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Remember to support the American Cancer Society, and challenge me to 5 push-ups and as many push ups as possible that I can complete in 86 per dollar. I’m up to 200 push-ups and 57:20 minutes of push-ups already. Donate here.

Plantar fasciitis is a devastating injury for long distance runners, so I am going to cover it in some detail this week. It takes you off your feet for at least 2 months, and up to 6 months. It tends to happen when a runner gains weight and/or increases their mileage. For me, I am heavier than I usually am, and I got injured right after my epic, long distance, Tough Mudder, which I didn’t give myself enough time to rest after.

How did we figure out that it was plantar fasciitis? When diagnosing, you think of everything it could be, then rule out and rule in each one of them. Here is the differential diagnosis (Uptodate):

  1. Plantar Fasciitis
  2. Heel fracture or stress fracture
  3. Heel bruise
  4. Nerve pain from entrapment
  5. Painful heel pad syndrome
  6. Tendonitis

We ruled out heel bruise as well as muscle and tendon strain by waiting for 2 months. The heel fracture was ruled out by a foot x-ray, with multiple views. These fractures can be small and hard to see, so they aren’t always seen. In my case, nothing was seen except a bone spur on the other side of my heel that didn’t hurt. Nerve pain was ruled out because tapping on the posterior tibial nerve did nothing. Painful heel pad syndrome was ruled out because of the pain that was localized to the arch, in addition to the heel pad, at least initially. Here are the main symptoms and signs of plantar fasciitis:

  1. Arch pain acutely, that changes to heel pain over time (I have this.)
  2. Pain with the first step in the morning (I did not experience this.)
  3. Prolonged pain that gets worse with activity (walking or running, which I had.)
  4. Pain elicited when you dorsiflex the foot (pull toes up towards your body, I have this.)

So how could I have avoided it? Simple, take a real rest after a big event. Conventional wisdom says that you should take one day off per mile you raced. For long distance runners, that can get to be a huge amount of time quite quickly. I would say if you race longer than a half marathon, you should at least stay off your feet for a week. For longer than that, it really depends on what your training was like before that. If a marathon was just a small step up in distance, then you could be fine. If the marathon was the big thing, resting for at least 2 weeks is warranted.

Okay, so now that I have it, what do I do about it? The central tenant is rest. By rest, they mean reduce running and walking distance, but activities like biking and the elliptical can be good cross training. Next, fasciitis means inflammation of the fascia (connective tissue), so you can add anti-inflammatories like Naproxen 550mg, twice per day. Naproxen is prescription only, and is basically a stronger version of ibuprofen. If it stays bad for a while, you can consider direct injections of steroids, which help but also if used too much, lead to weakness of the tissue there.

As I listed above, one of the problems is the first step in the morning. While you sleep, your arch is relaxed, so that first step stretches it hard and fast. There are two ways to solve that problem: (1) wear shoes with arch support at all times, including right after bed and (2) wear a device to keep your arch stretched at night. I have been wearing a Sofshoe high arch support insoles for the past couple weeks, and it’s made it possible to play frisbee again. I wear the insoles in all of my shoes, including my cleats. I also just ordered a soft night device to see if that will help too. I bought it from Amazon for just over $8 because Walgreen’s cheapest one was $35.

One thing that is easy to forget is physical therapy and stretching. This can make a huge difference on recovery times. Let’s start with massaging and stretching. First, put a water bottle in the freezer and, once frozen, roll your arch over it for 20 minutes on/20 minutes off. This will both massage the fascia as well as apply good cold, which decreases inflammation that is the source of the problem. Next, stretch the arch for 3 sets of 30 seconds, as much as three times a day. This could either be by pulling your toes back with a towel or your hand, or doing the classic calf stretch.

Other good exercises include:

  1. 3×10 heel raises (otherwise known as standing on your tip toes, repeatedly)
  2. 3×10 single leg squats, without using anything for help with balance
  3. 3×10 side leg raises

Let me know what works for you! I’m looking to get back to running ASAP, so I’m doing all of the above.

Remember to support the American Cancer Society, and challenge me to 5 push-ups and as many push ups as possible that I can complete in 86 per dollar. I’m up to 200 push-ups and 57:20 minutes of push-ups already. Donate here.

Workouts

Sunday: 14x(10 burpees with push-ups, 50 crunches)
Monday: 2 hours UCLA ultimate
Tuesday: 90 minutes pickup ultimate, 30:00/8.5 mi stationary bike
Wednesday: 2 hours UCLA ultimate, 2hrs/35.28 mi stationary bike, 4×5 pull-ups, 4×10 hanging leg lifts
Thursday: rest
Friday: 2 hrs UCLA ultimate
Saturday: 5x(10 burpees with push-ups, 50 crunches)

Weight: I had some big ups and downs this week, with a high of 186.8 lbs (BMI 27.7) and a low of 181.8 lbs (BMI 27.0). Thats a new record low. However, I am ending the week at 183.0 (BMI 27.2), which I am viewing as a success. It is, overall, one pound less than last week.