Recovering from Plantar Fasciitis – Part One

Over the past 24 months I have gone from the height of being a qualified marathon runner, ultrarunner, triathlete and ultra mountain biker to the low of not being able to do anything outside of a few paltry calisthenics and a few sad minutes on the elliptical machine.  I was laid low by that most insidious of running injuries – Plantar Fasciitis.

Over the last 9 months I have built my base back from a couple easy runs a week to 50+ mile weeks and a marathon a month.  I have worked through and beaten back Plantar Fasciitis.

This article is the first in a series. Of articles on what I discovered in the process.  I will document my battle and the multitude of false cures; what worked and what didn’t. I am not unscarred from my journey.  I will probably never be at the level of running capability I was at before but I have gotten back to the point where I can execute the volume and quality necessary to pursue the sport as a competent amateur.

What is Plantar Fasciitis?

This is one of the insidious things about plantar fasciitis.  That label can refer to a number of different ailments.  All it means is that you have an injury somewhere in the fascia somewhere in the plantar region of your foot.

In my case and in many cases it manifests initially as heel pain. The heel pain gets progressively worse until you can’t run any more.

Fascia is a generic term for the sheathing and non-muscle connective tissue in the body.  There is a large amount of fascia in the foot.  In my case of Plantar Fasciitis I had a tear in one of the tendons that connects the big hunk of tissue that forms the arch of the foot to my heel bone.

I have heard of cases that involve different area of the foot fascia.  For example the forward attach points of the arch near the toes.

Why do you care?

Because when you are diagnosed with ‘Plantar Fasciitis’ it is a very general description.  You need to understand specifically which part of which tendon or ligament is effected in order to treat it.

For me it is about the arch.

I have high arches.  The arch of the foot is a big spring, like the leaf springs in a car.  The arch is designed this way to absorb the shock of the foot hitting the ground.  As runners we use this arch shock absorber thousands of times in a run.  The faster we go the more force the arch absorbs.

The arch of the foot is a critical part of the connected system of muscles, tendons, ligaments and bones that work together when we run.  Unfortunately it is so critical that it is very hard to run with a damaged arch.

The piece of tissue that forms the big spring of the arch is a very robust thing.  It is heavy duty equipment.  It has to be for the role it plays in our locomotion.  My 190 pounds hit the ground with a force 4 or 5 times that.

When my foot hits the ground this giant, heavy duty spring compresses to absorb that energy.  When I toe-off the spring uncompressed and returns that energy as lift and forward propulsion.

My doctor described this piece of tissue as being the consistency and strength of a car tire.

Why do you care?

First because when you get an injury in the arch or its connection points you are transferring all of that force into the injury every time you step making it very hard to have an opportunity to heal.

Secondly the thickness and robustness of this tissue make it difficult to use normal therapies you might use on muscle tissue.  Topical heat, ice, or ointment type treatments have a hard time penetrating the thick tissue.  Stretching it is also very hard because of its robustness.  (Think of trying to stretch a car tire.)

Finally the tissue does not have a great blood supply system, like a muscle and that makes it hard to get healing and more likely to get scar tissue.  Scar tissue doesn’t flex, it cracks. Having a chunk of non-compressible, non-stretchable scar tissue in this arch system means it will never, ever, really heal. Once the scar tissue is in there, it doesn’t matter how much time you take off, as soon as you start running again the force into the arch will crack the scar tissue and it will hurt again.

What are the symptoms?

Common symptoms for Plantar Fasciitis is some sort of pain or ache in the foot.  Mine manifested as an achy heel.  It was hardly noticeable at first.  I thought I had maybe trod on a rock in the woods and picked up a bruise.

Certainly it was nothing to worry me or to make me think I should stop running.  It slowly and progressively got worse until finally it was quite sore and I went to the doctor.  I could still run on it, it just ached.

This ache for me, because of where the tear was, on the attach point on the heel, was on the bottom inside of my heel.  Not on the point of the heel.  It is about an inch and a half in towards the center of the foot where the arch meets the foot.  (Remember, Plantar Fasciitis is a general description and the location of your actual injury could be anywhere in this general area).

One sure sign of plantar fasciitis is that it will hurt like hell when you get out of bed in the morning and take those first couple steps to the bathroom.  This is because as you sleep the arch of the foot contracts and when you step on it it is stretching it out for the first time.

Part one Summary:

I realized that I had Plantar Fasciitis in June of 2011.  It is now September of 2013.   At the time, in the spring of 2011 I was very fit.  I was coming off of a successful marathon campaign where I re-qualified at Boston.  I was running 40 – 50 miles a week and was trying to decide if I should run another ultra, a triathlon or something else.  Then, because of this tiny torn piece of fascia in this very important foot structure I could do nothing.  I ended up having to take the better part of 18 months off and am just now getting back to my previous race fitness.

My Plantar Fasciitis still aches as I sit here, but I have it under control.

In the next part of this series I’ll talk about potential ways I managed to give myself Plantar Fasciitis and start working through the theory and efficacy of some of the treatments.