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Plantar Fasciitis Running Down Options

I have had a nagging bout of plantar fasciitis since May of 2017.  It resulted from an increase the volume of speed work in my wko's.  I immediately rested it for a week and then started a run walk routine with little success in eliminating the symptoms. 

I read through all of the PF threads on EN and a number of websites online.  In all of the articles and posts I read, each had a different experience, but the consensus I gathered is that: stretching exercises and rolling of the PF is the way to go and that the symptoms will eventually go away.  So, I did these and put off seeking medical attention. 

By August, the PF pain was constant, except when running.  It didn't hurt when running, just afterwards.  I stopped run/walking completely for 6 weeks, though still cycled.  The PF symptoms did not decrease.  At the end of September I saw a Podiatrist, who recommended off the shelf orthotic inserts and a cortisone injection.  I got both.  Post injection, I took another four weeks off from running.

I resumed run/walking 1'on/1'off, in November.  On my third wko a 2 mile wko and a day at Disneyland, the symptoms returned.  Back to the Dr. and a second injection.  After another month of rest, the symptoms appeared again after run/walk number 4.  

The Dr. Rx'd intensive PT, of which I am not in my third week: ultrasound, scraping, taping, strengthening exercises and icing.  The symptoms are not getting much better as the PF pain is constant while just walking. 

I am looking ahead at potential Tx options as these options are narrowing down into the realm of surgery.  I see the next steps as getting an x-ray to see if there is a bone spur causing the inflammation and potentially an MRI.  

If you've read this far, my thanks go out to you.  My question is in regards to the efficacy and recovery from surgical options in the event that PT isn't effective.  I am not relishing the idea of a potential surgery followed by months in a boot, but things aren't great now either.  
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Comments

  • @Phil Mills I don't have experience in this area, but I sure wish you a speedy improvement.  
  • edited March 27, 2018 12:32AM
    @jeff horn thanks. I certainly hope so too.
  • Phil,
    I had an issue similar to yours that lasted nine months. I had everything
    you did plus:
    Off the shelf night splint purchased from amazon.
    A week of oral steroids
    About seven rounds of dry needling- I think this was the key
    And stretching- 30 seconds calf, bend ankle for 30 seconds of Achilles on
    both sides. Then 10 reps of heel raises- up for 2 seconds, down for 5, with
    the horizontal point being at 3 seconds. Work up to 3 sets of this stretch/
    heel raise
    Also- use a tennis ball to find points of maximal tenderness on calf. Jam
    the ball in there and then flex ankle back and forth 15 times.

    No running until you are pain free upon morning rising and walking. I’d
    give it a good three months.

    The Stretching and dry needling is the key.

    Good luck.

    Leslie
  • I second the dry needling.

  • @Brenda Ross & @Leslie Knight - Interesting on the dry needling.  It is the one suggestion that I have not tried yet.  Thank you both.

    Acupuncture is also on my list, along with a MRI.
  • It takes time to recover from plantar fasciitis, me 6 months.

    I used all the time shoes in my home and sleep with Strassburg sock.

    Did you using your toe to push when you walk or running? If not, you must! (I got my plantar fasciitis because this).

    Orthotic insert, I use to used it too, not any more, the arch is spring to help you with running fast and orthotic just stop it…

    I also got “gift” from plantar fasciitis- Heel Spur, last year I start to have heel pain after run, I start to  soak my foot in hot water with salt and tea tree oil (EPSOAK) every day and pain almost gone (planing to do it after every run when I recover).

    I’m using one Advil on long run (planning to stop when pain gone).

    After every run I’m using Penetrex to message my back leg (Achilles and calf).

    @Phil Mills I like dry needling, I do it about every 4 months or when I start to have pain (shoulder or foot/leg), It helps me to recover very fast with most of the time, like @Leslie Knight say it's the key.

    Good Luck, we all getting time to time some issue....

  • I forgot that I also did acupuncture. It helped for about four hours. I’ve
    tried it for other stuff and don’t get long term relief (days), but I know
    people do. I think it’s worth a shot.
    Leslie.
  • @Phil Mills, On your stretching, have you concentrated only on the foot/ankle?  
    I just am now recovering from an achilles tendonitis problem that had me out of running for 2 years.  It presented a lot like PF.  For the last 2 years, all of my stretching/strengthening was focused on the achilles/ankle, and didn't really help. 

    About 2 months ago, I changed my stretching/strengthening emphasis to the upper leg and lower back, especially the hamstring.  I continued to stretch out the achilles, but totally kept it light and avoided over stretching the achilles.  I noticed that any time my hamstring was tight, the achilles would hurt.  So after every run/bike, I spend a bunch of time working on that hamstring.  I'm back to running now, but have to be super careful with it.  My ramp up is very slow, as is my pace.  But I'm happy with my stretching, and my mom still loves me, so that's something.  
  • @Chris Davis I am curious where your pain was and how it presented, specifically.  Did it start on the back of the heel, and hurt like shit in the morning (like PF)?  Did you have insertional achilles tendonitis?
    Since wishing @Phil Mills well in the above post, I am getting plagued by this pain as well.  Had been getting better after about 15 min of walking in am.  Now it is there all day, and can certainly feel it during runs.  Did 10 miles Sunday and now feels like I am getting PF as well on the underside of the heel.   I have been stretching, rolling and starting night splint this week.
  • @Jeff Horn the biggest similarity was with the morning tightness and pain.  It’s a different pain though.  PF has the feel of needles in the bottom front of the heel.  My injury was more of a radiating pain around the sides of the heel.  That difference in pain is how the doc figured out it was Achilles, and not plantar fascia.  Nobody ever mentioned “insertional” but as I healed up, the PT could feel the location of the injury (scar tissue maybe?) about 3” above my heel, which is probably too high to be insertional.  I’ll also say that once I warmed up, the pain went away during excercise.  But the second the leg started to tighten up, the pain returned, which was also my experience with PF in the other foot.


  • Thanks @Chris Davis.  I think mine is more on the meat of the heal in the back low down, likely "insertional."  Gonna schedule Dr. appt next week to see what the pro thinks and how best to adjust the running.  Used to not even notice it when running, more of the morning after.  Now it is noticeable in all activity, but still worse morning after.
  • ... stretching- 30 seconds calf, bend ankle for 30 seconds of Achilles on both sides.
    Then 10 reps of heel raises- up for 2 seconds, down for 5, with the horizontal point being at 3 seconds. Work up to 3 sets of this stretch/ heel raise
    Also- use a tennis ball to find points of maximal tenderness on calf. 

    To recap, PT has had me doing the above stretches that Leslie detailed.  Added to that are:
    1. 5' plantar stretch - facing a wall, place heel 3" from wall with foot angled up at a 45 degree angle.  Press knee into the wall to get a stretch in the heel.  
    2. Runner's stretch for the calf/achilles
    3. Alternate raising of big toe, then all other toes.  
    4. Towel scrunching to strengthen foot mucsles

    Over the past three weeks, I haven't had much improvement.  I switched from my walking shoes (retired running shoes) to Hoka Cliftons, thinking more cushioning would help.  It actually did the opposite. 

    Work doesn't usually require me to wear my leather work boots, but I had an occasion that would require wearing them for 3-4 hours.  I put in the off the shelf insert and proceeded to wear them for the whole day.  My foot pain was reduced from the day before.  I've been wearing them for over a week now and continue to experience a reduction in symptoms.  

    @Chris Davis - My PT also has me working on stretching the Achilles as well as the foot.  My hamstrings are also pretty tight and should work on them too.

    I am waiting on a referral for an x-ray or MRI to see if there is any other anomaly that is causing the pain to linger for so long. 
  • Met with the Dr. today to go over my MRI.  Confirmed PF, as if we didn't already know.  The fascia is 4x thicker than normal and there is edema in the heel bone at the attachment location. 

    Apparently, I'm in the 10% of PF patients who's symptoms are not cleared up by the usual treatments. 

    Recommendations:
    1. Wear a walking boot for three weeks and see if symptoms decrease
    2. Cast my foot for three weeks and see if that works
    3. Surgical release of the fascia. 3-4 months in a walking cast, with an 85%-90% success rate of resolving the PF symptoms.

    I start a two week vacation tomorrow, so the boot will wait until I get back.  Potential Sx options will wait until fall while I enjoy summer and get in a couple of cycling events.
  • @Phil Mills If you are doing limited running with continued problems have you done anything with your bike cleat position?  I moved my cleats back.  There were several articles (slowtwitch, Joe Freel and a few other places i don't recall) a few years ago mentioning this.  I read some and took the plunge.

    I know when I was having problems I do feel some increased stiffness in my lower calves which contributes to my PF.  This stiffness from cycling usually comes more with the high power VO2 intervals but the repetitive use of higher volume weeks will also do it. 


  • edited April 20, 2018 4:18AM
    @Phil Mills hope things are improving.  I have been in run jail since I joined this thread because the pain got pretty bad (aside from running at FL70.3).  I have had about 3 weeks off, night sock, golf ball and some voltaren gel.  Feels like whatever I had is almost gone, but good lord I never want to have it again.  The heel feels fine walking in a shoe with an insert in it.  I had some old power steps that I started using again.  Hard floor barefoot I can still feel pain.  
    I was at running store today and picked up some Hoka Clifton 4s and some Superfeet pain / pf inserts.  I have been in Newtons for a years, but gonna give the Hokas a try.  Read several forums where people consider the lugs to stress the heel, pf and posterior chain.  Not a big deal if no injury, but if PF develops can make it worse I suppose.  So far walking in the Hokas feels great.  No running for me until next week, we shall see... 
    And @Gordon Cherwoniak I like the idea of examining the cycling shoes.  I had a bike fitting about 4 weeks ago before this stuff got worse and the guy put "shims" under my cleats.  They are not big, but he said was for knee alignment during pedal stroke.  Those will likely get removed while I'm thinking about it, and I'm going to replace the insoles of my cycling shoes this week as well. 
  • Went to my ortho this week, he gave me medrol dose pack and said I could resume running next week.  So will transition out of jail.  No more severe limping morning pain.  It is a background nag at this point.  No barefoot walking has helped a bunch.  Put new inserts in cycling shoes this week too.  Went to specialized store and got some specific to my arch type.  
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