Tricks of the Trade – Plantar Fasciitis

Plantar fasciitis is irritation and swelling of the thick tissue on the bottom of the foot.(1) I first learned about it when my wife, Sandy was struck with it. Running and even walking was painful for her. So painful, she was “out” for four months. Thankfully, Sandy has fully recovered with no pain at the time of this writing.

When Sandy was going through her Plantar fasciitis trial, we both did a lot of Internet research. We also made a trip to The Running Lab in Orange, CA. Sandy went through the full evaluation, was fitted with new shoes as well as orthotics. We also received some excellent advice which we will share later in this article.

Now I am having pain. I believe it to be Plantar fasciitis. Mostly, my foot feels warm. But, at times, when I am not wearing shoes, I get a sharp pain in my arch. I have a full schedule planned for the rest of this year including a 24-hour event, the Paris Marathon and the annual running of the 100-Mile Endurance Challenge. So, I thought it made sense to write down our prior experience and follow it myself. My hope is that I can help others with this debilitating condition.

Note: While I am not a doctor, I have put together these four “Tricks of the Trade” to address common medical issues that affect runners. Some foot injuries will not get better with the techniques listed below. I recommend that you consult your health care professional before making any changes to your workout regiment. Full disclosure: I am the race director for the Run 4 Kids 24-Hour and the 100-Mile Endurance Challenge.

Week 1 – Stop Press!
For the first week, I recommend a cessation of all exercise. (Ouch!) If you are not willing to do this, I would at least recommend that you reduce your distance and difficulty of your workouts. Those who belong to a gym should consider other sports such as swimming. Weight training and using an elliptical trainer are alternatives. This is going to sound ridiculous, but, I also recommend limiting your walking and even walk with a limp so that you don’t put your full weight on your foot. Another alternative is to implement this advice for a few days.

Next, I recommend that you go to a discount store and purchase some waterproof sandals that have good arch support. If you are standing, you should have arch support. Period. This includes waking up in the middle of the night to go to the bathroom. The reason I recommend waterproof sandals is so you can… (you guessed it) wear them in the shower. OK. I’m probably lost most of you. But the reason for the sandals is based on the idea that you heal every night and then re-injure yourself ever morning when you step out of bed. When I heard this, it made sense.

Finally, I recommend you ditch your current running shoes and buy new ones. Try to find a place like I did that will fit you for new shoes and also recommend arch support from a pair orthotics. At The Running Lab they watch you walk back and forth in the store, they use pressure sensitive material to determine whether your have a flat or high arch, and, for an additional fee, they will put you on the treadmill with your new shoes to ensure you have the best fit possible.

Week 2 – Start to Walk
Assuming you took my advice for week 1, you may be able to introduce a little walking in week 2. If it hurts, stop immediately and limp back to your car. If you belong to a gym or have one at home, you can walk on a treadmill. The idea here is to always stay below your pain threshold. Just below pain is discomfort – this is where you want to stay. I call this “active healing.” And it seems to me based on other injuries from which I have recovered, that this technique accelerates the healing process.

Weeks 3-6
As you get stronger, you will continue to stay in the discomfort zone but, your distance should improve. It’s going to take all of your will and self-discipline, but, slowly increase your distance. You can wipe out weeks of progress with a single hilly trail run! Continue to push yourself on other non-running activities like swimming or the elliptical so you can stay in maintain your fitness (and your sanity). Stay with the sandals. At some point, you will want to reintroduce running into your workout schedule. Start with run walking – run a minute/walk a minute. Then, slowly lengthen the distance and the percentage of the time you run vs. walk.

Additional Tips
1. One thing that my wife and I learned during her bout with Plantar fasciitis was that at night, she was “cupping her feet”. Specifically, as she was sleeping on her side, one foot was pressing on the arch of her other foot. I too have caught myself doing this. The result is sore feet. In fact, my wife feels that this prolonged her recovery. If you sleep on your side, make sure that your feet are separated so that they don’t touch each other.

2. A shorter stride and faster turnover will reduce the strain on your body at the same time it will increase your speed and endurance. While you are running, say to yourself double time” and double the number of steps per distance traveled. Ideally, your right foot should hit the ground 22 times in 15 seconds.(2) Time yourself with a watch at the same time you count to yourself.

3. It’s a well-known fact that protein is needed by the body in order to repair muscles. Plantar fasciitis is basically an injury to your muscles. So, it makes sense to ensure that you are getting enough protein. A position statement published by the ADA, DOC and ACSM recommends that endurance and strength-trained athletes have between 0.5 – 0.8 grams of protein per pound for the best performance and health.(3) Vegetable sources of protein, such as beans, nuts, and whole grains, are excellent choices, and they offer healthy fiber, vitamins and minerals.(4)

4. Think about how you hurt yourself in the first place. I put 668 miles on a single pair of shoes and did almost all of my training in the hills. It is recommended that you replace running shoes between 350-550 miles depending on your running style, body weight, and the surface on which you run.(5) Instead of running all your workouts in the same manner, try to vary the pace, distance and elevation gain. Another rule of thumb is to not increase your weekly mileage more than 10% per week.(6) Finally, if you want to introduce something new (e.g., hills, swimming, weights, etc.) do so slowly.

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Footnotes:
(1) “Plantar fasciitis.” Google Health. https://health.google.com/health/ref/Plantar+fasciitis
(2) 3 Ways to Improve Your Running Form. Active.com. http://www.active.com/running/Articles/3-Ways-to-Improve-Your-Running-Form.htm
(3) “How Much Protein Do You Need?” About.com. http://exercise.about.com/cs/nutrition/a/protein_2.htm
(4) “The Nutrition Source. Protein: Bottom Line” Harvard School of Public Health. http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/protein/
(5) “When to Replace Running Shoes” About.com. http://sportsmedicine.about.com/od/tipsandtricks/a/replaceshoes.htm
(6) “The 10-Percent Rule” Runners World. http://www.runnersworld.com/article/0,7120,s6-238-267–1051-0,00.html

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