Plantar Fasciitis

I have had lots of injuries in my short running career. Most of them are overuse injuries. Plantar Fasciitis is just one of them. So many runners I know either have had, or have PF than it must be epidemic among us. Here are the techniques that I've used to solve this particular problem for myself.

First off, a good resource for basic information about PF can be found at http://www.heelspurs.com/.

I'm convinced that PF, like many running injuries is something that can be controlled, but never cured. That means that you will be managing this condition from here on out. If you want a magic bullet, you're out of luck. Despite that grim outlook, I think that most runners can run and walk pain free with some time and effort.

Here are my recommendations for how to deal with PF.

1. Never go barefoot.
Always wear good supportive shoes (such as old running shoes) unless you are in the shower. I know that there are some wags that suggest that modern running shoes are ruining our feet and that walking and running barefoot will make your feet stronger etc... Fine, but your feet aren't normal. They are sick and broken and walking barefoot is just going to make them worse. Deal with it.


2. Stretch your foot.
Before getting out of bed in the morning and before going to bed in the evening stretch your foot. Do this by taking your palm and gently pulling all of your toes back. You can also gently twist the foot as well. If done properly you should feel the fascia of the foot gently stretch. The idea is to gently stretch the foot before you stand on it and do a very forceful stretch with your entire body weight, re injuring the fascia. As with any stretch 3 reps of 20-30 seconds.


3. Stretch your calf muscles.
This means stretching in the morning, afternoon, evening, before your runs, after your runs, and when you even think about running. I've changed my mind a bit about stretching in general, but I consider this to be a therapeutic more than simply a preventive measure.


4. Tape your foot.
The web site I mentioned about has a good pictures and descriptions of how to tape the foot.http://heelspurs.com/_intro2.html#tap When the PF is really acting up, taping, along with the other interventions can help it to heal faster.


5. Over-the-counter Orthotic Arch Supports.
Spenco, Superfeet, and others make these in both 3/4 and full sizes. These work well in your dress shoes to give your foot some better support. Furthermore, if you are like me and spend most of your day in an office environment, you may want to look at a very supporting casual/dress shoe like Rockports


6. Prescription Orthotics
What you should have done, if you haven't already, if to go see a podiatrist or physical therapist that is familiar with working with athletes and good at fitting orthotics for runners. My prescription orthotics have been great. They are made to be worn in running shoes, not dress shoes. I use them all the time in my training shoes and have even used them a lot in my racing flats. Well worth the money and some insurance programs will partially cover them. Some folks do fine with the OTC inserts, but I've had better luck with the Rx orthotics for my running shoes.


7. Night Splint
Besides the prescription orthotics, this is one of the best treatments available. The idea is that at night, your calves, Achilles tendon, and plantar fascia tighten up. The night splint keeps your foot and toes from pointing away from you while you are sleeping. There are a number of different kinds on the market. I've tried three of them and hated one and liked two others. They are not particularly comfortable to sleep in, but you get used to it and PF is even more uncomfortable.


8. Ice your feet after running.
I don't mean that sissy stuff like rolling your foot over a frozen juice can, but take a bucket of water, fill it with cold water and ice, and soak your feet for 10-15 minutes . If you can do this with your toes gently being flexed back on the side of the pail, so much the better. Just close the door so your screaming doesn't disturb the family. Hey, if running was easy, everyone would do it.


9. Massage
There are a number of ways to do self-massage of the fascia. Not sure why this works but my guess is that it is breaking up some of the adhesions created by the injury to begin with. The frozen juice can or water bottle can be used here but I found the perfect solution was a baseball. A golf ball was too small for my size 12 foot, but the baseball worked fine. I would sit at my desk, take off a shoe, and massage the foot by rolling it over the ball. Concentrate on the areas that are painful. It is best if you have a private office so your co-workers don't wonder about the sounds you are making.


10. Anti-inflammatories
NSAIDs like Ibuprofen (Advil), Aspirin, or Naproxyn Sodium (Aleve) can help reduce the inflammation from the injury. The over-the-counter dose listed on the bottle is for pain however, not inflammation. The effective dose for inflammation is about double that for pain. The problem is that these drugs can do very serious and nasty things to you and can do it in a hurry. They help, but don't start self-medicating yourself. Talk to your doctor first.

If you do all of the above, you should be able to start running again at reduced mileage relatively quickly. Slowly build up your mileage while doing as much of the above as it takes to keep the symptoms at bay. To be honest, I don't do all of these things now all of the time. At the moment, I have no PF pain or symptoms so I'm simply doing the stretching, wearing good shoes and orthotics. At times it does flair up again and I add back the items above as I need to.


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David S. Hays, O.D.,dhays@davidhays.net