Friday, March 13, 2009

Plantar Fasciitis

Dealing with plantar fasciitis

If you run, sooner or later you will get hurt. Lately, seems all of my friends are dealing with plantar fasciitis (pain in the heel and/or bottom of the foot). Here is the advice I usually dispense, which seems to be helpful. Major Caveat: I am not a physician and will never pretend to be. What follows is homespun advice coming from my experience with this injury and my attempts to help my friends deal with it. If you think any of this advice is hogwash, well, you are not only entitled to your opinion but you may even be completely right. All I can say is that this stuff has been helpful to a lot of people within my (admittedly limited) circle. If you are in real pain and it’s not getting any better, then stop reading blogs and go see a real doctor!

1. While running: use hard, thermoplastic heel cups in your shoes. These will look and feel funny at first, but they just plain work. In fact, every runner should make sure to have at least one pair around and use them anytime you experience even a twinge of heel pain, arch soreness, or Achilles tendon tenderness. Note: do not even think about those silly “gel” heel cups or anything made of rubber or soft materials; they might seem like a good idea, but frankly they could make your problem even worse. Hard plastic heel cups can be hard to find because they aren’t popular sellers at chain stores. Try checking eBay.com or amazon.com under “hard plastic heel cup”. Should be relatively inexpensive, maybe $20 or less per pair.

2. Get some supportive sandals or shoes to wear around the house and as much as possible. There's the classic Birkenstock Arizona, for example, in men's or women's models. There are also some stylish women's sandals by California Footwear Company, they offer support and need almost no break-in period, and IMHO offer the best price for the features that you can find. As much as you can, try *not* to walk barefoot until the foot is fully healed, EVER. Don’t even tiptoe to the bathroom in the middle of the night with bare feet, or you will re-injure tissue that was trying to heal while you were sleeping.

3. For your everyday shoes, if feasible, adding a significantly firm arch support will really help. I think that these $60ish Birkenstock blue foot beds work really well (women’s model shown in the link, but they make them for men too). These are almost as good as expensive orthotics. I've found them available at Zappos or directly from Birkenstock

4. Loosen the calf muscle through gentle stretching. Best stretch is a non-weight-bearing type. Easiest is simply to engage the shin muscles to lift the top/toes of the foot toward your knee, about 5 seconds at a time, then relax. Start with maybe 5-10 repetitions about 3 times per day; you can increase by a little every couple of days until you are literally doing this a couple hundred times a day. (After you are fully healed, do these every other day as a preventative measure).

5. Loosen the calf muscle through self-massage. I like “the stick”: http://www.thestick.com/products/index.cfm You enter your vital statistics, and they recommend which model to buy. Or just go to the nearest running shoe store, or sometimes your health food store will carry them. Doesn’t really matter that much which exact model you get, using it consistently is the trick. Your goal is to relax and elongate the calf muscle, encourage it to release. Warm soaks in the bathtub prior to the massage will help even more.

6. Exercises: Do only if this doesn’t cause pain! Either pick up spilled marbles with your feet, or do the “dish towel curls”. There are decent descriptions of these on WebMD.
Marble Pickups
Towel Curl
A note on WebMD: while they show these exercises well, the other stretches they recommend are, in my humble opinion, too intense and likely to cause Achilles irritation or even injury. Stick with the stretch in #4 above.

7. Fighting inflammation: The Dr. will probably want you to take anti-inflammatory medication, which is fine (if your stomach can handle it). You can eat certain things that will also be anti-inflammatory: pineapple, mango, banana, garlic, onion, mustard, fresh fish, soy, yogurt … and reduce your intake of caffeine, alcohol, eggplant, cabbage, grapefruit juice, and anything that you might be allergic to (shellfish, peanuts, whole wheat, strawberries, tomato?). Okay, all of this might be just old wives’ tales, but I’ve found that it has worked for me and for others. Finally: never ignore the anti-inflammatory properties of good old ice. For this injury: fill a small plastic water bottle (a round one) with water, freeze solid, then take it out twice a day to simply roll the afflicted foot back and forth on it until it melts. It's cheap, re-usable, and remarkably effective.

8. Go to your local health food store and purchase “bromelain” in pill form. It is a natural substance (found in pineapple) that some studies have shown to be nearly as effective as acetaminophen ibuprofen or aspirin at fighting inflammation, with no real side effects (although be careful taking it with antibiotics or blood thinning medications. (UPDATE June 2015 - I stand corrected by a reader, who pointed out that acetaminophen isn't actually an anti-inflammatory, but is a pain blocking medication. Also, summaries of bromelain's benefits - and minor risks - can be found here and here)

9. Practice patience. I know that you are a runner, and living through even one day without a run is nearly as painful as your foot. But take the actions described above, and you’ll get over this injury just like you have gotten over all of the others. What’s that you say, you never get injured? You are one lucky, lucky dog (or, you are basically a liar).

UPDATE: July 5, 2013: I'm very glad that so many have found these tips and tricks helpful since I posted the information over two years ago. I hope that anyone suffering with the pain and annoyance of plantar fasciitis is healing quickly. I just ran across a short article in Runner's World that offers a few more decent tips: Five Tools for Treating Plantar Fasciitis.

UPDATE: July 13, 2015: This post continues to be the most-visited of this blog, I guess it's got some staying power and/or is a reflection of how all-too-common this frustrating and painful injury can be. I remain hopeful that this information is helping at least some people. I've discovered another article that may add to what's been shared above: New Techniques for Treating Plantar Fasciitis

9 comments:

  1. I am not a runner but am on my feet alot. I have flat feet and have just recently had trouble with plantar faciaitis. Thanks for all your helpful (and drug-free!) information.

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  2. Thanks for sharing, I will bookmark and be back again.

    Plantar Fasciitis

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  3. Tremendously helpful, new-to-me information here, Douglas. Thank you for posting. Online looking at hard shell inserts and bromelain. Thanks!

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  4. Yep, just found this. Have a marathon in 4 weeks. I'll be getting the heel cups. Thanks!

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  5. Jerry in Lakewood WADecember 29, 2013 at 3:03 PM

    I had to stop running last April due to supposedly plantar fasciitis. Foot Dr gave me cortisone shots, orthotics, medicine, and nothing helped until I saw a physical therapist who said it might not all be plantar fasciitis. To her, it seemed that my fat pad in that heel was deteriorated. She showed me how to tape my foot and also wear plastic heel cups and immediately my pain was going away but not to run until beginning of 2014 to allow my fat pad to heal. I'm following your advice and will run in them without taping.

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  6. Nit: acetaminophen (Tylenol) is not an anti-inflammatory. So hopefully bromelain is _more_effective. :-)

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    1. Good catch. Clearly I'm no physician. Sigh. I edited the post to reflect your input. Hope you are injury-free!

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  7. I had PF right when I was coming back from pregnancy and it was so bad in both of my feet! Gah. I focused on my calves like you're doing, plus also rolled my feet (and used a foot massager while watching tv , and a majority of it really did clear up in a few weeks.

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    1. Glad to hear that you've managed to fix the issues with your plantar fascia. Hope you remain injury free!

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