Holly, PLEASE Tell Us More About Your Feet! [aka A Plantar Fasciitis Update]

So this PF thing started just over three weeks ago.  [Yikes, has it really been that long?!?!]  I’m still pretty mad at my foot.  I expressed some of my recent frustrations with this particular injury in a conversation with my Coach Self.  But I didn’t say a lot about what we (Coach Self and Runner Self) are doing to fix things.  So let’s talk about that for the duration of exactly 1 post.  Then, it’s back to stretching, photos, food, and probably a toilet post coming up (OH GOODIE! You can’t wait to come back now, can you??!?)

Going into this injury, I knew the basics of PF.  But there’s a difference between knowing the “basics” and working with someone (yourself or a client) who has it.  Suddenly, I really had the motivation to become an expert.  So, I consulted my coaching books (all of them), my anatomy books (all of them), some trusted friends (with relevant experience), and the internet (just a little bit) to learn all I could about PF and people’s different experiences with it.  Briefly, there’s quite a bit of controversy over the “best” treatment for plantar fasciitis.  Without belaboring the point, here’s a quick summary:

Traditionalists/Most Medical Experts: The pain is caused by inflammation at the PF insertion point (this post discusses some of the common causes of PF).  Treat to reduce inflammation and take measure to reduce extra stress on the arch and PF.  Wear supportive shoes all the time.  Baby the foot and arch.  Reduce any stress so that it can heal. 
LOTS of Anecdotal Stores and A Few Medical Experts (who asterisk “but this hasn’t been shown in any study”):  The pain is caused by inflammation at the PF insertion point, but that is rooted in weak foot/lower leg muscles.  Go minimalist (barefoot, or minimalist footwear) to strengthen these areas.  Your PF pain will disappear (usually quoted as “within days”)!
Most Everyone Agrees On: Ice, Calf Stretching/Rolling, Massage.

So what did I do with all this?

Week #1
Well, I started with the more traditional approach.  I wore supportive shoes and did what I could to reduce/eliminate my PF discomfort. To me, this approach made good sense.  Pain is my body’s way of objecting/signaling a problem – it’s my job to stop and listen!

“Listening” mostly meant NOT standing or walking barefoot, which is when it was most likely to hurt.  I also stopped running and jumping.  I stuck to Spinning and a bit of Body Pump with modest weights.  I sat when I could.

After a week, what was the result?  Basically nothing.  In shoes, my foot felt pretty OK.  Out of shoes, it still hurt.  (Sometimes.)  I had the Venus Run coming up, and wasn’t sure what to do.

Week #2-3
So, I figured I’d be a little radical and try the minimalist option (I know, I live on the wild side).  I started walking around the house barefoot, even though it hurt a bit.  I wore my Vibrams when I went out.  I went to the gym in a pretty low-support sneaker.  Those for whom this strategy worked often felt improvement in a matter of days, after battling PF with more traditional approaches for months.  

What happened to me?  Once again, not much. My PF felt pretty good while I was working out in sneakers – I even ran 3-4 miles a few times, including the Venus Run, without a noticeable difference in pain, post-workout.  But still, when I went barefoot or wore really minimalist shoes (Vibram Fivefingers), my foot hurt.  (Sometimes.)  It also didn’t hurt. (Sometimes.)  It was also somewhere in-between (most of the time).

Throughout the three weeks, I kept up my stretching/rolling/icing routine.  Because adults are actually remarkably similar to Kindergartners in some ways, I have a little checklist that helps keep me accountable.  [You can view or download the Good Habit Accountability Chart for yourself; customize the fields to match your needs!  Even better? Blow it up extra big, and use stickers.  You heard me.  Stickers!!!]

Ellie and Rhino can't wait to help me demonstrate with the foam roller!

Ellie and Rhino can’t wait to help me demonstrate with the foam roller!

I already shared my calf stretching routine, and am working on a post about using The Stick and foam roller on your calves.  My foot-rolling tennis balls all seem to have gotten soft – either from the Singaporean humidity, or from overuse – I’m not sure which.  So I exchanged them for this awful device that I’d purchased for KMN back when we were dating.  [I actually don’t recommend it – it’s very poke-y and doesn’t really apply consistent pressure that’s easy to direct.  I think a golf ball would be better, but I’ve been too busy/lazy/cheap to go find or buy a golf ball. But I can work the center roller there pretty deeply into my PF.]

Dig those miniature wheels into your plantar fascia.  Go ahead, I dare you...  (ouch)

Dig those miniature wheels into your plantar fascia. Go ahead, I dare you… (ouch)

Be very careful when grabbing a water bottle from our freezer.  One of these has spent the last 3 weeks between the floor and my foot.

Be very careful when grabbing a water bottle from our freezer. One of these has spent the last 3 weeks between the floor and my foot.

I’ve also been icing.  But let’s talk about icing.  While stretching/rolling result in no change, or perhaps a slight temporary improvement in my PF symptoms, the ice definitely makes them worse.  If I roll a frozen water bottle under my foot for 10 minutes, when I stand up – guaranteed – my PF will hurt.  It will hurt more than it has for most of the day.  This makes me feel really tentative about continued icing, to be honest.

So, I’ve spent the last few days synthesizing and considering all this personal PF data.  [I’m a scientist. I love data.]  During this time, I may have been slightly more grumpy than usual (sorry, KMN!), mostly because: (a) I didn’t have a plan; (b) I wasn’t convinced things were getting better; and (c) I’m registered for a half-marathon in 2 weeks, and have been unsure of what to do about it.  But, over the last 24 hours, I’ve regrouped, and have come up with the Revised Holly’s PF Treatment Plan.  Here goes:

  1. Stop icing.  [If icing makes it hurt, and it’s not obviously improving the situation, then why do it?]
  2. Keep stretching and rolling.  [These don’t seem to do any harm, and might be helping, so why not?]
  3. Wear more supportive shoes for day-to-day activity, and wear my Adidas sandals around the house.  Be more diligent about my foot/leg exercises.  [This way, I can build strength in my legs and feet without doing things that specifically causes pain/aggravation of my injury.  Personally, this approach feels smarter to me.]
  4. Continue workouts – including running – without guilt, unless I correlate that specific exercise/workout to increased pain in my PF – in which case I’ll stop immediately.  Even if that activity is running.  Pinky swear.  [Although to-date, I have seen no correlation between less running and less PF trouble.]
  5. Deal with half-marathon plans: Today, I ran 6.5 miles and my PF felt pretty dandy for the whole distance, and even into this evening.  My plan for the next two weeks is pretty simple:  Run a few shorter runs this week.  Check PF.  Try 9-12 miles next weekend.  Check PF.  Run a few shorter runs next week.  Check PF.  As long as my PF stays in check (ie, no worse), then I’ll run the half as a training run.  But if my PF starts acting up, I’ll stop, rest it, and grab my cheerleader pom-poms for the half instead.  [*Note: The increase from 6 to 10 is quite large; but before the PF trouble, I was regularly running long runs of 10-12 miles, so this isn’t a “first time” jump – it’s really a return to mileage I was quite comfortable with pre-PF issues.]
  6. Beyond checking in with it periodically and monitoring it for changes, I’m going to ignore my PF for now.  I won’t do things that I find aggravate it, but I will stop obsessing.  Perhaps it’ll decide to wander away on its own.  Maybe my stretching and strengthening will fight it off.  Maybe some voodoo magic spell one of you says will help.  Maybe I’ll go for a sports massage or some ART.  But for now, I’m treating him like a toddler with a tantrum: Don’t let him hurt himself, but otherwise, don’t pay him any extra mind.  DONE.

Ahhhh….relief.  I love to have a plan.  Now, instead of guessing what workout will be the “best” or “right” one for any given day, I can relax.  Instead of guessing whether I’ll be safe running the half, I have a series of tests for myself.  If I pass, I’ll run.  If I don’t, I’ll cheer instead.  Either way will be OK – I have plenty more races in my future.  For now, my fingers are crossed. I’m hoping for happy feet in the near future…

These socks can't hurt, right?

These socks can’t hurt, right?

Do you sigh with relief over having a plan, or bristle at the imposition of structure??

Any suggestions/contributions/modifications to the Revised PF Treatment Plan?

11 thoughts on “Holly, PLEASE Tell Us More About Your Feet! [aka A Plantar Fasciitis Update]

  1. Cecilia @MommiesRUn

    I am definitely a planner. I like to have my workouts written out in my planner even if I know them in my head. Even my core teacher recognized me as being Type A yesterday! And I’ve only worked out with her twice! I wish I had some good advice for you about your PF like you had for me, or I wish I could hit a golf ball over to you in Singapore!

    1. Holly KN Post author

      Hahaha! No worries. Things are actually (shhh! don’t jinx it!) feeling pretty good over here today. And there’s a golf course just down the road… Task for today: Head over there to find a few stray golf balls… [Thanks for the kick in the pants! ;-)]

  2. Kristen L

    Sounds like a good plan that you have put together. I get frustrated when I try to work through something and nothing seems to be working. It is good that you are figuring out what bothers your foot and what doesn’t seem to. I like to have a plan, but I’m usually pretty flexible with changes too. I hope your foot starts to heal up soon — it’s been long enough, right?!? 🙂

    1. Holly KN Post author

      Long enough? DEFINITELY. About three weeks TOO LONG, in my opinion. 🙂 But heck, life is life. <-- Me, trying to be flexible and roll with it. This was definitely a good reminder to listen to myself, my experience, my body, and my intuition. It's good to explore unexpected options/ideas, but at some point, you have to listen to what feels right for YOUR body. Glad I've come full circle back to that. Now, *fingers crossed*, I hope it works! Can't wait to hear about Sunday's race! 🙂

  3. Jean

    Wow, three weeks already?! That sucks! It seems the literature/experts are totally split on how to actually treat PF, so perhaps ignoring it (and checking in periodically) is the way to go about it? At least you’re figuring out what NOT to do (ie. icing). Hopefully it’ll be okay for the half!

    1. Holly KN Post author

      When you start to dig into things, it’s actually quite amazing how little is “known” about most injuries/rehab options – for many reasons. Working with human subjects is a pain: recruiting them, getting consent, collecting accurate intake information, and performing analyses in a way that accurately synthesizes all this info. And that’s before we even consider that my PF may not be the same as my friend’s PF – our symptoms might be pretty much the same, but our bodies are different, our feet are different, our training is different, etc – so if we get the same (or different) treatment, who’s to say we’ll respond the same (or differently)? It’s overwhelmingly complicated.

      So, I (and everyone else) is mostly left with lots of options and his/her own experience. Things (might?) be looking up a little today – or else my “not pay too much attention” idea is working – fingers crossed!

  4. Tamar

    1) I love your toddler with a tantrum analogy.
    2) your socks look like rainbow brite threw up on them. Do you need more fun socks?

    1. Holly KN Post author

      Thanks! Pretty good for a non-parent, right? 🙂

      And…I hate vomit. Suddenly, those cheerful socks have become significantly less appealing.

      Actually, I don’t, really. I wear sandals here, most of the time…

  5. Elizabeth

    Yes you NEED the golf ball!!! It hurts and feels sooo good!!! I have had mild PF before. But I have been dealing with post tib tendonitis for about 6 months. I had great success at the beginning with PT, using their modalities to decrease inflammation. When the acute flair went down, I then had custom orthopedics inserts. BUT now, it’s starting to verge on flaring again, and I’m in your boat it’s difficult to find something that really works.

    1. Holly KN Post author

      Ugh…I’ve never had, but understand that’s pretty pesky, too (although kinda rare – so bonus points for you! 🙂 ).

      I’m not sure why I think giving medical advice to a doctor is a good idea…but I’ve had success twice in early-flare situations (not PF, but other) with a few days of high-dose ibuprofen to reduce swelling and let things calm down. And although I’ve never tried it, KT Tape advocates claim there is a taping method to help post tib tendonitis (also called reverse shin splints, right?). I’m skeptical, but the tape is relatively cheap (find it at a specialty sporting goods store), so it might be worth a go. A quick Google search should show you how to apply it for ptt… Good luck. Hope you can catch this before it gets too aggravated. Not cool, for someone who is on her feet all day…

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