Monday, May 2, 2016

Do I Have Plantar Fasciitis?

There is nothing worse than hearing those dreaded words from the podiatrist that you have plantar fasciitis (PF). I've been there. It's a knock-out blow to both your psyche and activity level. Now I'm no doctor, but experience has shown that often times the symptoms of PF present themselves well in advance of the actual diagnosis.

If you can answer "yes" to any of these questions, you may have plantar fasciitis and should really take a break from running.
  • Does it hurt to stand on your feet for any period of time?
  • Is the pain worse first thing in the morning?
  • Does the pain go away later in the day or when you run?
  • Have you altered your stride (walking or running) to avoid pain in your foot?
  • Is there a specific spot on your foot that is tender when you press on it?
  • Do you feel any unusual pressure with your existing insoles or shoes?
Here's the honest truth though. We (ultra) runners are stupidly stubborn. We always try to 'run through it'. This NEVER works. I think subconsciously we're afraid of the potential diagnosis and lack of activity that we ignore the signs or secretly hope it's something else that will go away with 1 or 2 days rest.

Don't let your ego or stubbornness get in the way of letting your feet heal
Again, if you've answered 'yes' to any of the questions above, you are faced with 2 choices.
  1. Force yourself to take some time off (from running).
    • We're not talking about a day or two, we're talking a couple weeks minimum. During this time, your focus should be caring for and rehabilitating your feet. We'll talk about this a little bit later.

  2. Keep running and ignore the symptoms.
    • The body is an amazing machine. It does not deal with abuse for very long before shutting down. If you're unwilling to take the time off, your body will eventually force you down whether you like it or not!
You might be thinking to yourself, "Geez, I have to take time off regardless of what option I choose". You'd be right! But would you rather it be a couple weeks or a year or MORE (I dealt with PF for over 2 years). The great news is that those weeks pass by quickly when you're focused on rehabilitation, cross-training and stretching instead of being stuck in a walking boot.

If you find yourself taking a couple weeks off, fill your days with any of the following. They're great distractions and ultimately will help your feet, legs and supporting muscle groups for when you ultimately return to running.
  • Squats, lunges or calf raises
  • Cycling (stay in the saddle)
  • Core/ab workouts

If you're going stir crazy during this time, it's usually acceptable to do some light hiking provided the pain is tolerable. If you spend time on your feet at all during this time, it's important that you ice them and/or take ibuprofen after you're done.

When folks tell me they have PF, I do what I can to save them a little money...physical therapy sessions, massage, acupuncture and other clinical treatments will help speed along recovery but they're also expensive and not typically covered by insurance. If you have the resources and money, you should take advantage of any of these services. They're typically focused on healing and strengthening the foot to ensure the issue doesn't pop up again.

Don't be tempted to buy anything from a catalog that says it cures plantar fasciitis either. You'll soon find out there is no silver bullet to 'cure' this condition overnight. You have micro-tears in the fascia ...so unless these tears heal, you'll never be 'cured'.

OK, on to the good stuff now. What can you do at home to help rehabilitate your feet? I'll start with the least expensive ones and go from there...
  1. Shoes/sandals* - your days of walking around without shoes or sandals is over. They prevent the tile or hard floors from bruising and/or irritating your feet.
  2. Frozen water bottle* - regardless of whether you exercise or not, icing your feet with the frozen water bottle reduces inflammation. Do 2x-3x a day if you have the time.
  3. Self-massage* - applied with lotion or BioFreeze to relief stress and pressure. Do 1x-2x a day if you have the time.
  4. Ibuprofen* - 600 mg every 6 hours is also a great way to keep the inflammation down and improve the blood flow to the area.
  5. Traumeel - a homeopathic anti-inflammatory alternative to ibuprofen. Comes in gels, pills or injections. Prices vary.
  6. Golf ball - pressing and rolling the golf ball on the target area helps stretch the fascia and tendon. Do 2x-3x a day if you have the time.
  7. Reusable ice packs* ($15) - less messy than frozen water bottles and cover more surface area at once. Plus you can apply them to other areas easily.
  8. Medi-Dyne ProStretch* ($20) - great to keep the achilles and calves stretched out (these muscles affect your heal and arches). Do 2x-3x a day if you have the time.
  9. TENS unit* ($30) - Trans-cutaneous-Electrical Nerve Stimulation unit puts a current through the muscles, tendons and connective tissue  helping increase blood flow (e.g., healing) to the specific areas. Great for feet, backs and shoulders...you'll wonder how you lived without one for so long :-) Make sure to check Groupon or Living Social for occasional deals...
  10. Straussberg sock ($40) - this sexy piece of hardware keeps your foot flexed at night when you you sleep to ensure the muscles and fascia stay stretched. Without it, the muscles tighten and then tear again when you step down out of bed.
* to be clear, these are things you can do as preventative measures after every run...not just when you start to feel pain.

If the time comes and you decide to go see a doctor, I would remind you that the fundamental injury needs time to heal. Nothing they can provide will guarantee your recovery. So be wary of (1) custom inserts (2) cortisone shots (may give temporary relief but they hurt like a motherf*cker) or (3) surgery. The only thing I would buy from a doctor is any sort of anti-inflammatory medication - topical or internal.

Overall, the key is rest. I know active people HATE hearing that word but it is honestly the only way you'll get rid of plantar fasciitis. You may speed up the recovery by doing the at-home remedies we talked about but don't set yourself back by thinking your foot feels good enough to do a crazy run on it...you'll re-injure it and start the entire process again.

Take the time to care for your feet immediately. If you don't, PF could set you back months, maybe even years. Like your mom used to say, "They're the only feet you've got so treat them well!"

Let me know if you have any other questions. Stay healthy out there!


  1. I tied all those treatments for the heel for months with no success. Swimming was my only outlet. Then I bought a foam roller and attacked my calves for 2 hours while watching TV. Hurt like a mother, but next morning my PF completely disappeared.

    That was my silver bullet.

    Worked up to 100-mile weeks within 6 weeks of coming back from injury, and have been able to maintain that base, and feel healthier than ever.

    Roll HARD during any downtime. daily.

    1. Great tip! The calves are definitely an area to focus when heel pain appears. Loosening up the calves and achilles often releases the pressure on the heel and fascia in your aches. Glad to hear you've recovered nicely!

  2. I don't have any pain in my feet but can I take two weeks off anyway just because I'm lazy?? I promise to pursue other types of more fun cardio :P

    1. Definitely take 2 weeks off just for the hell of it!

  3. May I recommend swapping out the frozen water bottle for a can of frozen baked beans? A friend recommended that to me and it was a great recommendation. No air bubble at the top, it doesn't sweat or crunch like a water bottle and stays cold longer while still fitting the bottom of the foot.