Plantar Fasciitis Part Three
You’ve got it, now what?
You have to be careful. There are a whole lot of ‘guaranteed cures’ out there on the internet. This is a very common running injury so everyone you meet will have some advice. Be careful.
There are two things you need to absolutely burn into your head.
- “Plantar Fasciitis” is a very generic term and the manifestation that you have is unique to you. What everyone else has is not what you have. What cured them may or may not cure you.
- The degree of seriousness of the injury will determine what options are available and appropriate for you. Applying a cure that is meant to be ‘preventative’ to a chronic injury may make it worse.
Go to a good sports foot doctor specialist and have the diagnosis confirmed. Again, be careful with doctors and health professionals in general – they are good people but they are quick to make decisions based on their experience and that may or may not be appropriate to you.
Plantar fasciitis is a soft tissue injury. The only way to really ‘see’ it is with an MRI and your doctor is going to be hesitant to schedule that expensive procedure just because you say your foot hurts.
Here’s what you need to find out at your appointment:
- Is it plantar fasciitis?
- Exactly which specific muscle(s), Tendon(s) or Ligament(s) are injured? (All of these little guys in the foot have unique names – get specific.)
- How bad do they think it is? “On a scale of 1-10 how bad in this injury?” Is it irritated? Is it swollen? Is it torn? Is there scar tissue? The injury may be quite swollen when you go in if you’ve been running on it so they may not be able to answer these questions until the swelling goes down.
- Have them dig in there with their fingers and feel around for obvious lumps and bumps. Have them show you on a model or in a book or on the internet exactly which structure is injured. Have them pinpoint it manually for you when they are digging. Visualize it from the model then get your fingers in there and feel it. Connect the two in your mind.
Great! Now you know specifically what it is (as much as possible without an MRI) you can start to deal with it.
Your doctor may want to take some action right away but you should probably hold off until you know how bad it is and whether it will recover with some rest. 9 times out of 10 the doctor will proscribe anti-inflammatories, rest and ice. They will probably give you a set of exercises to do. They may move you straight to physical therapy. If they are very aggressive they may try to give you a cortisone shot or something else.
Your first step should be to let the inflammation come down and let it heal to the point where you can treat it.
Don’t start doing any exercises until the swelling has come down. Don’t start PT or any other kind of treatment until the swelling comes down. Your first goal is to get the injury into a state where you can treat it.
How do you get the inflammation down?
Common injury practices to reduce inflammation:
- Stop running (2-3 weeks here could save you 2 years)
- Ice it a couple times a day. (I froze a plastic bottle and put it under my desk while I was working so I could roll my foot on in)
- Anti-inflammatories are fine but only for a couple days – after that your body adjusts and they don’t work as well.
- Stop doing the things that make it worse (Walking, standing, yard work – all that stuff)
- Get out of your work shoes (if your company will let you, spend your days in socks, if not try running shoes. We’ll talk more about shoes later)
- Watch your diet. (Eat your green, leafy veggies – don’t eat inflammatory foods – yeah I know it sounds a little new age, but seriously, ask one of your vegan friends)
The next thing you need to do is learn how to support the injured tissue to let it heal.
Common methods to support your injury (i.e. prevent re-injury while healing)
- Learn how to tape the foot to take the pressure off the injury. (There are different methods for this but I used this one -> http://youtu.be/Wy1ZEJ-kKTg ) If you have a situation where you can’t stay off your feet do this to support the arch for that activity. Don’t leave it on for more than a couple hours or your skin will ‘pickle’ and tear off with the tape.
- If you can’t get out of your work shoes you can try different inserts to relieve the pressure on the injury. This is going to be specific to the shape of your foot and the position of your injury. I bought a couple of different flavors of orthotic type inserts, but at the end of the day had the best luck with off-the-shelf Dr. Scholls Gel heel cups. http://www.drscholls.com/Products/MG_index There is no magic here. You’re going to have to try different ones until you hit on the ones that work for you.
- If you can get away with wearing sandals I found two that did a good job of supporting the injury. The Spenco Slide sandals http://www.footcaredepot.com/spenco-mens-polysorb-total-support-kholo-slide-sandals/?gclid=CMqHvN7n8bkCFcaj4AodCHgAfg. And the Adidas Adidassage sandals that you can pick up at any store for $30. I got mine at Kohls http://www.kohls.com/product/prd-142134/adidas-adissage-sandals-women.jsp The nice thing about these is that the little nubs dig into the injury and promote blood flow.
- Get a night splint. This will keep the Plantar system from contracting while you sleep – this is what causes the morning pain. There are different versions of these – mine looks like something like this http://www.birdcronin.com/product_categories/product.aspx?product_id=430&product_name=Baker%E2%84%A2%20Plantar%20Fascitis%20Night%20Splint&folder_id=190 The added benefit of a night splint is that it treats Achilles tendonitis as well.
- If you have to wear work shoes get some that don’t’ make the injury worse. Again, there is no universal silver bullet here. I ended up going to DSW and trying on every pair of shoes they had. Focus on shoes with less structure, more flexibility and squishier rides. You want something that is not going to fight the foot.
Now you are ready for phase 1 of the Plantar Fasciitis recover process. Letting it heal and keeping the pressure off of it to allow it to heal.
Give it a few weeks until the swelling is completely gone. You may still feel the pain in there but there should be no visible swelling, redness or heat in the injury.
Do not start treating the injury until the swelling has gone down. All those exercises that your well-meaning friends will recommend are fine, but you’re not ready for those yet. Give it time to heal.
And, it goes without saying; you have to take some time off from running. If you have a race scheduled cancel it. Clear your calendar. There is no running away from this injury. Your job now is this injury. There will be no more racing or training until it is on the mend. Make an investment now and it will save you months of recovery. Do the smart thing. I wish I had.
Next time we’ll talk about phase two. Treating the injury.