The Ten Step Plan to escape the pain of Plantar Fasciitis

Plantar Fasciitis

There have been times over the last few years when I thought my running days were over. I’ve been so crippled by the pain of plantar fasciitis that I’ve had to use hiking poles to get into work and at it’s worst I’ve resorted to moving around the house on my hands and knees.

Plantar fasciitis is the curse of runners.

Most runners will be struck down by a running injury at some time in their life but few are as debilitating as plantar fasciitis. As a breed we have a tendency to push ourselves hard and increase volumes and intensity too far and too soon and usually combine the two for good measure. Overloading your body, running with inappropriate footwear and ignoring other aspects of your fitness such as core strength training and flexibility will unfortunately increase your chances of being struck by plantar fasciitis. Overweight runners are also more prone to overuse injuries such as plantar fasciitis.

So how do you know if your foot problem is caused by plantar fasciitis?

Plantar FasciitisTypically the pain is felt on the sole of your feet, around the fleshy part of your heel pad. I had it in both of my feet but more often it is restricted to one side. I described the pain as though I had a large pebble in both shoes, causing a pressure pain and a bruised sensation.

It was also associated with stiffness which was much worse after resting, so after waking in the morning I would find myself hobbling for the first few steps as my feet accustomed themselves to movement. It felt like I was walking on stumps rather than fully mobile and flexible feet. For a while I was able to run through the pain and suffer the consequences after I stopped but when I started increasing the intensity again, the walking sticks had to make a re-appearance and the enforced rest periods started again.

How to recover from plantar fasciitis.

I’ve been dealing with the injury for well over a two years and have worked my way through most of the advice available, some of which provided only limited success but I am pleased to announce that I am now pain free and back running and training for my marathon.

Here’s my ten step plan for achieving pain free running:

  1. Stop running. This sounds drastic but should only be necessary for a few days to a week to enable you to get through the acute stage of your injury.
  2. Start a 2-week course of ibuprofen or other suitable anti-inflammatory, 1 tablet three times a day should be sufficient. I wouldn’t normally advise medication, I very rarely take tablets but I have to admit that this was one of the most successful elements of my recovery plan. The injury is caused by inflammation of the plantar fascia that runs underneath the foot and a short course of anti-inflammatory medication along with a period of rest can be extremely effective in helping the foot recover.
  3. Ice your feet 2- 3 times daily. I did this by filling a small bottle with water and freezing it, you can then roll your feet over this to combine icing with a strong plantar fascia stretch. You may find it more convenient to soak your feet in a bucket of icy water.
  4. calf stretchBuild a stretching routine into your day. It is very likely that tight calves are part of the problem and if you have lower back pain as well you’ll probably find that your hamstrings are knotted up too. I stretch my calves while going up the escalators at the tube station, keeping the balls of my feet on the edge of the rise and dropping my heels. You can also do the standard runners stretch which involves you pushing against a tree or wall while applying gentle tension to the outstretched rear leg.
  5. Foot and calf strengthening – grasping golf balls with your toes is a great exercise for working out your feet and step raises are brilliant for strengthening the calves.
  6. The Stick and other methods of tortureMassage – foot and calf – I use The Stick which is a marvellous gadget for rolling out knots and tension but a foam roller would probably have a similar effect. I aim to do this before and after a run and find that the pre-run roll is most effective at ensuring that my calves don’t tighten up.
  7. Build core training and flexibility into your program – stretch daily and add in a core workout 3 times a week. A simple yoga routine such as the sun salutation repeated a few times will take less than 10 minutes a day and core routine needn’t necessarily take longer than 20 mins. I use an iPhone app for both routines but there are plenty of ideas on the web.
  8. Cross train. There is no need to cut out the aerobic exercise while you are on your enforced running rest, and in fact it is always good injury-proofing advice to maintain an element of cross training in your program. Try pool running if you really miss the running or cycling and swimming as great fitness alternatives.
  9. Experiment with insoles and consider replacing your shoes if they are worn. Running shoes have a shelf life depending on the distance run and the weight of the runner. If you have foot pain and your shoes have taken a battering it might be time to invest in a new pair. Insoles are worth considering if only as a temporary measure but you might need to seek professionally podiatry advice for this.
  10. Try the Paleo diet to relieve the pain of plantar fasciitis – I saved this one for last as it sounds a bit nuts. I started the Paleo diet a while ago for health and weightloss reasons and had absolutely no expectation that it would help my plantar fasciitis but by the end of the first week of sticking to the diet my foot pain had gone. I was surprised and didn’t actually draw the connection until I started researching the paleo diet and read in Loren Cordain’s Paleo Diet book, a case study which indicated that another dieter had found relief from plantar fasciitis after starting the paleo diet. The mode of action is likely to be anti-inflammatory and maybe more appealing to many than the ibuprofen option.

Other methods of treatment for plantar fasciitis:

  • Born to RunBarefoot running. Barefoot running has gained huge levels of support and is often cited as a potential cure for plantar fasciitis following the success of the amazing book “Born to Run”. I’ve done quite a bit of barefoot running or minimalist running using shoes such as Vibram fivefingers and the Softstar run amocs but I cannot wholeheartedly recommend that you throw away the cushioned support shoes you are used to. I’d love to be able to do that but my fear is that, if you are anything like me, you will go too fast and too far down the barefoot running route and increase your risk of running injuries. Barefoot running is not for the fainthearted. You need to strengthen your feet and calves and take the transition extremely slowly – so proceed with caution.
  • A Strasbourg sock can be an effective plantar fasciitis night splint, worn while you sleep. It forces your foot into a 90-degree angle in order to stretch out the plantar fascia and can provide some relief.

I hope this program helps you in the way it helped me. When you start running again start back slowly and maintain the stretching and strength elements built into your recovery plan, the aim is to remain strong and flexible and to build the running levels slowly.

It’s always tempting, following a little bit of success, to throw yourself back into the running with a rather heroic attitude, but you should resist. If you’ve had plantar fasciitis already then you are going to be prone to relapses and that is just not worth it. Progress slowly, keep stretching and roll out the muscles of your legs before and after each run – if you don’t have a handy masseuse on hand, try the DIY option and invest in The Stick.

The Bedroom Scene

The Bedroom Scene

I haven’t exactly gone into hibernation but I may as well have done for all the running that has happened over the last couple of months.

I think the bedroom scene explains the situation:

Somewhere between the Great North Run and home I developed a niggle, just a minor dead leg feeling during a long run, then over the weeks it developed into a twinge and then shifted from my thigh to my hip to my calf and then for good luck decided to start throbbing in my knee.

After two weeks of rest but very little recuperation I brought out the big daddy of physio tools – the Rumble Roller. I braved the weapon of torture for two days, squealing my body over its vicious nobbles but have now lost my nerve and give it a wide berth when I hobble out of bed in a morning.

I’ve got til March to sort myself out as I’m booked into the Hastings Half and that doesn’t look like a route to drag a dead leg up.

The Square One Tavern Plan

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My enforced rest from running was initiated by a trip to a pub.

Me and my good lady gathered around a couple of pints of Wandle, pulled out the Moleskin and jotted down a recovery plan to rid me of plantar fasciitis for good and set me right for my already deferred entry to the VLM.

The Plan allowed for 4 weeks of proper foot rest – icing, gentle stretching. It included core training sessions and a bit of cardio in the form of cycling. I have a feeling it might have mentioned a diet but I can’t remember that bit.

4 weeks came and went and I was still limping so I introduced yoga and ibuprofen.

Some 8 weeks of sitting on well endowed backside has had some effect though, an additional 5lbs of lard have been added somewhere and the feet are somewhat more springy – success and failure in equal measure.

Cue the next phase of The Plan – time for structured re-entry into the running world.

I think The Plan might have specified gentle walk/runs but somewhere between home and the start of the Wandle Trail I made the mistake of programming the Garmin. I felt heroic. I set the interval beeper to 5 mins run with 1 min walk – 20 of them! That is 2 hrs of hardcore running with a teeny bit of walking thrown in.

That 1 minute walk is pure torture no sooner has breathing calmed down sufficiently to swig water than the garmin beeps at you to start up again.

I’d happily have ignored it’s little beeps and followed the beat of my own drum but Lynn was with me and she’s not a quitter. I’m leaving her at home next time. I was shattered at the end.

I got home, slipped into my ice bucket and that was it for the next 36 hours.
Completely crippled again. I was forced to drag my sorry body around the house on my hands and knees and could only handle the upright position with the aid of my long discarded hiking poles.

Square one again.

The Stick and Other Methods of Torture

The Stick and other methods of torture

I’ve been using The Stick ever since I suffered with a painful muscular injury to my hamstrings.

It has a very simple design – a slightly flexible plastic stick around which a set of plastic spindles can independently rotate. It is these spindles that work on your muscles to ease out knots and release tension.

It’s extremely effective and a superb substitute for daily massages for those not lucky enough to have a full time masseuse on hand.

You can use it almost anywhere on the body but I have found it particularly useful for the larger muscle groups such as the calves, quads, hamstrings and buttocks. It can be incredibly painful when you first start using it but you can control the pressure and it’s amazing how quickly the muscles loosen up and stop screaming.

I came across the Posture Pro and Footeez at the The Running School, I was just preparing for a high intensity blast on the treadmill but I was suffering from a niggling cramp in my calf. I was quite concerned that I was going to do myself a mischief so the running instructor had me sitting on the floor with the blue nobbly gadget under my calf. The trick is to roll back and forth using your body weight to apply quite forceful pressure to a defined spot. I found it to have a miraculous effect, clearing the knot within a minute or so. I bought these two the very same day.

I find that The Stick is ideal for routine treatment as a preventative measure while it is worth rolling out the Posture Pro when rapid remedial action is required. The Posture Pro does take a little bit of getting used to and is tricky to use without giving you carpet burns on your buttocks as you roll to and fro.

The Footeez is similar to the Posture Pro, another knobbly hard plastic cyclinder but is specially shaped for foot rolling. I use the two interchangeably to relieve the pain of plantar fasciitis. The podiatrist recommended the use of a golf ball for focused massage of the PF which is a far more economical method but I find it quite irritating. It’s hard to apply sufficient pressure to the heel region without the golf ball shooting out from under your foot and scuttling across the room. I soon get bored of retrieving it.

Pool Running for the Injured

pool running

The enforced running respite has resulted in a very slight improvement to my plantar fasciitis pain so I’m motivated to keep up with the recommendations from my podiatrist.

I’ve stuck to the stretches, swapped the running with cycling and been wearing the temporary insoles in my trainers. The only remedial action left to tick off is pool running or aqua jogging.

I hunted around for aqua jogging classes in the local pools but couldn’t find anything at all. I imagined groups of frustrated (ex)runners bounding up and down the lanes.

A couple of weeks ago I found myself next to an empty exercise pool while on a weekend treat at the Sanctuary. The opportunity was too good to lose so I dropped in, grabbed one of the buoyancy tubes as substitute running belt, and attempted the run motion.

I now know why there was a distinct absence of organised pool running groups – this is definitely a solitary experience. You bob around mostly on the spot and may as well tuck yourself away in the corner of the deep end and try not to raise too much concern as you flap away in a frustrated doggy paddle.

I attempted a few different styles with the body either upright or sloped and felt as though I was either cycling or swimming but not running. I discarded the flotation aid to see the affect of adding some realistic arm action. I bobbed around, just millimeters under my nostrils and managed 20 mins without drowning.

It was by no means as exhausting as running, I was exerting myself but I could hold a conversation whereas I can barely gasp out a greeting when I run on land.  You do move a little bit so its not entirely on the spot running. I was circling a pillar in the middle of a pool and it probably took me 4 mins a lap. The scenery didn’t get any better but I suppose treadmill runners are used to that sort of drudgery, a waterproof mp3 player would have helped.

It was moderately satisfying and helped delay the stir crazy impulses but by golly its boring.

Plantar Fasciitis and General Running Woes

My running outlook is looking grim again but I’m not completely despondent. I feel the opportunity for experimentation. The sort of experimentation that probably got me into this mess in the first place but blogging fodder nonetheless.

I’ve just been to see my latest running guru and as expected it has resulted in yet another path opening up to me. Another path for me to hobble along and bemoan the runners curse that is plantar fasciitis.

Why don’t experts ever agree?

Of late I’ve dabbled in normal running and then barefoot running of both the truly barefoot and the partially shod variety. I’ve crosstrained, army trained, occasionally weight trained and swung kettle bells to destruction.

Along the line I’ve taken my dose of injury from ITB, spondylolithesis and plantar fasciitis. It would be tempting to pin each ailment to the latest fad but my records are just not that clear.

Almost everyone else is happy to blame barefoot running for my latest spate of crippling PF and although I know it is not conclusive and despite suffering with PF before I discarded the shoes, I’m tempted to go with the crowd and abandon all hope of truly minimalist, pain free running.

Today’s guru was the podiatrist who told me my calves and backside are too weak for barefoot running and that I need to abandon the running school with its fore foot running focus, until I see some improvements in the pain level.

This all makes me feel a little glum.

She did instruct me to find a functional trainer for lower limb strength building and a pool for a spate of aqua jogging. Now that could be fun. Or highly embarrassing.

Time will tell.

If the Knee Hurts

i am tools

It feels as though I’ve done a lot of whingeing over the last 3 months. I’ve gone from chest infection to pulled calves to meniscal tears and it’s beginning to sound like I’m manufacturing my own get out of the London Marathon free card.

It was rather convenient then that Craig Carroll contacted me last week to offer me a trial session of his services. He is billed as a Performance and Injury Specialist and that is just what the doctor ordered. At least, that is what I wanted the Doc to order, instead she wrote out a prescription for no more running.

I tore the prescription up and went along to see Craig instead.

Craig never once gave me the impression that sitting back and giving up was an option, in fact he never even hinted that my knee injury should hold me back from my goals. Craig himself has a military background and has experienced being written off following injury. Apparently he suffered horrible shin splints on one of the mammoth, full kit, training runs and was discarded by the military doctors. It sometimes feels like civvy doctors can follow the route of least resistance too, if your knee hurts, stop using it. Simples.

So back to my session. Craig set me off doing the ministry of silly walks. Side to side waddling and full on drunk staggering, all of which apparently enabled him to determine potential problems with my gait and assess imbalances.

I think the results suggested I may over use my left side to compensate for slight weaknesses in my right side and the basis of Craig’s style is understanding that the body works as a chain. The site of your pain is not necessarily the cause of your pain, so for example a blister on your right toe my lead you to alter your pose so that you end up with lower back pain or an overuse injury on the opposite leg.

Having completed the initial assessment we moved into the treatment room where Craig started to do a little work on my feet. He had me doing repeated squats and lunges – both of which are exercises that I never do because of the knee pain. I get sharp pains in both knees and they feel like they are about to give way. Still, I did as I was told and lunged on command. As I was doing it Craig was manipulating my feet. Not quite sure what he was doing, it didn’t feel like much but all of a sudden I was able to lunge without the knee pain. Odd.

He did a little more work on my feet, loosening up the joints before discovering my special toe. My second toe on the right foot has been “special” for a long time now. I often refer to it as my broken toe as it makes me yell like crazy when it gets knocked or bent. He whipped out a special little tool that looked like a perfectly moulded Alessi can opener and started working the hooked end into my toe tendons (I later discovered the tool was from I Am Tools). After 5 minutes of deeply painful massage he was able to bend my dodgy toe back into the sole of my foot.

I remain quite impressed that he discovered my achilles heel quite so quickly. Could it be the source of the pains in my left leg? Who knows.

We finished off with a series of exercises that I could use to warm up for a running session. They were a little bizarre or maybe balletic would be a better description. Either way they are a bit hard to describe without pictures. They were a form of lunge with a plie style arm movement but with the arms going in opposite directions. I started the move under my own steam and then Craig stepped in to force the movement just a step further. Taking me beyond the point at which I felt I would fail or fall was designed to inspire muscle confidence. It worked actually. Back under my own steam I was able to take move further than before and still stay standing.

I took something very positive away from the session. I learnt that I can do more than I think and that it is also possible for me to move without pain. I got a small dose of muscle confidence and it’s much easier to move when you aren’t waiting anxiously for the next problem to appear.

When I ran the next day after my session with Craig Carroll, I started to get the usual twinge with my knee but I remembered his action of altering the position of my feet and so tried adjusting them myself. A slight outturn of my left foot and the pain went again.

I’m very happy with the result of my session, I could get quite used to the idea of having a personal trainer, especially one that works so specifically to my goals and treats me as an individual, accepting the strengths and weaknesses that are wrapped up in the package.

If you are in central London and want a personal trainer to help you achieve your goals then I would really recommend getting in contact with Craig Carroll for a session.

To run or not to run

run-with-nordic-poles-150x200

I started my last long run in the barrel of an MRI machine and finished it 9.2 k later skipping up the steps of the local Morrisons where my lady was waiting.

I felt on form and on top of the world.

Somewhere between then and now my running world took a big knock. My wandering leg pain that had been focussed in my calf for the whole of November, shifted to the front of my knee and then I got the results of the MRI.

I called the Doc for the results and it seems I have a small horizontal tear of the medial meniscus with a little cyst. The recommendation from the Dr, who I’ve never met before was that I strap it and quit running.

I think it’s a pretty obvious response to tell me to quit. I’m not designed for running, I’ve been specially moulded for the couch, and at the best of times it’s hard to imagine that running could be beneficial for knees.  

I need to ignore her advice though, running has done wonders for my mental health, it’s brought me confidence and spirit and pride and for someone in a constant battle with the scales it’s the only thing that has enabled me to exert some control over my spiralling body mass.

I’m not sure what to do just yet. I’ll try and see a specialist but in the meantime I’m looking for options. Maybe a knee brace will help or perhaps I could try my next running commute with a pair if Nordic poles.

I feel this years London marathon slipping away from me before I even start and Janathon could be a litle shaky as well.

Injury Groans

cow

I’m spending my morning learning how to cross my legs. Apparently I am supposed to work my right knee into the back of my left calf and wiggle. I’ve never been the sort of lady who can sit with an elegantly crossed knee, I have slightly more inner thigh than is absolutely necessary and it’s a struggle to get the pivot point anywhere above the ankle. My dodgy leg keeps clattering to the floor and I’m creating a bit of a stir in the office.

I’m following the advice of my osteopath though and with my marathon training scheduled to start in exactly one month’s time I’m prepared to look like a bit of a buffoon if it will work.

Up til now I’ve been resting a few days, pummelling my calf into submission and then attempting a short run. In every case I’ve been forced right back to square one as tendons twang and muscles cramp up. I’m getting close to the point of panic and drastic action is required if I hope to be fit enough for VLM next April.

I’m encouraged by David at Running Matters and think that maybe a full month off, with no running attempts but with more cycling and a crazy routine of stretching might just put me in the best position for starting my marathon training. The osteo agrees, but also reckons I should try and fit in an MRI and possibly a bit of key hole surgery.

I’m not holding out much hope of the NHS delivering one of those within the next month.

Underground Surgery

An absolute scorcher today, June has finally arrived and what better way to enjoy the sun than spending 2 hrs locked in a tube train and another couple running through the crowds of Central London?

Salomon XT Wings Challenge - Progress 080608

I wonder if I’ve ever mentioned my dislike of the London public transport system. I’m sure the feeling is mutual, I hate it and it feels fairly venomous towards me.

There are some building works going on outside my flat that have resulted in restricted traffic flows. As I left my flat this afternoon I could see my bus waiting patiently for an opportunity to turn into the main flow. I sprint down 3 flights and out onto the street, timing my crossing perfectly to run between a car and the bus to arrive just in the nick of time at the bus stop. Arm goes out but the bus doesn’t stop, instead he honks his horn and starts to gesticulate as if he can’t understand why I would have just run in front of him and stood by the bus stop. The woman running along behind me is absolutely incensed by this and taking no chances, throws herself in front of the next arriving bus.

The next bus decides to pull off just as I’m about to climb onboard but temptingly he leaves his door open so I try a run and leap manoeuvre. The jury is still out so I’ll leave it until tomorrow to decide whether I’ve done myself any lasting ankle injury.

On the way back home the tube decides I’d look better as an amazon and with a particularly swift and violent door closure, attempts a single mastectomy in full public view. Not pleasant, but I survive with a solid black line bisecting me from chin to nipple.

Graffiti - Chalk Farm

I did manage some running as well as performing heroic transport antics. I started in Belsize Park for my journey along the Northern Line (Charing Cross branch). I love this area of London, the moment I become monied I’ll be buying a flat on this street. perhaps one just above the book shop.

It’s a great start to a run as well, from the top of Haverstock Hill you can enjoy a downward sprint all the way to Camden. I had to slow down briefly at Chalk Farm for graffiti purposes and then ground to a complete stop by Camden Market. Camden on a hot weekend is a nightmare, far far worse than Oxford street. There is no room to run but even if there was, this is not a street for deep breathing. Inhale too hard here and your head will be swimming for hours and I didn’t have time for the munchies.

Mornington Crescent

I start running again past Mornington Crescent, which is pictured here for the benefit of any Radio 4 listeners. Quite an unassuming tube station but obviously carrys a great deal of competitive importance.

The Northern line is relatively short, about 7km from Belsize Park to Waterloo so I decided to make the most of my travel card and complete the Central line as well. Heading back to Embankment I took the district to that joyful little retreat at Mile End. This time round it was sunny which added a positive glow to the place and I noticed the canal which I’d missed the first time here but I still didn’t want to linger. Some error in navigation had me running along the road to Stepney Green again, before I hung a right, heading through social housing city and up to Bethnal Green.

End of the Line

Bethnal Green to Liverpool street is quite an interesting route. I liked it around there. It looked like I’d just missed a street market as I was having to work quite hard not to slip on discarded portobello mushrooms and grapes. I’d also overlooked my invite to a hip biker event. There were stacks of cyclists around and every one had a cool fixie with aero wheels and aggressive track styling. Odd to see people bouncing down curbs with 5 spoked wheels though, can’t imagine they’ll last very long.

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Beyond Liverpool Street it was in to City Boy Land.

This shot shows St Ethelburgers Church which was apparently destroyed in 1993 by an IRA bomb. It had previously survived the Great Fire of London and the blitz.

It has recently been rebuilt and they’ve done a fantastic job as the building just grabs your attention, maybe its enhanced by the backdrop of the Gherkin.

Threadneedle Street

Threadneedle Street has many more impressive buildings but at this point I’m getting a little too hot and bothered for further architectural appreciation. Besides, I’m preparing for the Underground surgery awaiting me at Holborn.

Two more lines completed!

Salomon XT Wings Challenge
Today:
19 Tube Stations
16.04 km

Cumulative:

71 Tube Stations
64.17 km
See the combined progress map here.

Juneathon Tally
Runs: 7/30
Total Distance: 26.6 m