severity grade: 4
Nov 2007: Here is the everything that I've done for anyone's reference!
First, it can be incredibly frustrating and each case is different.
I've talked to friends who ran through it without a problem as long as
they did some extra stretching... and others who have dealt with it
for years. Unfortunately, I tried to run through it for a long time
because with a few measures I felt like I could keep it under control
while running. I was also living in Sweden so that I could train, so
it was hard to take time off when I was so excited to be around such
great forests and running with a great club (clubs in the US are rare
and small). However, after a friend noticed that I was limping
through yet another finish line, I realized that to make it actually
go away for good I would have to take some time off. Now that it's
better, I realized that I had also changed my stride a lot to try and
compensate for the injury which was leading to twisting my ankles and
other problems. Here are the various things I've tried (and chosen
not to) along with a bit of commentary about each.
1. I did not do surgery or cortisone shots-- my impression from
reading online including some journal articles and talking to physio
and a guy in our club who is an orthopedist is that surgery is a
pretty last ditch effort. It should only be tried after you've done
everything else, taking extensive time off, and been dealing with it
for several years. Cortisone shots can reduce the pain but do not
actually cure anything. Plus, in some cases they can cause the tendon
to rupture. So, I chose not to go with cortisone shots because the
pain was really the only thing keeping me from running through it even
more than I was. It just didn't seem like there was any real benefit.
2. Deep needle acupuncture-- They stick pins into the heel with the
purpose of breaking up scar tissue and encouraging the body to heal.
I did 4 sessions of this and would have done more if the sports
acupuncturist hadn't gone on vacation for all of August. I heard
about this technique from a friend (Annika Billstam who is one the
Swedish team, actually) who had also dealt with pf. It seemed to help
me... but it was unclear if it was the acupuncture or the fact that I
finally started taking some time off. I was impressed by the
knowledge of the sports acupuncturist (in the US acupuncture is seen
more as a fringe, side thing and isn't an much a part of mainstream
medicine).
3. Massage-- This can definitely help. The root cause of pf is
sometimes that the calf is too tight... and it's all connected through
the achilles tendon. When it was really bad, i had a friend do a 20
minute calf massage which helped tons. Plus, you can do massage on
the foot itself. Usually I start just on the toe-side of the heal and
massage either across or along the arch of the foot. This is
especially good to do in the morning so sort-of wake up the foot
before you start walking around. One of the big problems with pf is
that you heal during the night, and then re-tear everything when you
take your first step in the morning. Stretching and massage in bed
helps with that. I went to a napropath as well... but it was hard to
say how much that helped.
4. Night-splint-- for the same reason as morning massage, you might
want to try a night splint. This is a sort-of hard plastic brace with
velcro (I've also seen some sock contraptions advertised online) that
keeps your foot in a flexed position during the night. I tend to
sleep on my stomach with my toes relatively pointed which means that
the plantar fascia is in a shortened position. Thus, any healing
during the night is "short" so that it is more likely to get reinjured
the next morning. This helped a lot with the pain you feel getting
out of bed too. I found in the end though, that it's been better to
not have it in the final stages of healing. I forgot it when I drove
to California a month ago and it's been fine for the last month.
4. Taping! -This has been incredibly helpful for me. I do it
anytime I know that I'm going to be on my feet a lot; walking,
standing, hiking, or running. I'll probably keep doing it for a long
time, even after I am running again a lot. There are several
methods-- mine is adapted from what Annika showed me which was taught
to her by someone on the Swedish coaching staff. Start with a long
piece of tape (I usually tear mine in half so it's a little skinnier)
going from the outside of the foot (starting at the widest part),
around the back of the foot pretty low and then angled in so that it
ends up just below your second toe on the squishy part of the ball of
the foot. You should rotate your foot when angling so that it is
relatively tight along the tendon (basically this piece of tape will
keep your heel pad nicely supported and will take some of the stress
that the tendon normally takes). Repeat with another piece of tape.
Now do several pieces around the foot to support the arch. I usually
do three that are a little staggered to cover the whole area. They
should fill the space between the heel pad and the ball of the foot.
Play around with how tight you want them-- it's easy to put them on
too tight. You might be able to find pictures online or in a
sports-medicine book.
5. Contrast Baths- When I was running through the injury, this
helped tons to make me able to run the next day! Once it started to
heal more, these felt like they made things more painful, so I
stopped. It's 1 min cold bath (ice or snow in water) + 30 seconds in
warm to hot water (not too hot). I alternated that for about 7.5
minutes or so, being sure to start and end with cold. I did it
nightly before bed.
6. Exercises-- There are a range of exercises to do the strengthen it.
Look online and see what you can find. I liked a mix of one-leg
squats, calf-raises, a penguin sort of step (like calf-raises but with
some torque), lunges, and just walking on toes while lifting the other
foot up and flexing it. TOE CURLS are really good. These are just
sitting around and crunching your toes... or trying to pick up a
towel.
7. Stretching-- calf stretches, sitting down and pulling back with a
towel, etc.
8. Orthotics-- Definitely helpful but it took a couple tries to get
ones that were good for me (the first pair were too hard and just made
it feel worse). Now I wear them all the time. It helps keep the arch
supported like taping. It's very hit or miss with getting good
orthotics. But, I think they were important for me. I had taken some
time off before and it didn't seem to help as much because I didn't
have the orthotics yet.
9. Time off-- A combination of 4-7 was allowing me to run for several
months with limited pain. Still, I was having some bad days and
finishing lots of races limping. Finally, I went to see the
acupuncturist and he encouraged me to take some time off again (I'd
taken 6 weeks off earlier... but that wasn't enough). For a long
time, I'd been still trying to make goals-- like "I'll take 2 weeks
off and then get back to running and be ready for a training camp" or
"I'll just run 3 days a week and cross-train and then I'll be ready
for Tiomila." Finally, I sort-of had to give up on goals for a while
and realize that I just had to give my foot however much time it
needed. This is also part of the reason I came back to the US so
hopefully I will move back to Sweden and keep studying sometime. I
want to come back to Sweden or Norway and train when I'm in good
running shape again so I can get the most out of being on such great
maps with great training communities. It took about three months for
me to consistently be able to walk with no pain, even long walks.
And, it took a total of about 5-6 months before I was ready to start
running again. It was feeling tons better after about 3 months and it
might have been ok for me to start earlier. But, having dealt with
this for so long and having thought that it was getting better before
when it wasn't, i decided to be cautious. I'm so so so excited to be
running again! Time-off definitely needs to be combined with other
efforts as well. I took 6 weeks off pretty early in the injury (but
after an 8 hour adventure race) but wasn't doing any exercises or
using orthotics or anything then. It was enough time off to get me
running again... but not enough to actually get it healed. Again,
it's different for everyone. I think I'd managed to give myself a
pretty bad case just because I thought I was invincible and I was so
excited to train in Sweden.
10. Never walking barefoot-- A lot of people will say that you should
never ever go barefoot. I don't believe that although I do think that
sandels are not good (when barefoot I think I'm more on my toes... but
in sandals the heel abused more without cushioning). I did no
barefoot for a long time, but in the end I felt that you need some of
the strength in your foot that you get from walking barefoot. So, I
found that if I tape, it's ok to go barefoot. The taping keeps the
arch up and gives you a nice heel cushion. It's also nice to do some
of the exercises barefoot. But, mostly I love walking in grass
without shoes (although i guess it will be a few months before you can
do that in Norway:).
11. Ibuprofin/advil, etc. I didn't use these much... but some people
recommend them. I could see using them when it's bad or maybe
consistently for a week or two (3 x a day) to get the inflammation
down in conjunction with taking time off and doing lots of other
stuff.
12. Cross-training-- when it was at it's worst, even biking and
swimming were tough because of having to push off the walls
explosively in the pool and use the foot so much while biking.
However, once it was a little better both of these felt good to get
some blood pumping and exercise without running. Aquajogging was also
fine I think. At the same time, it's possible that some time fully
off could be good too (I ended up with about a month of just walking
when I was traveling in Turkey). It's hard to say.
------------
something wrong with my heel... has been annoying for a while.
Talked to Sandra today (August 2cd) and found out that it is most likely a heel spur. At least I feel like I can do something about it now... definately frusterating as it has gotten more painful.
More input from Mike Smith, Charlotte, and the internet. Seems like heel spurs and plantar fasciitis are quite related. So, stretching, ice, rest, exercises, etc.
Damn it!
Dec 11... perhaps heading in the right direction... cautiously hopeful...
running more...
Here are some things you can do. As a warning-- this is not coming from doctors or anything like that. Rather it's the accumulated info from websites, a physio I talked to, friends who have dealt with it, and what I've tried to do. I've tried some different combinations of this at different times. Going to a doctor is clearly a good idea too.
Stretching is the first line of defense for the pf. Stretch the calf in all the normal ways of course. Also, when you wake up, massage the bottom of your foot (around the arch) to get the blood flowing and stretch out the tendon along the bottom--- pain when you get out of bed or stand up is one of the characteristic signs of pf and that pain is often related to creating new micro-tears. Do both several times a day as well.
Shoes-- have you gotten new shoes recently? Are your shoes getting old? Have you been doing more running that usual in o'shoes? Often this problem relates to some shoe problem and it may be worth trying a different pair. I think I got it in the first place because I switched abruptly to a pair of shoes that for some reason weren't great for my feet (although they felt comfortable).
Exercises:
"Tennis Ball"- get a tennis ball and roll it under the bottom of your foot-- good to do while sitting down for a while
"Towel Toe Curls" - get a towel and stand on it (or do while sitting) use your toe to pull the far side of the towel towards you. To make this more difficult you can put some sort of weight like a water bottle on towel to weight it down.
One legged squats (may be bad for the achilles at this point... not really sure)
Walking on toes but when you bring the foot up between steps dorsal flex it (so you go from tippy-toes while standing to flexed foot as you step)
Slow lunges where you go up on your toes as you step
Many people say to never walk barefoot. I'm not sure if I totally agree with this but I think it's a good idea if walking barefoot is painful. Otherwise I think walking on your toes barefoot can be ok-- but flatfoot barefoot is tough because your arch has no support and your heel pad may not be padded enough so it's painful.
Other lines of defense:
night splints- a boot that you can put on while you sleep that keeps the foot from being pointed (especially helpful for stomach sleepers who point their feet). Thus, when the body heals during the night it will heal in a flexed rather than pointed position-- that way you are less likely to retear everything in the morning when you get out of bed.
orthotics- you might not need these yet but they are one of the classic things to do if it continues
contrast baths at night-- alternate 1 min icing in ice with cold water with 30 second warm water for about 7:30 minutes (I would do it longer but at that point the water is usually not as warm or cold). Start and end with cold. It's possible that just ice can also help, especially early. Nor sure about that.
Acupuncture-- seems to be helping me... perhaps a later line of defense
Some doctors do cortisone shots, I haven't tried these yet because I've heard pretty mixed reviews both from real people and from what I've read online include journal articles. There is dispute about whether they are actually effective or not and they increase the possibility of tendon rupture-- but for some people they seem to help. I'd rather not do them if I can get rid of it some other way.
Several years ago I also had the crepitis in my achilles-- it sucked. I rested for one month at first. Then I did one week of taking ibu every 6 hours plus a friend gave me a painful calf massage to help the calf loosen. I think I was pretty lucky with that going away as quickly as it did.
Rest-- a good idea but not necessarily a cure by itself because you still have to be careful of lots of standing or walking or getting out of the bed. So, rest smart-- try to do lots of the stretching and such so that the time you are taking off is productive. Some say they can run through it and it's ok... but I'm finding that now that I'm finally taking rest again it seems to really be helping.
--- acupuncture in early June-- no running since then. Stopped contrast baths while in Latvia since I didn't have any access and then continued to not do them later because I found they were causing more pain than helping-- perhaps a sign that I no longer had an active inflammation?
--- between July 5th and 17th only had pain on the 6th and 12th I think.
I'm playing beach ultimate and wearing heals sometimes. Let's call it healed. But not forgotten. Consider this a major resolution to continue taping, stretching, sleeping with "the foot," and massaging.