Plantar Fasciitis (PF)

This is an email article from Dave S which I am publishing now.
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Zenmaster asked me to educate the group about Plantar Fasciitis (PF) Evidently we have a few folks suffering from PF now (ironically myself included for the first time in many years). This will be more information than most of you ever want to know about PF. So, if you're not having heel or arch pain, stop reading and discard this note now and I apologize for the spam. If this doesn't reach someone in the group with PF, feel free to forward it to them.

I would guess that Plantar Fasciitis is the second most common injury for new runners -- after shin splints. Shin splints heel pretty quickly and easily, PF does not.

How do you know if you have PF? If you get out of bed in the morning and with the first 2 or 3 steps it feels like someone is poking a hot needle into the middle of your heel -- you definitely have it! If you have other heel or arch pain which is worse when you get out of bed or after sitting for a while, you probably have it. Somebody may have told you that you have a heel spur. That's really the same thing as plantar fasciitis.

What causes it? As usual, lots of things. But primarily it is calf muscles and an achilles tendon that is too tight. This in turn can be caused by "toe running", inadequate stretching, and inadequate arch support. Toe running is easy to cure -- this is just poor running form.
Unless you are sprinting, your heel should strike the ground first and you should gently rock through the length of your foot until you push off from your toes. If your toes or the ball of your foot strikes first, you are putting undo stress on lots of parts -- including your plantar fascia.
Yes, your heel hurts because you're not landing on it -- believe it or not.
So, no matter how steep the hill that Khalid takes you up, make sure you are not running up it on your toes.

Stretching is a little trickier. Many books will show the old fashioned calf stretch which has you leaning against a wall. Usually this only does half of the job. Instead, I like to find a curb or steeply sloped rock. I put my foot on that with the toes as elevated as is comfortable, turn the toes slightly inward and bring the other foot up parallel, but flat, shoulder width apart. Then by shifting my weight back and forth, forward and backward, I can feel the point where I get a good stretch deep within the calf. Play around with this a bit until you find it. If it still doesn't make sense, have me or Dave Clark show you how. Stretch each calf, one at a time, for about 30 seconds and then repeat. This is most important to do after a run when the calf and achilles are warm, full of blood, and most able to be stretched without causing microtears. Caution:
if your Achilles Tendon is already sore ... do not do this stretch until you solve the achilles problem. See me about that separately.

Arch supports are trickier yet. Some people are perfectly happy with nothing or whatever comes in their running shoe. Others do fine with some drug store arch support. Still others need a custom, or near-custom arch support. Many people actually need podiatrist-provided orthotics because their feet are not the same, their legs are different lengths, or a variety of other causes. In any case, good arch support will help prevent a lot of the other related problems.

If you can't seem to shake the PF through these preventative means, you may need mild treatment. The first is more targetted exercises -- in addtion to stretching. Try sitting in a chair with your knees at right angles and directly over the ankles. Rest your foot on a towel. Keeping your foot stationary, bunch up the towel by grabbing it repeatedly with your toes.
Once you learn to do this, you can do it without the towel and with your shoes on while sitting at your desk (if your shoes are loose enough). To avoid that early morning poke in the heel, you can stretch your toes toward your knees before you get out of bed. The pain is worst in the morning because your foot relaxes and your toes point downward (I think it's called dorsaflexion, but it may be the opposite). You can also roll the sole of your foot lengthwise back and forth on a tennis ball or, better yet, a frozen juice can. This massages it to break up calcification and ices it to prevent swelling. Ironically cold alternated with heat also helps. The heat increases the blood flow, while the cold soothes swollen tissues.

If all of this doesn't do any good, the next step I'd recommend is a thing called the Straussberg Sock (sp?). You can google variations on the spelling until you find it. It is just a cotton sock with a band which runs from your toe to a strap around your calf. You wear it at night and it keeps your foot in a better position (dorsaflexed??) to keep the plantar fascia stretched. Many doctors recommend a fancy boot that looks like a ski boot. But I don't think it is any better than the cheapo sock and is much more likely to bruise your partners shins and get you kicked out of bed.

The next step is medical intervention. This is a case for physical therapy. They know how it works, have all the cool toys to work it over, give you better exercises to do, and can actually break stuff like scar tissue up. Don't let a doctor inject your heel with cortisone or anything else. And certainly don't let him convince you that you need a surgery.
Another step, for long range happiness is to see a podiatrist about getting orthotics. It's kind of like of asking a chiropractor if you need his help with your back. The answer will always be "yes". But in this case, if you've alredy diagnosed foot problems that don't go away easily, it might be justified.

The good news is that, for most of you, this will just be minor start up pains. Your body was intended to be running since childhood -- chasing down deer for food, etc.. Unfortunately, you probably haven't been doing that. So, as you start running, your strength (read muscles) builds up more quickly than the supportive soft tissue (fascia, tendons, bursa, etc.).. Over time these other things will catch up and you will be running injury free like the zenmaster (unless of course you are running competitively, in which case you'll still be fighting nagging injuries because you are always pushing the limits). I went through a number of start-up nagging little injuries years ago. At the time, my knees were especially weak and rotten -- even when hiking. Today my knees are in better shape than they were 40 years ago! So, pay attention to what your body is trying to tell you, but keep at it!

I hope this helps,

ultra Dave Doctor Dave