Guest Post – Coming to terms with Plantar Fasciitis

Coming to terms with Plantar Fasciitis

By Don Chapelle

Before we get started I want you all to know this is my recipe for success as I have Plantar Fasciitis in both feet. This paper will help you manage the onset of the condition and in mild to semi-acute cases, aid in your recovery.

Five years ago I tore a bit of the plantar tendon in a track workout. Like Achilles Tendonitis only rest will help a plantar tear: 6-8 months to be exact. If you have a tear and when that tear has healed – only then subscribe to using the tips outlined below utilizing these tips the last 3 months of healing process with some easy running.

Plantar Fasciitis results from age, flatting arches and most importantly for runner’s overly tight calf muscles including soleus and the Achilles tendon. Once you get plantar issues you will never rid yourself of the condition but you can manage it and reach peak condition for racing. Once the condition has been neutralized you can run years without flare-ups.

Critical footnote is that you must find the tasks from the list below that work for you. It goes without saying; all of us are different and have different deficiencies so it is up to you to concoct the right recipe from the ingredients below that work for your condition at a specific time. Also important to footnote as the condition heals, things what worked when the problem was acute will most likely not help when you when you are in the throes of healing and normal blood circulation resumes,  so you will need to mix and match through the healing process. This point is what folks just don’t understand or remember.

Q. How do I know what is working and what is not?  A. You will feel relief immediately whether in a few minutes or a few days. Any change is a good thing.

One thing that must be a constant when healing the Plantar is the consistent use of a night splint to stretch the calf muscles. (Usually up to 6-8 months)

Here is an outline that works for me in a day’s chronological order:

Before you get out of Bed:

Upon waking up in the morning BEFORE your feet hit the floor, point both of your toes and spell the alphabet with your entire foot moving and swirling around to form the letters A-Z this will loosen the Plantar/calf/ache lies to allow you to go to the bathroom.

WAIT! Before you put your feet on the floor put them in a very soft pair of Isotoner or Dearfoams slippers.  (See the link below paragraph)  A well-padded slipper will support the arch and cushion the foot. This will help protect healing that went on the previous night. As getting straight out of bed and hitting the hard tiled bathroom floor without support and stretching will defeat any healing gained the night before. If you have any hard wood or hard flooring in your house wear your slippers 100% of the time while home. You should have almost 80-90 comfort from the condition while wearing these specific slippers. If not you have purchased the incorrect slipper.

http://www.dearfoams.com/dearfoams-dm528/321527/687885

If you run in the morning it might behoove you to change your running schedule to a PM run. This will allow you the whole day to loosen up those muscles that are tight in the AM so you can have an enjoyable run or workout.

If you do run in the AM:

There are a few things that can help immediately if you have a mild condition.  Firstly, use this link below to find these Dr Scholls inserts, they make three kinds of plantar inserts for various conditions, and I find that only this one works for me and have tested all of them. I have worked with at least 5 runners and each said that this insert is the real deal and really helps. They cost 13 dollars and are to replace what ever money you wasted on orthodics.  You can get these at CVS, Brooks and most large stores they come in different sizes.  I found that a woman’s large worked perfectly for me. Stop laughing – that’s all that was on the shelf when I needed a pair and said who is going to know? Remember this exact insert no others as Dr Scholls makes three that look very similar.

Here is the link for the inserts

http://www.drscholls.com/drscholls/productSearch.do?method=doProductDetailsLookup&searchArg=2

I hear there is one Doctor inDanversthat makes a soft orthotic for runners. Matty Rivit and Coach Paul McGovern swear by them and wear them 100% of the time for the last 12 years. Do not waste your cash on anything else. I have a pile of hard orthodics that aren’t worth the price of the plastic.

The Doctor’s name is Dan Bishop,74 Elm Street,Danvers,MA,01923,   978-774-0473

The reason behind a supple arch support is that it is supports ever so gently the Plantar without pressing too hard against the tendon taking off some or most of the pain and pressure. Rigid orthotics just hammer the tendon and causing pain and resulting in inflammation.  This is an important keystone fact.

New Balance says they have a shoe that helps with the plantar problem. You can identify a NB plantar aid shoe by its “NLock” insignia on the inner and outer arch of the shoe.  Use the Doc  Scholls inserts in all of your running and work shoes.  I’m not entirely sure that NB has the right formula yet to control plantar problems but it is worth mentioning. I have a few pairs and they work ok.

Back from your run:

So you are back from your run. Towel stretches while on the floor are good for Achilles as well as calf and plantar and a must, if you are not a stretcher and don’t take the time to do so forget running and take up the Piano.

Let warm water build up around the foot while showering, then when out of the shower take some message oil or cream and massage your plantar using good pressure on either side of the tendon. If you feel an itchy and crackling feeling with hard pressure you have buildup of scare tissue, you will spend the next month to 8 weeks messaging away the scare tissue in this fashion. Just take your thumb and first finger and rub up and down the plantar hard for 5 minutes. Now you are ready to go to work. (Do not try this unless you are warmed up)

Lots of runners use a golf ball as well rolling it over the plantar to breakup scar tissue while watching TV or on the PC. This step must not be confused with any healing efforts as it is not, it’s just allowing the tendon blood flow to start the healing process. If you skip this step arrange your piano lessons.

While at work if you sit all day take a frozen water bottle Poland Spring 12 or 16 oz. and roll your plantar over it barefooted.  And do the same thing while watching TV, eating dinner, FB, reading this email.  Stop wining this will work…

While sitting in traffic try to give your calf muscles a stretch my bending your toes upward. I have a spot in all my cars where I can take my shoe off and stretch the toes upward taking pressure off of the plantar. Don’t go too nuts just every 10 minutes on and off.

Daily shoe wear:

You will need to purchase several pairs of shoes that the Dr Scholls insert will fit in or a shoe that offers a very soft and gentle support. Birkenstocks work well for some I use rubber clogs the kind you might see in industrial kitchens worn by chef or nurses in hospitals. They offer great support and a huge amount of cushioning as well as a good heel stretch. (Yes heel stretch) The same style is available for women

Here is a link of my favorite work shoe. Some people with wide feet like “Clogs” (it’s a brand) Never-ever wear wooden or rigid clogs. Clogs (the company) are acutely aware that folks who have plantar issues come to their site. So they are continuously coming up with new designs for plantar issues. I like the Bistro model mentioned below but others like the following.

http://www.crocs.com/crocs-bistro/10075,default,pd.html?cid=001&cgid=men-footwear-clogs

http://www.crocs.com/crocs-specialist/10073,default,pd.html?cid=001&cgid=men-footwear-clogs

http://www.skechers.com/shoes-and-clothing/styles/casual_shoes/work_shoes/slip_resistant_shoes/product/work_oswald_-_balder/blk

Well at some point you are going to have to wear shoes that look nice for work, church and such so try to find a flexible shoe that works for you, using what you now know about the issue. I can’t tell you how many shoes I purchased within 10 minutes of wearing them my plantar became inflamed sometimes acutely. They felt great when I tried them on in the shoe store, but just didn’t work later. Give it some time, this part is not an easy process find a friend with the same shoe size and pass the new misfits along to them. DO NOT WEAR ANY UNFLEXABLE STIFF LEATHER SHOE- EVER! If you cannot bend and or flex the shoe (to include your running shoes) give them away and start over.

A huge suspect for women who have plantar is high heals and very rigid shoes. The high heal compresses and shortens the calf muscles over time, putting lots of stress on the plantar doing exactly the opposite of what is needed.

Also there is a band that you can put around the arch to keep it warm and in my case I wore it with dress shoes with little or no support. I did like this during the acute stage of the injury but it aggravated it later during the non acute stages. See link below the better ones are sold at sports stores I think Whirlaway sells them.

http://www.drugsupplystore.com/servlet/the-532/PediFix-Arch-Bandage-Plantar/Detail

Worth a try – maybe?

I tried physical therapy and Active Release Technique both work well for getting the problem under control but are not fixes. You must do the work as well.  Ultrasound and the “barbed foot roller” fall into the category of “maybe”.

Candy O’Toole an MVS runner swears by acupuncture for the plantar, although I’ve never tried it many report good results. It’s not going to fix your problem just reduce the inflammation.

Night Splints

Ok now it’s time for bed the most important time for plantar healing. Night splints do what you failed to do when training/running. They slowly stretch the calf muscles over time lengthening the muscles which take the pressure off of the Plantar so it can heal. Again the intention is to let this happen slowly, you might not notice any change in your condition for the first 3 weeks, furthermore I would venture to guess that little happens in the first 6 weeks of wearing a night splint. This is one of those consistency things that work over time. Again this is the #1 aid to getting you back to smooth running so jump on this one ASAP.

The Strasbourg Sox is not recommended and very uncomfortable – don’t waste your money.

The full length knee to toe night casts are heavy unless your spouse likes black and blue marks from getting kicked in her sleep, they are an ok option; althoughit is the most effective night splint system. They are expensive and most likely you will need a referral from you Primary Care Doctor to get one. There is a Medical store inAndover on Rt 28 North Main Street that sells them over the counter at least 200.00 without insurance. They are heavy and cumbersome I found it hard to sleep with it on. But they work the best.

If you sleep with a partner best choice is the Futuro Night Splint see link below.

They are light and adjustable comfortable and not rigid. If you need to “go” in the middle of the night, no biggie just hobble over to the bathroom, also machine washable and only 34 bucks. You can find them at most CVS pharmacies.

http://www.futuro-usa.com/product_detail.aspx?id=38

Speed workouts or hills

You have worked you way up to doing some speed and hill repeats. The plantar is going to nag each time you ramp-up your training so manage the process with ice and IBP and all the other things that you have learned about the condition. Ice bath works the best post workout.

More Random items:

There will come a time that you are feeling the Plantar is healed about 85-90% and is not getting any better. I find at that point you need to get blood flow to the area from easy running (no hills or speed work) bike or Elliptical.  I also like to suggest depending how long you have been laid off several sets of heel and toe raises to help blood flow. \

An additional foot note. It’s been 14 months since my last flare up. Mummm what have I changed?

I started barefoot running – yes I can hear you rolling your eyes and smirking.  But when I pass you in the next 5K because I wasn’t laid up or slowed down by my plantar we will see who’s laughing at the finish line.

Barefoot running is not a full-time activity think of it as another part of the week’s workout of strength training, like speed, tempo and long runs. I now run 3-4 times a week maybe a mile sometimes more sometimes much less to keep my feet and plantar strong and I can tell you it’s the coolest thing a runner can do to help with leg speed etc.

Before you go out and run barefoot get a book, the best one on the market is barefoot running by Michael Sandler a bit of a flake, make that really flaky but he explains and warms you to the sport.

I run barefoot without the 5 finger shoes – best way to go. With the 5 finger shoes you don’t get the strengthening of the foot as fast. Yes, I run on concrete, through the woods, grass, paved roads and side walks totally barefoot. You can stop laughing now and get out there and run your first 100 yards barefoot. Once the plantar is 85% healed you can start this step for preventive measures. It really works

Good Luck

Donald Chapelle