A few questions about recovery from Plantar Fasciitis

Husky44

Barefooters
Dec 8, 2014
5
11
3
58
Vero Beach, FL
Newb here, but not new to running. Battling plantar fasciitis that showed up for the first time ~3-4 months ago. Went to the podiatrist today, and got exactly what I didn't want. Doctor's treatment plan is cortisone shot (which I got), taping my foot, come back in a week. Eventually he's talking orthotics, etc, etc. Never go barefoot, wear shoes whenever you're not in bed, blah, blah... When I tried to discuss my needs with him, I got the "I'm the expert, do what I say and you'll get better" speech. When I told him I had been wearing VFFs exclusively for running and casual wear for the past 4 years, and barefoot whenever shoes aren't required (lived in a culture where it was normal to take your shoes off when entering anyone's home), he told me to stop it all immediately. When I told him that switching to VFFs for running eliminated my back and knee pain from using high$$ motion control shoes, his response was (wish I was making this up) "I only work on feet. I don't know anything about all those other body parts. If you want your feet to get better you'll do what I tell you.":eek: :mad:

So, here's my back-story: 49 y/o male, 72", 230#, running for over 30 years, averaged 25-30 miles/week until about 10 years ago (weighed about 210 until that time). Went through a bad stretch of health that really messed up my training base, and now I'm down to running 3-5 miles, 3-4 days/week. I ran in high-quality motion control shoes that I had to replace every 3-4 months because of knee and back pain. I was definitely a heel striker, and ~20 years ago I was a bad over-pronator. As stated above, I have spent the past 15+ years living in a culture where you took your shoes off as soon as you entered anyone's home, and I prefer being barefoot whenever possible. Never considered barefoot running, but when I read about VFFs I thought it was worth a try. I switched to them 4 years ago, and had a really easy break in period. It only took me about a month to get back to 3-5 mile distances. I transitioned pretty easily to a midfoot running style.

I've never had issues with feet, ankles, anything like that until ~3-4 months ago. At first I thought I had a stone bruise in my heel (left foot) and tried to run through it. At the same time I got the "broken glass when you get out of bed" symptoms, but didn't connect them. I laid off running completely for the past 2 months, and my foot was getting better, until the stupid cat got out about three weeks ago, and I took off across the yard barefoot chasing him. Something popped in my foot, and it put me on the ground. I couldn't walk at all that day, but the next day I broke out the old motion control shoes and wore them for the day, along with pounding motrin. I'm back to where I can do my 1.3 mile walk with my dogs without any pain, and just a little "soreness". I'm very proficient at feeling better before I am better, and jumping back into stuff too soon, so I want to go at this carefully.

Sorry for the long intro, but wanted to try to answer as many questions up front as I could.

MY QUESTIONS:
1) Should I go back to the podiatrist at all? If he wants to stick me again, should I let him?
2) Assuming the answer is "no" to #1 (which is my inclination), how do I know when I can start back to running?
3) When should I start working more on flexibility? I've always had tight hamstrings, along with very strong calves and whatever that muscle is along the shin. Flexibility has never been my strong suit, but it's never hurt me before either.
4) Other suggestions for self-rehab?

Thanks for the wonderful service you provide on this site!!!

EDIT: More questions I forgot to ask last night:
5) I'm assuming my root cause is probably some sort of asymmetry/imbalance issue. Is chiropractor a good place to start? Haven't been to one in >5 years. If so, what training/certifications/methods should I ask about when searching for a new one?
6) Is it ok to start rolling my foot while I'm still working to eliminate pain?
 
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I've had the same problem for 13 months. I have been running barefeet for over three years. My orthopaedic surgeon recommended rolling the foot on a frozen bottle and various stretching and strengthening exercises. He said I could keep running, however I was not improving after several months. I basically stopped running but kept up with the icing, stretching etc. I've just had three months of physical therapy with Graston technique for fibromatosis, stretching etc. There was some improvement but I cannot run more than three to four miles and then have to skip a day. I am now wearing minimal shoes to run (Sacony Hattori). I may try going back to a more cushioned shoe. I would consider a podiatrist only as a last resort.
Thanks for posting, I am looking forward to responses from others.
 
Regarding the podiatrist, in my extensive experience with runners, anyone who has that level of professional bias needs to be given the boot. Professional bias is quite common in healthcare providers, including chiropractors which is where I come from. You cannot solve problems such as plantar fasciitis which is a gait issue, resulting in a foot symptom from the point of view of ignoring the rest of the body.

To understand the mechanical aspect of why you hurt, I strongly recommend you read my book Cheating Mother Nature, what you need to know to beat chronic pain (available through Amazon and other booksellers). Some of the clues you gave were "I ran in high-quality motion control shoes that I had to replace every 3-4 months because of knee and back pain. I was definitely a heel striker, and ~20 years ago I was a bad over-pronator." which tells me you were having core issues back then and you are now.

Heavy heel strikers have core issues, because a torqued care is not only untrainable, but you will be a heavy heel striker. This can explain the episode when barefoot where you heard a pop (likely a muscle pull). I am willing to bet that you always had a short stride (people who over and understride with a torqued core do because of tight legs and an inability to open up.

Going barefoot changes the dynamic of running, however, your core issues will not go away unless first we understand your gait problem and you are evaluated properly. A good sports chiropractor who is certified is a great place to start. Make sure they either use myofascial release or Active Release Techniques, which does not assure you success, but gives them the tools to change your gait cycle by reducing restrictions creating the problems in the first place. This will address "When should I start working more on flexibility? I've always had tight hamstrings, along with very strong calves and whatever that muscle is along the shin. Flexibility has never been my strong suit, but it's never hurt me before either."

If you would like, you can post a video of you running on a treadmill for about a minute from the side and back which can help me better understand your problems, and if you have not done this, you should. You would be surprised at what you see.

The problems you have with PF has to do with a chronically hard foot strike period, tight hamstrings, lateral leg fascia and a torqued core. Read my book and this will make total sense. You have to treat the gait cycle, not the foot to truly get to the root of the problem.

A good sports chiropractor will at you, not just your symptom (important) and it is obvious to me you tolerate alot of things so be sure to give them all the info of what ails you, not just the foot since these are often important clues left out by people who do not understand that problems in the upper body can affect lower body, etc, etc.

Regarding shod vs. barefoot, there are people who clearly do well with one, or the other or minimalist with some support in the shoe. It does not have to be either or and a minimalist shoe with something like an off the shelf superfeet will give you more freedom than the supercontrol bricks you used to run in. Keep an open mind and be willing to go minimalist, if necessary. An insert can help level the hips which will activate the core, open your stride and perhaps give you relief as well, something you may not have tried yet.

I hope that helps
 
Wow! Thanks for the very comprehensive reply! This makes a lot of sense.

Is it ok to make the video now, or should I wait until my pain is gone? Right now it is not debilitating, but I would guess that it is going to slightly effect my stride.

Very much in favor of continuing to run minimalist and/or going barefoot - the idea of going back to regular shoes sucks. In fact, if this whole episode gives my wife valid medical proof that I have to wear my VFFs for health reasons (she hates the way they look) then it will be worth a few months pain.

Will definitely check out,the book, and use your suggestions to find a chiropractor ASAP.

Is there any reason to keep my podiatrist follow up appointment next Monday?
 
Sure, make the video. You may want to check out my blog post on going barefoot almost. Very enlightening and you can watch the videos too to back up my conclusions but do not base the findings on what is good for me, since you are built differently. Videos are a great tool for evaluating runners. Pass on the podiatrist and find another. Sounds like he is too professionally biased and too foot centric to help you solve this
 
Good stuff from the doc. Dr's who give cortisol shots should have warning labels. "i don't understand bio mechanics. I'm just going to drug you to cover up the pain."

I'm in chiropratic school and bad ideas are very ingrained. I want to challenge my teachers in class who contradict themselves but haven't, yet. I am getting certified in Rehab 2 Performance. Look for a good chiro with extra certification who understands mechanics better than ehat they tecach in school. R2P, dns, fms, sfma, pri. Those are just a few that i know. They focus on stable core first.

Proximal stability before distal mobility is r2p's motto.
 
Every article I read about plantar fascitis says to avoid going barefoot, but I honestly don't want to reverse course now. I like it, but I'm in enough pain to question what the hell I'm doing.
 
I've been meaning to post back for quite awhile now, and have no good excuse. To provide an update: I found a fantastic chiropractor who uses Active Release Techniques. She connected my neck and shoulder issues, hip misalignment, and my foot injury, which upon further review included a partial torn PF. Twice weekly adjustments initially, tapering to weekly, then bi weekly, really provided a lot of relief. Ice on the foot injury, and rolling my hamstrings and calfs, along with yoga to increase flexibility all got me back to regular running, but it took way longer to recover than I wanted to allow. But, I'm back to pre injury level, thanks to the great advice from this site!

Thank you!
 
In 2007 I had PF so badly that I had to keep a pair of shoes next to my bed for when I had go go pee in the middle of the night. It had been getting worse for years. I had orthotics, insoles, bought stiffer and stiffer and more supportive shoes and boots, nothing helped for long. Then I read somewhere that PF was caused by weak feet so I tried strengthening my feet. They got better. I also read that walking and running barefoot was a good way to strengthen my feet, so I tried that. At first I'd carry a pair of shoes with arch support along on my walks for when my arches fatigued too much. Eventually the PF went away. Now my feet feel great.
 
MY QUESTIONS:
1) Should I go back to the podiatrist at all? If he wants to stick me again, should I let him?
2) Assuming the answer is "no" to #1 (which is my inclination), how do I know when I can start back to running?
3) When should I start working more on flexibility? I've always had tight hamstrings, along with very strong calves and whatever that muscle is along the shin. Flexibility has never been my strong suit, but it's never hurt me before either.
4) Other suggestions for self-rehab?
5) I'm assuming my root cause is probably some sort of asymmetry/imbalance issue. Is chiropractor a good place to start? Haven't been to one in >5 years. If so, what training/certifications/methods should I ask about when searching for a new one?
6) Is it ok to start rolling my foot while I'm still working to eliminate pain?

Not a doc, but a fellow PF sufferer. Have been completely healed for 2.5 years.

1) You could go to a different one.
2) If you got a shot, don't even think about running for a while
3) Now, just avoid any stretches that pull on the foot. Focus on the calves.
4) Physical Therapy that includes electrical treatment. Graston after the area is feeling better from the shot. LOSING WEIGHT (Sorry if this sound harsh, but nobody seems to mention it in PF treatment). Avoiding activities that put a lot of weight on the front of the foot.
5) Sure.
6) I wouldn't. Look up recovery after getting a shot. Possible rupture was the reason I never got one because I knew I was not self disciplined enough to back off of the activities.

Hope this helps. Good luck to you.
 

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