Plantar Faciitis length of recovery

vykkio

I am on the mend from 5 months of plantar faciitis. I ran with it all season and gave it a few weeks off running here and there. Now that I am in the OS, I have quit running for the past 2 weeks. Today was my first full day without even the slightest twinge of pain. How long before I dare to start running again? In the past I have given it a week of no pain and it came right back with my first run. Should I wait several weeks? I am still wearing a boot at night and stretching 4-6 times a day.  

Leigh Boyle

The trick with PF and running is to figure out what's causing it? (i.e. the foot is twisting out, you're landing and staying on the outside of your foot, you're pushing off the inside of your foot/toeing in versus coming all the way over your ankle and big toe to name a few). traditionally, PF happens when you are not loading the foot evenly. instead of moving in a heel to toe direction, something has changed and you're rotating. In normal walking around, the tension is low enough that it can be pain free. When you start running again, the increased tension will cause reinjury until that underlying problem is fixed.

Soooo...what else have you been doing for treatment versus the boot and stretching??

vykkio

I do ankle and arch strengthening exercises, wear shoes with good arch support insoles 24/7 (unless I am in my boot) and occasionally use ice on it. Just about the time I took a break from running, I purchased a new pair of stability running shoes (I haven't run in them yet except at the store) that, on video, show my feet pushing off evenly from heel to toe. My old motion control shoes actually showed some "twisting" on video, so I'm curious to see how these new shoes will feel once I am able to start running again.

Leigh Boyle

Sounds like a good program. What about calf stretching?? you should be working on those guys like it's your job as you transition back into running. I'm talking 3x/day 5-10 minutes of dedicated stretching (not the occasional 3 second stretch when you think about it)

Also- are you still biking??

I would start them off in the pool with deep water running only for a week. That way you can add intensity/duration back without worrying about impact. Also good to refresh the muscles on good form without having to worry about pace/terrain. If a week in there is pain free, then I start off running back on softer terrain (trails/track/grass). I move half of the runs out of the pool and leave half in the pool. Ideally, you want to keep your "long" run in the pool for a few more weeks as the muscles catch back up to the workload. By doing that you can also build up endurance without the recovery cost. So think every other run on land. Keep it short and easy. No speed, no picks ups for the first week. cap it at 20-30 min and make time to stretch afterwards. You're also going to want to ice after each land run- 10 minutes right on the bottom of the foot. The recovery aspect should be the focus of these early runs. The run is only to warm up the tissues so that you can stretch them and ice them. The ice is important as you'll be breaking up scar tissue and stirring up the healing process again.

If the second week works well, then the 3rd week I switch another water run back to land running, same rules- short and easy. At the fourth week, all runs are outside. From there you can start to slowly build back up your volume. I'd give yourself two weeks of all land running before starting any intensity.

Notes: it may not be a smooth transition back, but...pain/symptoms don't require a full stop of all running. use the pool as a way to keep things moving to increase endurance strength. without that, you'll be battling just getting back into it all each time you stop and restart. if you look in the wiki, there is a whole section on deep water running resources including videos on form and even workout ideas. it may be boring, but it's super helpful and sport specific as you make your comeback.

vykkio

Thank you so much Leigh! That's great advice! I have been biking and actually have substituted my run workouts with additional threshold rides. I have also been stretching my calves about 6 times a day but for only 2 or 3 minutes at a time.  Looks like I need to step it up a bit! I'll start the deep water running asap. The detailed advice on how to ease back into it is very helpful too. Again, THANK YOU!!!

Leigh Boyle

No problem. Keep us posted on how you're doing.

mancona

I can't help much from a medical standpoint as I still have a TON to learn myself but I can share personal experience with PF as I strungle with it on and off every year.

The first time aronud I assumed it was the arch (as thats where it hurt). I did all the normal arch streches and treatments, made ok progress, it became managable for a while and then came back. A few more rounds of this I finally discovered it was not my arch/foot that was problem.

Both a massage therapist and PT felt the issue was calf related as my calfs are really really tight and get tons of knots in them. Over a year of focusing on my calfs and my PF is much better than it used to be but still comes back occasionally.

A PT/doctor that was looking at me last week in Kona noticed limited range of motion in my big toe on my right foot (the PF is always on my right foot), however he thought my calfs were actually in pretty good shape (as I roll them daily, strech and get massages often). He showed me how the limited range or motion was causing my calf and PF to work harder on every foot step while running and showed me how to strech the toe to work on getting the range of motion back.

Once I have better range of motion in my toe I'll find out if that prevents the PF or just exposes something else to work on next. For me it seems to be a never ending process but the good news is I continue to learn more about my body and each time around I am better at recognizing it sooner and fixing it faster.

Keep working on it and learning your body and you will make progress.

dougiann

Yup, PF sucks....I suffered for close to 2 years with it - did everything from acupuncture to cortisone to crutches and walking boots and nightime boots, etc. - finally had fascia release surgery...that worked! Anyhoo, after 2 sets of custom (and expensive) orthotics, too many different types of running shoes to count, etc. I finally settled on NO SUPPORT in any of my shoes. In fact I run in Nike Free's....and my daily footwear are Sanuk's (which are like sandals with really soft, flexible soles) - I know my PT/doctor would kill me if I told him what I'm wearing now, but it's working for me as I've been virtually pain free for over a year now - surgery was 18 months ago.

I also have an impingment in my big toe (that's what Matt's refering to) so I do stretch that quite often and have made an effort to run a little "duck out" which makes up for the lack of motion of the big toe during pushoff. Rolling a golf ball on the bottom of the foot seems to keep it rather supple too.

So, I guess my point is that maybe we often wear too supportive of shoes and that doesn't allow our foot to work the way it was meant to. At least that's what I've found to help me....

Leigh Boyle

big toe mobility is huge in running and very often overlooked as everyone focuses on how the foot lands versus how it unloads and relaxes. The big toe has 4 muscles all to itself, some of which are under the PF or just next to it. very very common for them to tighten up with the PF. be sure to work on those guys, especially the FHB muscle (flexor hallicus brevis- it's the one your sesamoids sit in) and your posterior tib as they often go hand in hand.

vykkio

I never thought about the big toe. Mine seems mobile enough, but it can't hurt to add that to my stretching routine. My calves are full of knots, so that is likely the culprit. I was getting ART earlier in the season for some other issues. I'll have to start going again! Interestingly, my left foot has the plantar faciitis...I have also struggled in the past with left-sided achilles tendinosis, ITB syndrome, and piriformis syndrome. Hmmm...noticing a pattern here!