Plantar Fasciitis....the never ending saga
I posted a question regarding this issue to the coaches in the Macro thread but thought I would ask for advice here as well. I have been battling plantar fasciitis for 9 months, haven't run in 5...I've done everything recommended so far with very little improvement. If anything, it's getting worse. My PT tells me that I am loose and have more range of motion in my ankles/feet. etc. than most people. I've been stretching like it's my job, rolling as Leigh shows on her website, ice, had ART, Graston, now I'm getting PT with ultrasound and e-stim twice a week. Stretching and being on my feet for 10 hour shifts seem to aggravate it more than anything. I try to stretch as gently as possible, but afterwards it gets really painful. I am considering dry needling, PRP injections, and the Topaz radiofrequency procedure...anyone had success with any of these treatments? Opinions?
I'm pretty sure my Ironman CDA is toast. Even "IF" it were to miraculoulsy heal up in the next 6-8 weeks, that would leave me only 8-10 weeks for run training. At this point I have two options besides pulling out of the race altogether. Go to Ironman and do the swim & bike, then DNF or walk the marathon if my foot tolerates it.
Comments
Vicki,
I'm not sure what stretches you are doing but this is the one I found that really helped
http://sportsmedicine.about.com/b/2...s-pain.htm
As for the 5 months of no running if you have really back PF that may or may not be a long time. As you say being on your feet for 10 hours I'm sure is not helping, but you can't do anything about that. How are your shoes for work and insoles, arch support?
In addition to this I actually quit cycling as well when I has issues. In the end I believe ramping up for a 1/2 marathon and being over weight was one of two major factors. The other was my cycling cleat position. I corrected this by moving the cleat backtowards the heel and switching from speedplay to look pedals. The look pedals provided more of a base.
I would look at your pedal set up and ensure that this is not contributing to the problem. I don't believe that the cycling would have created the problem but it sure was creating some stifness and soreness in the PF once I had the issue. Finally consider your cycling shoes as well, are they old and flex, perhaps a stiffer cabon sole would help.
When my feet were the worst I also found that stretching or rolling caused some soreness. I can't offer an opinion on any of the other treatments as I choose to just quit biking and running (Sept-March) and totally take time off.
Gordon
Thanks Gordon. That stretch is new to me...looks like it's worth a try! To answer your questions about my bike shoe set up...my shoes are fairly new (1.5 years old) and my cleats are as far towards the arch as they will go. I have Look cleats/pedals. I do think you are right about cycling adding to the problem...it seems that cycling tightens my achilles, but I think if I stop working out all together I'll go crazy!
I have orthotics in my bike, run and work shoes.
but please DO NOT STOP stretching your achilles when ur doing this stretch.
also, try rolling an ice bottle over the PF - that might help.
keep us posted
-hb
cadence (decreased cadence = increasedd stress on the PF
seat height - low seat height = increased dorsiflexion of the ankle, which increases stress on the PF. high seat height increases stress on the achilles, which can predispose to PF. so seat height is a thin line......
Hate to hear about your PF. I've had it since Boston last year. but more of a nagging issue to me. I've stretched, iced, worn Strassburg sock, massaged, ART'd all year and managed to continue last season w/o much loss in fitness. After Clearwater in Nov I took 2 weeks off w/o improvement, a shot of cortisone w/o improvement and finally ESWT 5.5 weeks ago which has helped. I'm doing all I can to improve it but am training for Boston and hitting all my workouts. After ESWT, I was instructed to not ice foot but rather do warm soaks twice daily and avoid NSAIDS to provoke the inflammatory process in order to allow it to heal properly after ESWT and keep tissues more pliable.
I'm a physician and have researched this a good bit and would look at all options EXCEPT for the surgical option. I'd have to have more than one doc recommend surgery before I'd even consider it. Too many complications and not high enough improvement %'s except in rare cases.
Good luck!
@Hasan
Thanks for the advice on saddle height. I've had a Retul bike fit, but may need to tweak it a bit.
@Jeff
When you say "surgical option", I assume you mean plantar fascia release. I am considering the Topaz procedure... a surgical procedure but very minimally invasive...the surgeon makes pinholes in the heel and uses bipolar radiofrequency to debride the soft tissue to stimulate healing...it is supposed to have a 95% cure rate. Like after the ESWT, ice and ibuprofen are discouraged. Are you familiar with this procedure? Even if it cures my PF, I am aware that I will have to do the stretching for life or it will come back.
just as a disclaimer, not sure about the 95% with Topaz. what is your source of info?
-hb
Yes, I meant the release option. No one locally I know does Topaz here but does not sound too dissimilar to ESWT. Love to hear your thoughts if you have it!!
I battled PF for years as well. I remember the first time I ever felt the pain. I had just gotten a new pair of Brooks Adrenaline shoes. My 3rd or 4th pair I believe, but after wearing that new pair for a couple of weeks, BOOM, full on PF in my left foot. Went through NB, Mizuno, and several Asics and nothing changed. Tried everything discussed above and nothing changed. Finally had to take over a year off from running to get it to totally heal. About 2 months into new running program my right foot started hurting. It never really got to the pain level that I had in the left so I could continue training and racing through it by managing with stretching/icing.
Completely unrelated, I purchased a pair of Nike Frees to kick around in b/c I thought they were cute. Shortly after, the whole minimalist running thing took off and I thought I would give the Frees a try on some short runs. Long story short (too late for that?), my PF has been completely gone ever since I started running in the Frees. Now I do all runs in Frees.
This is my N=1 and I really haven't seen anything about shoe selection in any discussion about PF anywhere. However it has absolutely worked for me and I remember how desperate I was for anything that would work so I thought I would throw this out.
Best of luck to you on your search.
I had my first “dry needling” treatment tonight. Not for the faint of heart!
@ Bob
@Vicki ; Definitely not pimping Frees in particular, just the notion that a minimalist shoe was the key for me.
Here's my PF story - hopefully some of it might be helpful for you. I *sooooo* feel your pain with this problem - it's so frustrating and hard to get rid of.
Two years ago it started as a nagging problem - not that bad, didn't pay that much attention to it, kept running. By the end of the fall it was pretty excruciating, definitely limiting my running time. Without turning this into a novella, here's what I tried, and what ended up working:
Things I tried: orthotics in both my bike and run shoes, stretching, taping, night splint, massaging, rollering with the Triggerpoint therapy roller thingy for your feet, cortisone shots, scrunching a towel with my toes endlessly, icing. I think I fairly much covered all of the treatment possibilities. Most of it would seem to help for a little while, and then it would come back.
What finally worked (for me - I know everyone is different.) Finally it seemed like I had totally exhausted most treatment options, so I threw in the towel and decided it was time for my feet to learn to support themselves again. When walking around the house I went barefoot - a lot. That'll definitely train you not to lean back on your heels all the time - which I discovered I had been doing a lot in my super cushioned Keens I like to wear. I started wearing Vibrams for every day use. Started running in a cross-country flat - but started SLOWLY - 5 or 10 minute runs every few days etc. Definitely takes the feet and lower legs a while to adapt when they're used to a lot of support. Discovered that the main factor for whether it hurt a lot wasn't whether I ran, but how much I was on my feet during the day and in what shoes. It seems counterintuitive, but if I'm on my feet a lot during the day I'm way better off barefoot or in vibrams - I think for me it's because I tend to stand with a lot of weight on my heels if I'm in a cushioned shoe.
It's been over a year since I've had real PF problems. I ran through the whole OS without any problems - but I do all of my running in cross country flats. (The reason I chose XC flats - they don't have any support, and they're way cheaper than the new "no support" shoes.) I've noticed if I slip back into wearing really cushy shoes a lot, it'll start to feel a little sore again - then I wear Vibrams for a few days and it goes away. I did leave the orthotics in my bike shoes - not sure why, but it has worked for me so I'm not changing it. For sure climbing on the bike with no orthotics used to make it flare up.
Hope some of that helps - GOOD LUCK!!!
hi vicki,
i just read took a look at this thread.
a course of rehab as in Sumner's story (i.e. the foot adaptation to minimal support) is what i would have presecribed for you if you were my patient. no surgical procedures or releases and the other physical therapy techniques only to help with the adaptation to the minimalist shoes.
if your body composition is not the excessive heavy side, then in time, the natuaral architecture of your foot and ankle, including achilles, will grow strong enough and flexible to enough to have you running pain free. alter this natural architecture by too much cushion or too much heel height in shoes or surgery and you compromise the natural super strong design.
cushy shoes raise your heel. your achilles then basically gets no stretch and no tensile pressure to remain strong. move to racing flats and you suddenly put too much strain on it and it will hurt. so, the change needs to be gradual and at all times. so, use racing flats or minimalists shoes at all times, not just for running. i use my sub-6oz ascics flats at work and i run in them. this keeps your foot/tendons/ligaments strong and flexible at all times. also, the cushy shoes pretty much function like a cast for your foot and all the structures in there get de-conditioned.
this adaptation will take time and patience. start by selecting a shoe for day and workout that has less heel raise and less support than the ones you use now. then get some with less and less and less until you are pain free and a neutral runner. i used to wear big cushy, then light trainer with pronation support, now neutral and sub-6oz shoes. i can now run faster than ever and have no pain upon running on road or trail with these no support and light shoes.
start this process and by the time CdA comes around, you will know your limits and how to delay the onset of pain to get you through the race. also, 14-15weeks is long enough for at least some adaptation in your foot structures to take place, so you should have some relief by then.
hope this helps!
drgh
I'm new to PF (just diagnosed last week after it bothering me for a few months - all the while I was doing Leigh's stretches for the foot and calf).
The doc gave me a liquid steroid injection (which hurt like you would not believe) and for a day after that I was completely unable to walk then, out of nowhere, I felt great and I could walk without a limp for the first time in a month. I'm doing PT a few times a day (the standard achilles stretches) and icing (have a water bottle frozen at home and at work) and taking 500mg NSAID 2x per day. I was able to run relatively pain free for both bricks last week (I could feel the pulling twinge but it wasn't bad). I tried 7 on Sunday and I finished but post run was not so fun.
Got a second shot today and had lots of questions for the doc:
1) about the night sock thing - he said I could try it if I wanted to but he didn't think I needed it and it might affect my sleep... but it's not a bad thing to try.
2) doesn't think K tape will work
3) he'd prefer to not get me into orthotics unless it's absolutely necessary as he doesn't want me to become dependent on them. I do have a pair of superfeet inserts and as far as OTC inserts he thinks they're good. Caveat is that if I do the midfoot running they're not really helping.
We also talked about the midfoot/free running (he's a runner). While he agrees it's more efficient, he says it's new science. I didn't notice any problems with running until I started midfoot striking (and buying Newton's). I started that up last spring and did the recommended break in period and got through IMFL no problems. I started having problems after I picked it back up again in December.
I may have started off doing too much (perhaps I should have done the introduction to those shoes all over again).
I should also point out that I'm female... and have relatively flat arches. Both of which are risk groups for PF. I've also got a slight bunion in that foot and mild bone spurs --- all of which could be contributing factors. The doc didn't say that I shouldn't do the midfoot striking (my size and build lends itself to it, but my foot type not so much) as it will ultimately strengthen the arch... but, as I've experienced, it definitely strains the PF a lot.
So, my take away... not really sure. I've scratched 2 ten milers and will scratch a half mary this coming weekend. I can train around the injury and he's okay with my doing the bricks and testing the water on longer runs -- that's the point of giving me the injections, I'm fast-tracking the healing process.
I just wanted to throw out a counter point to the minimalist shoe and the midfoot striking... I ran 5 marathons in 19 mos (taking 30 minutes off my PR) with no problems. I've been in Newtons 6 months and well, either I haven't mastered the gait or my poor foot isn't cut out for it and I'll go back to being a less efficient but pain free heel striker. I just hope I can get back to running soon. Taken 3 weeks off of the OS plan and have put on the lbs to show for it. Nothing like running to keep you lean.
becky:
sorry to hear that it's been a not so smooth process.
definitely do what you feel is best for you at the moment, but don't give up on running properly.
running properly is not new science or unproven science, just new to some people.
that sort of statement is the moral equivalent of saying, 'the human body is a new invention'. in fact, it's been around awhile, although still being refined i admit. an article last year or so in the journal "Science" highlights the proper running technique for the human body from observations made in people who run all their lives, do not have access to shoes, and do not suffer from the injuries that those of us in the developing world get. This running technique or idea is not new, it is natural and refined throughout evolutionary time (or by God, if this is your belief). running properly allows many people across the globe to run a lot more and a lot faster than you and me. the fact that the aforementioned article appeared recently, just means that "science" is just starting to notice, due to so many people in the developing world having chronic running problems.
the other problem is that very few people get the proper guidance on how to approach individual ailments when it comes to musculoskeletal biomechanical issues. it also takes a long time to recondition your body to work like it was designed to work. we started running as kids, but then were conditioned not to, mostly, and then put in big cushy shoes. some of us got heavy, lose flexibility, etc.
in your case, becky, the alterations in your foot bone structure should definitely be taken into account, in addition to body composition/flexibility and analyzing your run technique. you spend much more time walking than running, so therapeutic measures need to include your walking gait and making sure your feet are getting strong during your normal day, not just when you run.
we all say 'midfoot striking', but that's way too vague a descriptor. the best way to find the natural running style that will be the best for your variation of the human anatomy, is to walk/run with minimal support and minimal heel raise shoes. the result, after a patient and mindful adaptation process, will be the best foot strike for Becky. might be midfoot, might be 3/4 foot or whatever. by the way, i'll have to try on a pair of newtons, but in the promos, they say that it 'helps' encourage a midfoot strike...try to avoid any shoe that 'helps' you to do anything other than preventing you from cutting your feet on sharp objects.
similarly, try running on your heel with minimal support shoe and you'll quickly see how not so good for your foot that will be in the long term.
my arches were flat a couple of years ago. now i have a noticeable arch. i can run on hard surfaces, but i definitely run lighter on the road than when on trails or grass. i have noticed that i use my toes a lot more when i run now, so i now make sure my shoes have a wide toe box, etc. all the above took about 2 years.
i should get back to work...i realize i am out numbered in my 'approach', most ironically by my own kind(!) (i.e. doctors/some PT's), but i do not think i am completely wrong
.
sincerely, gh
thanks, gilberto. I do hope that I can improve my arches and I do have VFFs that I hope to wear more often (and you're certainly right about not being able to heel strike in those). I may have to look into gait analysis and try to figure out the best gait for me. Evolution Running (mentioned in Born to Run) is here and I've my VO2 Max test done. I'll have to look into that.
Thanks J.T. I'm feeling encouraged that I might just finish, even if I have to walk it!
I would try everything else first before resorting to either surgery or steroid injections. One study shows up to 10% of people with steroid injections end up with a complete rupture of the plantar fascia, half of which end up with long term complications.
Good luck!
I kept training all last year through my PF and finally got better when I REALLY started stretching my gastro/soleus like it was my job. Also, ice, massage, ART and new shoes, inserts helped. Night splint (Pro Tec brand) made a very big difference overnight. I'm now about 80-85% better this spring desite training for Boston. I did lose about 15 lbs and think this reduced the pounding on my feet too. Good luck.
Jody,
My PF got worse by continuing to train. Having said that I was not diagnosed and was not doing the proper stretches/icing. It's hard to say what the effects of 4 more weeks and and 1/2 will do but PF can be a ongoing long term problem for many.
I know I was going in to my first half marathon when I had my issues start and the following year my longest run going in to Lake Placid was 6-7 miles. This was not all PF related but I finally took time off and then ramped up too fast, needless to say it was a mess but I finished.
Gordon
1. Stretching a LOT and using the foam roller
2. I got some new custom orthotics made by a PT. I wear them in my work shoes...even with 12 hour days on my feet I have no pain.
3. I go for "dry needling" twice a week. My PT needles every trigger point in my leg from the sole of my foot to my piriformis...it is working wonders!
4. I started running in Newtons so I no longer land on my heels. I am practicing good running form and running with a shorter stride and light, quick steps.
5. Core exercises along with strengthening my weak hip and butt muscles
I am hopeful that I will be able to run most of the marathon at CDA. My long run will only be ~12 miles, so I won't be setting a PR! I'm just delighted to be running again!
A big THANKS to all of you for your advice and encouragement!