Tag Archives: Physical therapy

Curing Plantar Fasciitis

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After a year suffering through the dreaded Plantar Fasciitis I can say that there is only two certain ways to get rid of it.

1) Never walk on it, i.e. don’t leave your bed.

2) Cut off the ailing foot.

I looked through my running log and it was a year ago today that I first mentioned foot pain and took a day off. I have tried a lot of things in the past year, all to no avail.  I’ve done physical therapy and spent a lot of time at the doctor’s office listening in as the doctor and therapists share with the residents about Plantar Fasciitis.

I’ve broken this post into three segments – immediate actions, intermediate actions, and last ditch/extreme measures.

IMMEDIATE ACTION REQUIRED

1) Stop running.  Take a few days (weeks) off immediately to give your foot a chance to heal. I recommend swimming to keep the cardio strong.  Everyone says it is ok to bike, but I’d be really cautious.

2) Stop walking around barefoot.  Nothing is nicer than kicking off your shoes and letting the old dogs relax.  However, walking around barefoot can exacerbate Plantar Fasciitis.  I’d recommend some nice Crocs or slippers with about an inch of padding to protect your heel.

Plantar fasciitis
Image via Wikipedia

3) Take ibuprofen.  I’m not a doctor.  My doctor recommended taking 800mg (4 tablets) 3x’s a day with food for 2 weeks.  This will help take down the inflammation.  The consistency builds up the amount of medicine in the body which helps it work faster.

4) Check & Change Shoes.  All of them.  Even if they are brand new I would recommend buying new running shoes, maybe switching brands or styles.  Go to a running specialty store and have them analyze your running (after resting for a few days).  Then check all of your other shoes for wear.  If they show a little excessive wear – get rid of them.  I know its expensive but it is better to be healed or buy new shoes?

5) Roll out the foot.  I used a can of soup for a long time before buying a more advanced roller. In a fluid motion roll the jar under your foot from heel to the ball back and forth for a minute or so. Really dig into the heel. Do this two times a day.  One of the times you should soak the foot in warm water first.

6) Stretch the arch.  Place your foot on the opposite knee.  Taking the 5 toes bend them towards the same knee.  This will stretch the fascia. Hold for 30 seconds.

7) Ice. At the minimum put ice on the heel. The best option is to take a frozen dixie cup of ice and massage the affected area.  I just rub an ice cube into it until it melts.  Another option which combines step 5 and 7 is to roll out your foot with a frozen water bottle.

8) Night Splint. I’ve used both the Strassburg Sock (my review or Amazon) and the Dorsi-Wedge.  Obviously, neither worked.  I felt the Strassburg Sock was easier to wear.  My sports doc (who works at the University of MN) felt like the sock allowed too much room for “cheating”, etting the foot move around or not wearing it properly. Other night splints on Amazon.

9) Stretch. Obviously stretching the entire body is always an important part of the routine.  It is important to stretch out the calves, achilles, and hamstrings.  I’ve used both the foam roller and the stick to do this.

Optional:

10) Massage.  Especially the calves and foot. This actually feels really good, I should go get one again.

11) Hot Tub.  Sitting in the hot tub really can feel great and helps relax the muscles.  I need to do this again too!

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INTERMEDIATE ACTIONS

1) Physical Therapy. This encompasses a wide variety of tactics and exercises.  Most of mine focused on hip, core, and ankle strength.  It is important to have a strong core to help hold your body together and in proper alignment.  This Running Times article covers a lot of the hip work that I was doing.

Physical Therapy
Image by crossn81 via Flickr

2) Iontophoresis (wikipedia). Actually a part of physical therapy, but this takes a steroid like dexamethasone and electrically injects into the skin.  This works well for a lot of people, but loses effectiveness after 8 treatments.

Iontophoresis

3) Taping.  I had mixed success with taping my foot while running and walking around.   I used this method. The idea is that this helps reduce the load that your fascia is forced to carry.

4) Inserts/Orthodics. I’m not really sure where to put this. I’ve heard of people having success with it, but I haven’t with inserts.  Also, with orthodics you’ll become dependent on them.  It might “fix” the problem but not change the body issues creating the problem. Treating the symptoms, not the problem.

5) Active Release Technique. ART, as it is called, releases the fasciia and other “tight” areas the cause Plantar Fasciitis.  I’ve heard that it works well and the Ironman offers ART Certifications, but my sports doc wasn’t aware of this non-traditional treatment.  It is often offered by chiropractors.  More information can be found here. Locally, some of my friends recommend Dr. Folske.

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LAST RESORT/EXTREME MEASURES

I’m sure there are more than these 2 but I don’t know of them.

1) Cortisone shot. Or other steroid injection. This injects a steroid into the fascia which speeds healing.  This is not a long term fix and masks the pain – quite well I’ve heard.  It has at least 2 major drawbacks:  tearing the fascia and atrophying the fat pad in the heel.  My sports doc really doesn’t like to use this option.  She thinks the long-term risks often outweigh the short-term gains.

2) Surgery. Yuck, who wants to go under the knife.  Basically they cut the fascia and it heals itself and is stronger.  This is the ultimate last resort. My thought is that if I just put my foot in a cast for 6 weeks I’d probably get the same results.

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Have you had success with any other treatments?

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Product Review: Strassburg Sock

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If  you’ve been around for awhile you know that I’ve been suffering from Plantar Faciitis for a while now.  I’ve tried a lot of different things, but one in particular is The Strassburg Sock aka The Sock.

The website describes how the sock works, when worn properly:

This easy to use, inexpensive device is designed to keep tension on the tissue (plantar fascia) so it heals in a stretched position at night. In this way many users find a reduction of their morning pain, some have noticed a reduced recovery time and yet others have reduced the need for medications.

When worn as prescribed, it does not allow the plantar fascia to contract while in the prone or supine position. The device holds the ankle and forefoot joints in a position of slight dorsiflexion that prevents a position of plantarflexion, that is the plantar fascia is not allowed to contract.

In addition the involuntary stretching of the plantar fascia over a long period of time helps to strengthen the foot’s arch.

Or more simply, the sock pulls the toes upwards during the night which if nothing else reduces the pain of the first step in the morning. It does promote healing, according to my MD, the sock and other night splints reduce the tearing of the fascia that comes from walking and promotes healing.

The sock is basically a tighter fitting knee sock that comes in 2 sizes based on your calf size.  There is a strap that goes from your toes to a “D” loop right under your knee that holds your toes in place.  It utilizes Velcro for both the toe strap and the strap below the knee.  One comment about the Velcro is that it can damage your sheets while sleeping at night.

The sock is intended to be worn overnight for 6-8 hours.  I found that it took a little getting used to before I could comfortably sleep the night away while wearing.  It is a little odd to have your foot in such a position.  The first few nights I would wear it for a few hours.  Because the strap makes a hypotenose from your toes to your knee the easiest position to sleep in is on your back.  I did find that you can sleep easily on your side and your stomach if you bend your knee.  It does seem like it’d be easier to sleep with this sock than a hard foot brace.

Their advertising is very clever, because while they claim to cure heel pain they don’t claim to cure 100% of Plantar Fasciitis.  They do claim that most people only wear it for 8 weeks and that within the first few weeks most of the pain should go away.  They don’t say whether their research subjects continued working out or what else they were doing.  I was wearing the sock back when I took 3 weeks off with 0 running miles and saw no reduction in pain.  Now with a prescription of Ibuprofen and physical therapy I am making progress.

I stopped wearing the sock for a few days and saw a significant increase in the pain I felt during the first few steps.  So the sock does help reduce the pain felt first thing in the morning.  It was amazing how much  more pain I was in by not wearing the sock.   So if nothing else your $40 will help with that part of the recovery.

Their website provides a fair amount of research and data that shows why their night splint is better than everyone else, but I’ll let you go read it and see for yourself.

[tags] Plantar Fasciitis, The Sock, Strassburg Sock, Heel Pain [/tags]

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Got IT Pain?

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A tight IT Band is not a good sign.  It needs to be stretched out and loosened up or it could turn into the dreaded IT Band Syndrome.

I was told my a massuse last year that my IT Band was extremely tight.  So I started stretching it on a regular basis.  I did some research and found this excellent information sheet about the IT Band.  By a trained physical therapist it lists some of the who, what, when, where, why, and how questions of the IT Band.

I think most of us are most concerned about not having problems with it and could care less about some of the anatomy that surrounds it.  She lists five keys to preventing ITBS – but they are actually almost identical steps to preventing any injury!

The list is:

– Changing running shoes every 300-400 miles and alternating between shoes with every run.  I’ve occasionally talked about my shoes and shoe preferences.

– Slowly increasing mileage (no more than 10% a week or on any run), including adding hill workouts gradually.  Downhills can add a lot of strain to the ITB.

– Avoid uneven surfaces.  More likely always running on the same side of a cambered or cantered surface like a road.  One leg can become predisposed to ITB because of the extra pressure placed on it.

– Keep the knees warm. Seems like if you are predisposed this might be helpful.  She said below 60 – but above 40 I’m wanting to wear shorts.

– Cool down and stretch after a run.  Ice if needed.

The article continues on and offers some stretches and strength training ideas specific to the ITB.  For now you’ll just have to go read up on it.

[tags] IT Band, ITBS, iliotibial band [/tags]

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Treatments for Plantar Fasciitis

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Plantar fasciitis
Image via Wikipedia

This post is popular, but I also wanted to point out an updated 18 steps to get rid of Plantar Fasciitis.

I’ve been enduring the pain of Plantar Fasciitis in my heel for most of this training cycle.  When  I first started feeling the pain I took almost a week off.  While the pain has never gone away it does ebb and flow.  It hurts the most in the mornings and then kind of tapers off throughout the day, likewise at the beginning of a run it hurts and then loosens itself up. Some days the pain is worse than others.  I’ve been icing and popping pills throughout.

As the weather has gotten nicer and I’ve been biking, I decided to see what the research said about biking and Plantar Fasciitis.  I didn’t want to make it worse by biking.  Fortunately, biking seems to be okay – but running and walking aren’t.

One thing that the resources I present below don’t talk about is checking your shoes – ensuring that your shoes haven’t been overused, in mileage or showing excessive wear.  I also found previously that I needed to check all my shoes – even casual and business ones.  A few years ago my work shoes were really worn down in the heels and I couldn’t figure out why my heels hurt so much.  I switched shoes and the pain quickly went away.  We spend a lot of time in our casual/work shoes – ensure they are working properly as well.

I love some of the simplicity of these ideas and the humor as well.  There are plenty of good tips though.

I found a website called Heel Spurs that lists a few simple treatments for Plantar Fasciitis:

  1. Stretching,
  2. Ice,
  3. Tape,
  4. Rest,
  5. Arch support, and
  6. Losing weight

Another website for North Coast Foot Care provides some more in-depth ideas:

  1. Stop running, jogging or walking. Swim or bike instead.
  2. If you work out on a treadmill, stop! This is the worst activity for your heels.
  3. Avoid the stair stepper. The stair stepper puts a lot of stress through your arch.
  4. If you are up and down at work a lot, try to limit it, and get up only once an hour, or once every 2 hours.
  5. At home, avoid going up and down the stairs multiple times. Have your spouse, significant other or child run up or down for you.
  6. Try to avoid steep hills. Stairs are better than hills. Walking up the stairs sideways will help take the stress off your feet.
  7. Do not lift or carry heavy items. This adds to the total amount of force that goes through your feet. This also increases the total impact on your heel.
  8. Do not lift your kids and carry them. Use a stroller, have them walk, or let your spouse/significant other carry them.
  9. Don’t lift weights. If you do, make sure you are seated
  10. The EFX (elliptical) machine at the gym can also aggravate plantar fasciitis. If you must exercise with this, lower the platform adjustment to it’s lowest level.

As well as some specific ideas for athletes:

  1. The best approach is to rest the foot for 10-14 days.
  2. Cross train by road or mountain biking, swimming or weight lifting.
  3. Do all the therapy outlined on the about heel pain page.
  4. Be aggressive about this treatment, stretching as much as possible throughout the day and
  5. Icing or contrasting between hot and cold as much as your schedule allows.
  6. Swim for exercise, or bike at low resistance at the gym and avoid the recumbent bike. If you bike outside, spin up the hills (use the lowest gears). Of course it is better to avoid hills if possible. Do not drop your heel while cycling, this puts excess stress through the Achilles tendon and the arch. Wear cycling shoes, or rigid shoes while cycling.
  7. Consider weight lifting. Avoid standing while lifting weights. Avoid squats, calf lifts and quad bench presses. There are many areas that we tend to avoid when we focus on specific training, especially the upper body. Try to readjust your focus for a few weeks.
  8. If you have pain at any time during the return, taper your routine accordingly. If you have a small amount of pain, then don’t increase the mileage or intensity, or give it a day’s break to rest and ice and stretch. If you have a lot of pain when you return, then you should take a full two weeks off from the activity and see your physician to consider more aggressive therapy. Physical therapy and orthotics would be good treatments to add.

I will say I’ve felt the best on Monday’s after swimming and sitting in the hot tub on Sunday mornings and any day after resting.  I’ve continued to stretch and ice, occasionally taking some ibuprofen, but other than that I’ve not done a good job of taking care of my heel!  After the half-marathon I plan on taking some time off and letting it heel some more!!

What have you done to treat Plantar Fasciitis?

[tags] Plantar Fasciitis, Heel, Injuries, Running [/tags]

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