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?
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.
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!!!]
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.]
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:
- Stop icing. [If icing makes it hurt, and it’s not obviously improving the situation, then why do it?]
- Keep stretching and rolling. [These don’t seem to do any harm, and might be helping, so why not?]
- 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.]
- 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.]
- 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.]
- 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…
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?