Plantar Faciitis

[Vampire]

So finally after about 4 months of pain I've had to bite the bullet and visit the doctors this evening.

I'd built up to running about 25 miles per week over last year and last winter (in zero drop minimal shoes - Brooks Puredrift, VFFs and Lunas), and ran a 14 mile mountain race in January, and a half marathon in March. I was enjoying running more and more so started building up the mileage in bigger steps than is recommended. Around the half marathon in March I noticed I had quite a quite a lot of pain in the bottom of both feet which was worst in the mornings, but usually improved later in the day.

Like an idiot I just tried to push on through the pain, and hoped it would go away. It got to a point where after running 13 miles and 11 miles on consecutive days, that I could barely walk for several days - limping around my office and downing piles of ibuprofen. At first I tried to manage it by reducing the mileage a little, buying some £140 cushioned running shoes (yeah - I know) and some orthotic insoles for my office shoes. My right foot actually healed on it's own, but the left has stubbornly refused, giving a lot of pain the morning/day after any run. Wearing the orthotics at home or around the office actually hurt more than not wearing them - so I ditched those pretty quick.

I took 2 weeks off running and then ran several times on holiday (Volcanoes in the Canary Islands - I couldn't NOT run there) in Brooks Cascadia 6, back came the pain with a vengeance. I had a ticket to the Barefoot Connections conference last month in Surrey (UK) where Barefoot Ted was speaking and coaching, I decided not to go when I woke up that morning and could barely stand or walk, let alone run the planned 10km trail race with Ted - I was pretty upset as you can imagine!

So for the last 3 weeks I've only been doing two or three 1-2mile runs per week, and only in bare feet or Luna's. The pain has receded a little but is still there nagging in the background, other than stopping running entirely there wasn't much left to try.

So I called the doctors this morning, and went in for an appointment after work. I realised within a couple of minutes conversation that the doctor is a traditional "get gait analysis, £200 orthotics, £150 shoes kind of guy"; so I told him I'd already had gait analysis twice, first time got pronation correction shoes which ended up hurting my knees badly, second time I got neutral shoes which were a bit better, and I told him I seemed to do better with less padding/drop/support rather than more. I decided to stop short of mentioning barefoot as he seemed to be set in his opinion, he even took a glance at my bare foot and said "oh yes you have very flat feet" (I don't at all).

Anyhow, he prescribed me 2 weeks of anti-inflammatory pills (naproxen) and then wrote me out a prescription for a depo-medrone (corticosteroid) shot. Which was what I was after to clear the pain up. He's also referred me to a podiatrist to have custom othotics made (I'm not planning to follow that up).

I left his office, took off my running shoes and slowly jogged 1.5km home in bare feet - no pain (yet) and felt great.

So the plan is, to take the next 2 weeks off running (that's not going to be fun - he said I'm fine to cycle or swim though) and let the naproxen do its job, then go back for the steroid shot in my heel. Once the pain is 100% gone, I plan to resume the barefoot running - gradually easing back into it at first and making damn sure there's no pain after each run. And slowly build back up the distance, without pushing it too far too quickly again. I was entered for a 15mile mountain race on this coming Saturday which I've cancelled and moved my entry to next year. I have entries for two half marathons in September and October, but I'm not going to risk them if I have any doubt at all that my feet are OK. Realistically I don't think I'll be ready for them, certainly not the one in September.

I'll update regularly with any progress/news. Hopefully the plan will work, any thoughts?

I've been trying to go barefoot everywhere at home, and wear zero drop Vivobarefoot formal shoes in the office, and Luna's everywhere else. Should I wear something supportive and/or with raised heel just while my foot heals, or keep wearing the zero drops and keep the tendons stretched and try to build strength in my feet?

 

[dutchie53]

Have started to rolling your lower legs and PF yet? If not, I highly recommend it.

 

[Vampire]

Ah yes, sorry I should have mentioned that. Among some things I've tried are, rolling feet on a golf ball (I was doing this for a few weeks after finding one whilst barefoot running on the local golf course at night - then saw Anna Frost post a photo of her doing it on Twitter), rolling feet on a small ribbed foot roller I bought in a pharmacy, rolling calves/quads/hamstrings on a grid foam roller.

I also bought a balance board after reading Eric Orton's book, and try to spend a few minutes on that each day, doing single/both leg balances and squats etc. I do calf dips on the stairs to stretch out my tendons, and quite a few other stretches I saw mentioned on here and elsewhere on the net.

 

[NickW]

For me, rolling my legs on a foam roller did not quite do the trick, but rolling on a softball on the calves did. Might want to just give it a shot. Here's one video that shows part of what I do. I will do the back of the calf, and then both sides of the calf on a softball. Good luck man, pf sucks and I hope you get over it much faster than I did.

 

[Sid]

I also bought a balance board after reading Eric Orton's book, and try to spend a few minutes on that each day, doing single/both leg balances and squats etc.

Off topic. I read an article where the author practices balancing on one foot while brushing their teeth. To make it more challenging (since I have an electric toothbrush), I try doing it with my eyes closed. It's trickier than I thought it would be!

 

[rickwhitelaw]

First off Nick, great vid. I had to watch it twice because the first time I didn't hear a word she said.

Ok, Vampire. Ready for some depressing news. PF is a nasty injury and takes a long time to get over. You are going to need to take some time off. Hopefully you can take care of it before it gets worse like mine did this winter. I am still not fully recovered, but I believe I have it in check. Of course, every case is different and every individual recovers differently.

The encouraging news is that you will get over it and your fall halves are not out of the question. I went from zero miles in February to Ultra distances in 3 months. Here is what I did.

Stopped running and did not register for any races. I found other activities that did not aggravate my heel. With the main one being hiking.
Went to Physical Therapy. Had the usual treatments and then he started Graston and ASTYM. Also went through stretching routines for my calves and rolling. Cross Training.
Lost weight. I had gained 5 pounds in the fall and another 5 after the injury. When the weight came off, I noticed a huge difference.
Wore shoes. Yes, I did go back to shoes for my longer hikes and runs. I am just now getting back to barefoot running.
Avoided pavement.
Wore a night brace.
When I was able to run again, I ran slower.

I was never prescribed NASIDs, but I would have not used them. The clinic doctor I saw recommended the shot, but as long as I saw improvement I figured I didn't need it. So if you go that route, I would be curious to know how that goes for you. I hear you have to be very careful about activity after the shot.

 

[Vampire]

Thanks Nick - I'll watch that video when I'm not in the office and do those stretches. I think you posted that one in a thread before, I'm sure I've seen it before but couldn't find it again when I looked.

Rick, thanks for the constructive comments. I've plenty of weight I can lose so I'll try and make more of an effort on that score. I'm pretty heavy, I was 130kg 2 years ago and have got it down to 114kg right now, there's a lot more I can safely lose though!

I'll keep going with the stretching and rolling, and will lay off the running entirely until after the naproxen/steroids, the doctor didn't mention how long I should stop running for after the shot (I think he was hoping I wouldn't go for the shot and save him some work), but I'll ask when I go back for it.

Regarding shoes. Do you think it's a sensible idea to wear shoes when I start back into running? I'm not rushing to get back to doing events, I'd much rather get my feet right and do things properly so I can run long term and injury free. I think if I wore shoes again there's a danger I'd start doing too much too soon again. Long term would it be better to stick with barefoot/minimal?

If I did go for shoes again, any suggestions? I already have:

Brooks Cascadia 6 - I was doing most of my trail mileage in these when I got hurt. I feel like these have too much padding in the mid foot though, almost like a rocker. They actually have part of the middle of the sole marked "Pivot" which isn't an encouraging sign to me.
Saucony Cortana 2 - Neutral, pretty expensive, only 4mm drop but pretty thick with 18mm forefoot and 22mm heel. I bought these to run in when my feet started hurting but didn't use them much as they felt like running on marshmallows.
Brooks Puredrift - 0mm/4mm (with insoles) drop minimal road shoes. I was doing most of my road mileage in these before I got hurt.
VFFs
Original Lunas

I was wondering about something like the NB MT1210 Leadville or Salomon S-Lab Sense, both fairly light weight and low drop trail shoes. But I don't know if more running in shoes is the best way forward long term?

 

[rickwhitelaw]

I think if I wore shoes again there's a danger I'd start doing too much too soon again.

That right there tells me you would be best to stay barefoot.

The key is to get yourself to a point where you start seeing improvement and then slowly start adding back some running.

Maybe it would be good to drop those half registrations. (I forget how fast the summer goes). There will always be more races in the future. It would take some pressure off for sure.

I hope you get a few more comments or suggestions here. Remember, I'm not fully recovered, so my advice is not very valid. I would love to find out how to get rid of that last little bit of pain.

 

[rickwhitelaw]

Can someone with more computer skills than me find that article by Dr. Mark that was on the homepage about 1.5 to 2 years ago?

 

[NickW]

Vampire, for me most footwear caused my pf to flare up. The only footwear I found I could wear for running is my luna sandals. In fact most of my running now a days is in them, with very little barefoot anymore. The only shoes (not counting my sandals) that I wear now a days for everyday wear are my vff's which I wear for gym work and then school twice a week when closed toe footwear are required for lab. I would say to rest, but that doesn't necessarily mean no walking. When I rest for more than a day or two my pf comes back as my legs tighten up again. For me, stretching really is enough to keep the pf at bay now, but it took me numerous times of rolling my calves over the softball (which not sure why I really call it rolling, more like sitting on the ball in one spot for 30 seconds or so) before my foot started staying better. After a week or so of me doing that every night the pf really started not coming back as much. Now I don't have to do this rolling thing unless I had an unusually hard run and my legs are tightening up. Maybe once a week or so if that. I'll find that link to my post about it and there may be more advice for you in that.

 

[Sid]

Can someone with more computer skills than me find that article by Dr. Mark that was on the homepage about 1.5 to 2 years ago?

www.thebarefootrunners.org/threads/plantar-fasciitis-by-dr-mark-cucuzzella.5671/

 

[Barefoot TJ]

I will just say, do your research about the shot. I've read some terrible stories about it. I understand it can cause the fascia to rupture, even one shot, not to scare you.

PM stjohnthegambler. He dealt with PF for a long time until he finally beat it. He can tell you his story as well.

I've had it, and I found that sleeping with a night splint helped a lot, as it prevents that first step of the morning pain so common with PF. And it's that first step that causes the "reinjury" to the fascia each and every morning. That's one reason why it takes so long to heal.

Good luck!

 

[migangelo]

ya, don't do the shot. you don't have pain because you lack cortisol and steroids. it will only mask the pain, not take away the problem which is what i assume you want.

i think you have some good advice from everyone here. it is a puzzle to solve to get rid of it but it can be done. i'm still dealing with mine and getting better. check out teamdoctorsblog.com look for videos 77-84 or so. can't remember and closed the tab i had open to find the proper link for you.

don't buy more shoes. you have plenty. go as bare as you can until it hurts then put on some different shoes for relief.

good luck.

 

[Vampire]

Small update. I've been taking the Naproxen for 3 days now and no difference to the pain at all so far, I have also not done any more runs in this time, and have cut down my walking a bit too. I've been doing plenty of stretching and foam rollering this week as well.

I have collected the shot from the pharmacy but am yet to decide whether/when to book in to the doctors to have it administered. I'll think on this some more.

My night splint (which I'd ordered) was delivered today, so will start using that as of tonight. The main pain (and subsequent re-damage of the tissues which started healing overnight) is first thing in the mornings, so I'm hoping this will help a lot.

Really hot day in the UK today and it's dress down Friday, so I'm wearing Lunas in the office - lovely!

 

[NickW]

Vampire, I would really strongly advise rolling your calves out on a hard ball, similar to the video I linked to above. Rolling on a foam roller is NOT the same thing. What can it hurt to spend five minutes doing it? At best, it could be an instantaneous reduction in pain like it was for me. Here's another great video for you.

 

[migangelo]

ya, it takes a little more than rolling. constant applied pressure to release your muscles. i keep recommending to everyone to buy "trigger point self therapy manual" by Clair Davies.

 

[Vampire]

Yeah I'll do that with the hard ball Nick, I just need to buy/find one first - I've been working all week and there are no sport shops near work. I'll pick one up tomorrow.

 

[NickW]

Yeah I'll do that with the hard ball Nick, I just need to buy/find one first - I've been working all week and there are no sport shops near work. I'll pick one up tomorrow.

I just hope it works for you like it did me. I'm still trying to find the best video I'd watched previously for you, but I haven't been able to come across it yet. Wish I had bookmarked it. Anyhow, they say to just sit there without moving on the ball (on the calf) for 30 seconds to a minute or so in each spot. No rocking, no rolling, just sitting. It showed you how to locate the trigger points and then just sit on the ball in those spots. Man, I remember standing up after about 30 minutes of working out all these trigger points in my leg and I had zero pain. I was floored. After 18 months of pain and several drs and one pt and doing xrays and an mri, all it took was a stupid tennis ball and a video online. The pain came back at first after a day or two but I kept up on doing this and within a week the pain was almost completely gone. Now, I do this once or twice a week as needed and I am good. I'll keep looking for that video as I think a lot of folks on here could use it too.

 

[mokaman]

I just want to say the best way for me to massage the calf muscles is to sit in a chair and use a hard ball like a tennis ball, golf ball or baseball...use your hands to move the ball around. Sitting on the floor with the ball under your leg doesn't give you the same control or pressure to really find the tight spots as well as you could.

Blah I should make a video or find the proper one...the video above works well for the hamstrings with a softball but isn't the best for the calf muscles.

And what Migangelo says once you find the knot or tight spot you have to apply pressure to it for at least 30 seconds to a minute or more to resolve it...that's what your paying certain practitioners to do for you....once you get the hang of this you do it yourself no problem.

 

[migangelo]

you actually don't need a ball. that is if you can handle self torture. just kneel on the calve you want to work. take your hand from the same side and use your thumb or fist to find the trigger point. when you have it apply weight, as much as you can handle until it lets go. i find i have to increase my weight as it's about to release, which ironically is when it hurts the most. just make sure to keep your thumb supported into your fist and not extended from your hand. that could potentially cause a lot of damage.