The Ten Step Plan to escape the pain of 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.

Custom Insoles from Profeet Fulham

Profeet is a custom insole, gait analysis and specialist footwear shop based in Fulham and as they have a marathon sponsorship package running at the moment I thought I would invest in their top of the range 3D analysis service and bag £20 for the Samaritans.

Profeet foot strike

The shop was bustling and seemed to be set up like a swanky gents barbers with it’s leather armchairs and one on one service.

Steve took me through the routine starting with a few treadmill runs alternating between my existing shoe and short barefoot jogs. Then I ran along a track landing on a pressure pad which displayed a moving hotspot as my foot moved through heel strike to toe off. I was fascinated to see that I had a normal arch – I’ve always felt that I’ve been as flat-footed as they come, but nope, I have normal feet.

Steve’s initial shoe suggestion was for a neutral shoe with some minor cushioning but after trying on ten different pairs of shoes with ever increasing stability elements, we finally arrived back at the shoe I came in with – the Asics Gel Kayano 17, a heavyweight in the stability running shoe arena. It was only then that video gait analysis showed a stable foot without excessive movement through the heel.

Having settled on shoe we moved on to the insole formation, which was quite a pleasant experience involving warm foam and a little sit down with a cup of tea.

An hour and quite a bit of running later, I’m ready to leave the shop with my frighteningly white shoes, chunky insoles and very much lighter wallet. I hope they are good for my feet – I’ve had some considerable success with my plantar fasciitis recovery program but I’ve been keen to play things safely as I gradually ramp up the training runs. I’m up to 5k individual runs now so I’ll soon be ready to knock out some proper distance runs and put the custom insoles to the challenge.

The Happy Magazine

My London Marathon acceptance mag dropped through the front door on Friday. It wasn’t unexpected as I’d had to defer from last years event due to a frustrating struggle with plantar fasciitis but it has come around frighteningly quickly.

I’m still supposedly trying to rest my way out of heel pain but now the mag has arrived I feel it’s time to man up and try regain some of the lost fitness.

I’ve been resting, stretching and overdosing on ibuprofen and although I still have pain, I have been able to cope with two 20 minute trial runs without exacerbating the problem further.

I have my fingers crossed for some injury respite. I don’t think you can defer for a second time and more importantly, 2012 would be such a good year to take part in the London marathon, with it being the Olympic year and the year OGB finally gets accepted in the ballot.

The Square One Tavern Plan

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

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

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.

Press ups for June

Having spent the entire day hobbling with my dastardly plantar fasciitis I decided it would be wise to take a day off the running.

Yesterdays barefoot treadmill run didn’t help matters at all. Barefoot running was supposed to offer a miracle cure for plantar fasciitis but I don’t think I have perfected my barefoot form. I checked out my Vibrams the other day and it’s clear from the worn down heel tread that I’m not forefoot striking.

Today’s offering to the Juneathon gods was the 100 push up challenge. We’re not quite at the full hundred standard yet but maybe by next Juneathon we’ll be there.

Views on Nike Free 3.0 as a Transition Shoe

Somewhere along the line I seem to have developed a shoe fetish. I started off in life with a classic shoe phobia and made it into adulthood with a pair of red wellies and a work shoe.

An interest in sport increased my repertoire but even then I managed to live in a pair of Specialized Sonoma cycling shoes throughout my student days.

I blame running.

It must have ticked disturbing boxes in my psyche. I have now commandeered the shoe rack that spans the length of our hall and still have an overspill. I still only have one pair of work shoes but there is a tremendous glut of running shoes and my stockpile is set to increase.

Hiking shoes arrived last week, Nike Free 3.0 trainers yesterday, I’m awaiting stock of a pair of Vibram Five Finger Bikilas and my Soft Star Run Amoc moccasins are slowly winging their way across the Atlantic as we speak. We have a romantic weekend booked away and my only packing demand after spare pants was a selection of running shoes. I may have to hunt out an appropriate 12 step program when we get back.

In the mean time, here are my thoughts on the Nike Free 3.0

I’ve pinned a lot of hopes on minimal running shoes and expect them to revolutionise my mornings and long runs by removing the crippling pains of plantar fasciitis. With this in mind I’ve been diligently introducing Vibram Five Finger runs in to my schedule but reverting to my standard shoe for long runs.

My standard shoe is a heavy duty, cushioned, supported, mega structure so I started looking around for a suitable transition shoe. RunBlogger provided me with some much appreciated advice and Donald from Running and Rambling has written an excellent overview of the options.

Hence the arrival of the Nike Free 3.0

It’s not a truly barefoot experience or even an almost-barefoot-best-described-as-minimal experience but its half way there and a half-way house was just what I needed.

The shoe is incredibly flexible, in fact you want to pick it up and mould it like playdoh. It has a peculiarly innovative sole, made up of little cubes of rubber that enable it to flex freely, this way and that.

We were at Waterloo Station last night picking up one of the kids of Railway Children fame. We were waiting patiently on the platform when I leapt up onto my toes and declared: “Tadaaaa….bet you can’t do that!”

Well it seems they all could but I maintain that it means something that I was the only one who felt suitably empowered by my footwear to display such idiocy in public.

These are flexible shoes.

The uppers are fairly minimal, a little padding around the ankle but in the main these are made of a lightweight waffle fabric. I’m used to shoes with rigid plates in the heel and all this floppiness comes as a bit of a shock. It makes for an incredibly comfortable shoe though. Regardless of your views of Nike and the position of the Free 3.0 on the barefoot-standard shoe scale, you can’t deny that the word on the block is “comfort”.

We went for quick midnight run when we got back from the station and it was such a joy. It was only a short one so I need to test this further with a weekend long run but the first impressions were great. No pain from my feet at all. When I wear standard shoes I get the impression that my second toe nail is being ripped from its bed but there was no discomfort at all with the Nike Free 3.0

The run was silent and fast – at least by my standards. The sole felt as though it had a strange stickiness to it but it didn’t seem to hold me back as we knocked a minute off our usual mile pace.

I think I might have found my half marathon shoe.