitis”. There was something nagging me that made me think there was something atypical about the presentation. I could not pick it. He was a big bloke, about 6’7. He told me that along with all the other things that worried it (including running), strangely, getting in and out of his car caused him grief. We went out to my car park where he had parked his car. It was a Mini.. old school. I asked him to demonstrate. He got into the car, and with great difficulty swung his leg over the sill to get in, whilst bending forwards at the waist to clear his head…”there” he said..”that’s when it hurts, and getting out too”. He was of course slump stretching with a straight leg raise as he got into the car, and his problem had nothing to do with his heel, although it was copybook “plantar fasciitis”. His problem was neural, and no amount of foot treatment would have helped him.
Ignore the proximal structures at ones peril!
Interesting post as always.. best.. Simon
that either arch profile or a pronated foot plays a part in the genesis of the condition…. make that NEITHER.. not either!
Simon,
Thanks for your input. Much as I’m always hesitant to use the word “pronation” since it has different meanings to different groups (e.g., clinicians vs. runners), I was also very hesitant to use the phrase “plantar fasciitis.” I toyed with the idea of calling it plantar fasciopathy to recognize the typical lack of inflammatory processes in all cases, but since runners use plantar fasciitis as a catch-all phrase for heel pain I opted to go with it – it’s a challenge in writing a blog vs. a scientific paper!
So, you are very much correct that I very likely did not suffer from “plantar fascitiis.” I’d even go so far as to agree that my pain may have not have even involved the plantar fascia. There were many times where I though it might be referred pain from somewhere else (e.g., perhaps trigger points in the calf) or perhaps a bony problem. What I do know is that pain was typically triggered by two things – walking in a hard heeled shoe (compressive force), and prolonged relaxed plantarflexion of the foot (e.g., sleeping, lying on a couch). I also know that soleus stretching seemed to almost immediately alleviate pain in the morning, and that my soleus muscles had gotten very tight from moving into flat shoes.
As you point out, and as I hammer into my students frequently, it’s always important to remember that a common set of symptoms may have multiple underlying causes, so for many conditions effective treatments may vary widely among individuals. This is why dogma is such a problem, it often ignores the need to consider the individual on a case by case basis.
Pete
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Very interesting topic. I am a physical terapist(not working as) running a running specialist retail in Norway. I run quite a lot, compeeting both running and cross country skiing(therefor less running in the winter). A few years a go I was trubled by plantar fasciitis for about a year. The same expirience as you. Pain in the morning, and the first minute of running, but no problem doing my pland trainingscedule. I did nothing to treat the problem(after all i am a pt, so I have litle belife in treatment:-)), but could clearly recognise that the more I ran, the less pain I felt. When I had a cople of weeks only doing cross country skiing, the pain realy aggravated after the first cople of running trips. So steady running(daily) was deffinitly the best medicin.
So, this summer I had a new interesting expirience. After four days of a row competition, I got some light irritation(maybe inflamation) in the tibialis popsterior tendon, right below the malleol. Nothing stopping me from training. But at the same time I went on a holliday in Spain. The terrain was realy steapy, so there was a lot of uphill running. After a couple of days, I felt an intense, suden pain while walking barefoot on the beach, exactly like havin plantar fasciitis. Distinctly located medial, anterior calcaneus. I understod it had to be a part of the same problem I had with the tibialis posterior. And, looking back, the heelpain vanished when I came home, but after a week or two I got severe pain/soreness deep in my calf, related to the tibialis posterior. It was a triggerpoint that I got rid of just by selfmassage(frictions) a couple of times.
This might not be any news, but I think that problems(overuse or to weak) with tibialis posterior(tendon or/and muscle) often are diagnosed plantar fasciitis.
Sorry for my bad English spelling.
Great comment, and I agree completely. I still am not entirely sure that my problem had anything to do with the plantar fascia. I recall very clearly working on some angry spots in my tib posterior earlier in the Spring, and made some excellent progress on them via self-massage. This now has me wondering since our symptoms are so similar…time to do some reading!
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Pete Larson’s Web Links:
My book: Tread Lightly – http://ow.ly/bdUO0
Blog: https://runblogger.com
Twitter: http://twitter.com/oblinkin
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I really enjoyed your post and I agree in your strategy for the injury: find the problem behind all the symptoms. Very often we runners forget that to run injury free you should take care of all your body: strong core, strong legs and so on…
I’m in the middle of reading Jay’s book at the moment. Very refreshing. I’m learning a lot and I can highly recommend it. I have not beat my PF yet but I think I’m getting closer!
Great story man, I’m glad that you recovered. This really tells us how important chiropractic care is.
Hi Pete,
Like in your case, since last December, I too am struggling with a self-diagnosed case of plantar fasciitis. It hurts more persistently and more intense after my speed workouts and after my long runs – in such circumstances, I can feel annoying, but still bearable heel pain throghout the entire day. It also hurts, but less intense, when I get out of bed and after I sit for longer periods of time with my feet in dorsiflexed position. In these latter cases, pain only subsides for several minutes after I start walking. My (self-diagnosed) PF is, however, not preventing me from running.
It’s important to mention that I started feeling pain under my heels after I dropped my custom orthotics and started rotating more pairs of different running shoes during my predominantly speedier workouts – from traditional lightweight, neutral trainers (Nike Pegasus 29, Adidas Adizero Boston 3) to shoes with lower offset (Saucony Ride 5, New Balance 890v2, Saucony Cortana, Saucony Kinvara 3). The custom orthotics were prescribed following a first gait analysis I did one and a half years ago, which, amongst others, revealed that I am a mild overpronator.
I must confess that I read an awful lot about running and decided to drop my orthotics after reading all the recent stuff which advocates that the concept of overpronation should be banished and all support shoes should be thrown in the trash can, and that, in most cases, orthotics make your lower leg muscles lazy and, unless you’re a heavy overpronator, you should not wear them if you want to have strong legs. Also, more recently I did a second gait analysis at another lab, which, while confirming that I am a mild overpronator (due to my knock-knees), also revealed that, during the dynamic mid-stance phase, my “valgus” leg axis and overpronation is largely neutralized. The recommandation was that, while I can still wear those custom orthotics, dropping them would most likely do not make me any harm. Given the above information and recommendations, I did decide to drop my orthotics in October 2012.
Ok, maybe I fell (again) in the “too much, too soon” trap. As my legs felt lighter and good without those clunky orthotics, I started running faster and felt great until, at the end of November 2012, I started feeling heel pain in both of my feet. I did a lot of stretching, foam rolling, spikey ball rolling and icing and, while the pain eased after these exercises, after my speedier or longer runs, it reappeared in full force and persisted throughout the day. Well, I found out lately that the only effective way to considerably alleviate such pain was to put those orthotics back into my running shoes!
Whilst I do want to completely elliminate the orthotics some day in my quest to have stronger feet and run in lighter shoes, I do feel – at least at this stage – that they are helping me a lot in recovering from PF.
As you can see, the information which is based on what I’ve read or what I’ve been told versus the information based on my own experience with orthotics is quite contradictory and confusing. Was my PF caused by dropping my orthotics or rather by the specifics of my workouts I did for 2 months (i.e. predominantly speedier sessions, from 3 to 8 miles; no orthotics; including, as mentioned above, some lower drop shoes in my weekly rotation without a real transition to minimalist running, altough my calves felt fine afterwards)? I would say both, but I would be grateful to have your opinion on this and on what to do.
Many thanks!
Seb
P.S. I’ve also put the same question on Jay Dicharry’s blog, I wonder what he thinks about this. :)
PF is a mystery to me, seems to hit lots of people in lots of different shoes and even lots of non-runners. Heel pain is quite possibly a symptom with many different causes – for you it may have just been the change from what you had grown used to – foot gets stressed in a different way that it doesn’t like. I’m an advocate for doing what works – if you can run without pain in orthotics, go for it!
For me, I seem to get the heel pain when I’m tight, particularly in the calves. When I run a lot and stay loose it seems to go away. I suspect mine has nothing to do with the plantar fascia and more to do with my calf/Achilles yanking up my heel bone and maybe tensing one of the nerves that passes under there. Hard to say, but fortunately doesn’t bother me enough to stop me from running.
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Yeah, I’ll stick to the orthotics and try to incorporate some lower leg strength training in-between. Thanks for your input, Pete!
on http://gttechandinfolit.blogsp… it says that there is a diffrence between plantar fascitiis and heel spurs my question is can you get one but not the other?
There are lots of possible causes of heel pain, and some would say that plantar fasciitis is actually a misnomer since there is often no inflammation of the PF. So yes, I would say that you could have heel pain without bone spurs
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I suffered PF on an off (mostly on) for 12 years. Finally, after 12 sessions of graston technique with my chiropractor, it is gone. But I’m still trying to be vigilant in preventing it. I’m thinking of moving to minimalist shoes, and the foam roller sounds like a good idea, as I know that my calves already get too tight in my “normal” running shoes.
anyway – thanks for the post.
Thanks! I’m not a minimalist runner, but a new runner. . . (last few years, and I’m almost 50). When I do long runs, I am plagued with this pain. I’ve started yoga, but am not up to down dogs yet (bike wreck/separated shoulder this summer), so I cannot get that intense stretch. Wall stretches, as you suggest above, as well as the ice in the pepsi bottle and the tennis ball have helped some–but I will absolutely try the foam roller on my calves. Perhaps I should stop wearing my two-strap birks that cause me to overuse my calf muscles all day long, too, huh?
Thanks for an awesome post. I REALLY appreciate it!
My friend TryGrandmatri send me over here. Glad she did!
(promisetodad.wordpress.com)
Thanks Sandra, good luck battling the PF!
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Great post. I have suffered similarly recently when I decided to go for zero lift shoes. I did not suffer as much as you though, probably because I have always done plenty of stretching exercises and have done since my early teens when a physiotherapist told me to do them.
I also agree that you should be concentrating on keeping your calf muscles in good condition as they take the most strain when you are running, especially when you are running properly and not landing on your heels. Keep your calf muscles happy and you will keep the chances of injury down to a minimum.
Over the last 40 years of running I can only think of one running injury above my knee, and that happened at the start of a 100m on a cold night. All of the other problems I have had, even when I was sprinting and hurdling, have been in my lower leg.
So important to not JUST focus on the foot. Also in both my personal experience with plantar fasciitis and clinically with my patients, Active Release Techniques is the way to go. I filmed a video about how plantar fasciitis is treated with ART which can be found at: http://www.riverstonechiropractic.com/2013/12/plantar-fasciitis-treated-with-active-release-techniques/
Sandy,
I actually work in a chiropractic clinic where ART is used frequently. I do think it’s something worth trying for PF.
Pete
My doctor recommended a golf ball muscle roller which i use before and after i run, wow what a difference!! Everyone runner needs one,night and day difference! http://zzathletics.com/Golf-Ball-Muscle-Roller-Massager-GBMR1.htm
Great advice – I have friends who have used insoles and light stretching to help cure plantar fasciitis. Here’s a link to a great orthotic insole site with more information about PF.
I had Plantar Fasciitis for over a year and tried many things. The Medicovi Twin-heels are the only inserts that have helped and I can be on my feet all day and the pain is gone after just using them for a few days. Even the pain in my calves and upper leg and lower back are no longer there. I really recommend them.
Thank God for this post (and thank God for giving the author a lot of motivation and determination to write and publish it.) :)
Since I started running I’ve gradually moved from 12mm drop, to 8mm and eventually 4mm drop shoes. 4mm drop feels so natural on my foot. I’m using Saucony Kinvara 5 and Saucony Type A6, both 4mm offset. But recently I decided to give another try a shoe that I’ve used before, Mizuno Wave Sayonara. (I’ve used it with much success, but due to change in drop I haven’t bought another pair since I got my Saucony’s.) So I got myself a pair last month because they were being sold at half price as part of a clearance sale. Little did I know that I will get terrible plantar fascitis out of it because my feet have been used to a 4mm drop (Kinvara and Type A) for the past 2 years and then suddenly running on a 10mm drop shoe (Mizuno Sayonara). And now I’m fighting with pain under my foot in the morning as I take my first step, and on the outer part of my left calf as the day progresses. I stopped using the Mizuno and got myself a new pair of Asics 33FA (4mm drop) to rotate with my Kinvaras and Type A. Never again will I use shoes higher than a 4mm drop.
I had Plantar Fasciitis for over a year and tried many things. The Medicovi Twin-heels are the only inserts that have helped and I can be on my feet all day and the pain is gone after just using them for a few days. Even the pain in my calves and upper leg and lower back are no longer there. I really recommend them.
Hi Pete,
any updates on PF? Did it ever come back? I am asking because from what I know PF is a chronic condition that goes away and then comes back in irregular patterns. I just wanted if that’s also the case with you regardless of a success described above or did it really go away forever in you case? Seven years should be long enough period for testing :D
Nope, never came back :)