Plantar Fasciitis – Part Two
How I got it.
This is the second article in a series on how I got through Plantar Fasciitis.
Why do you care? I don’t want you to have to suffer through a long layoff from running like I had to. My story might help you catch it at the outset or avoid it all together.
I knew I had Plantar Fasciitis and made an appointment with my foot doctor at the end of June 2011. I first noticed that my heel was sore sometime in May of that year. I made the appointment after running the Mojo-StLoco event in St. Louis. At that point I could not run any distance at all without my heel throbbing with pain. Walking aggravated it as well – especially in business shoes. It would throb during the day while I was sitting. I would be bad in the morning when I first got out of bed.
In May I had successfully trained for, raced and re-qualified at the Boston Marathon in early April. I had no heel pain at that point in time, even though I was logging some significant road miles and some high quality tempo workouts. I was running 5 days a week and around 30-40 miles total in the months leading up to Boston. I had been running injury free since breaking my ankle in 2007.
Looking at me you would not think I was at risk for an overuse injury. I had been running at this intensity and volume for several years in a row with no problems.
Whenever I get injured I look for what I changed in my routine, I look for what happened that was different that could cause the injury. In this case I can’t be sure, but I can hazard some guesses.
Usually after Boston I cut back the intensity of my training and transition into something with less pounding on my legs. In previous years it had been trail running, or triathlon or mountain biking. By changing my sports focus seasonally I prevented my body from wearing out.
In 2011 I decided to train for all three at the same time, a triathlon, a mountain bike ultra and a trail ultra. I figured the long slow distances of each sport would be complimentary.
Even though my total hours of training did not increase the mix of the training changed significantly and this may have contributed to tweaking something in my heel. Specifically I transitioned from long and intense road workouts to long and less intense trail runs. I cannot conclude that this training transition put more stress on my arch per se but it was a change and could be considered part of the causality.
When I transitioned back to the trails I did so in an older pair of NBMT100’s. These are a fairly minimal trail shoe with a stiff sole. The fact that they were getting a wee bit long in the tooth may have been a factor in the Plantar Fasciitis.
The combination of a training mix change and shoes past their sell by date could have been a causality. I do remember the first time I noticed a little heel pain was while running in the trails with those shoes on. It felt like maybe I stepped on a pointy rock and picked up a minor bruise.
This, my friends is the next thing you need to think about. The way this injury manifests is so slight and unobtrusive that you don’t get a chance to respond to it. I did not think I was injured. The pain was so minimal. In hindsight I can see that this was when the tear started.
There is something about the nature of the tissue in the Plantar region that makes it numb by nature and you won’t pick up any sharp pain when this thing starts. The only way you would be able to catch it would be to work over your feet with your hands and fingers. In this way, with some close inspection, you might find the tear.
After that moment it got worse, but not worse in a way that I noticed. I noticed a slight ache in my heel. It only hurt sometimes and was quite minor. I was in such great shape and had been injury free for so long I didn’t even see it coming.
But, over the weeks it got worse slowly. The long run in St. Louis on cement sidewalks pushed it over the edge. Having to walk through airports in my dress shoes pushed it over the edge.
The bottom line is that this debilitating injury that knocked me down for almost two years snuck up on me. By the time I figured it out, it was too late.
How can you avoid a similar fate?
Pay attention. Especially to any pain in the heel, bottom of the foot, between the toes or anywhere near the arch of the foot. If you feel any small ache in this area dig in there with your fingers and see if you can isolate it. For me I could feel the little knot of scar tissue when I dug into it.
Try to avoid any abrupt transitions in your training even if they are nuanced changes and pay attention to ANY pain in the weeks following that transition.
Don’t try to get an extra 500 miles out of old shoes. It’s not worth it. Spend the $100, it could save you two years.
When I start describing exercises to make your feet stronger in upcoming articles – do those before you are injured as prevention. (They don’t work so well once the damage is done)
If you have pain, no matter how minor, in the foot, for more than 3-4 days, STOP! Let it heal and get started on a strengthening/massage campaign before you get scar tissue.
I should not have joined my friends in St. Louis. I should have quit running weeks before I was forced to. Working out on the injury created scar tissue. That scar tissue is still in there and I work with it every day.
Be Smart.