Plantar Fasciitis

[Tussockface]

Interesting post, PhysioIan.
I think you're right, and having read lots of stuff and tried a range of things I think I'm now a lot closer to working out the underlying problem for me.
First, it came on after I'd resumed running too quickly after an ankle sprain. Tight calves/ankles are always an issue for me and my whole lower leg had even less flexibility after the injury. This put more strain on the foot structure. When I upped the pace on tarmac (a road 10k) it gave up.
After an initial period of bringing down inflammation, supporting it with an insole and a few weeks of rest, the key therapy was stretching - the type you mention being very important, but also whole foot stretches. I felt that direct work on the injured area needed to be complemented by work to increase flexibilty and strength in the surrounding tissues and structures. Balance work helped. Mountain biking on singletrack was unexpectedly beneficial in the later stages, with long sections up on my toes, continually adjusting weight bearing.
Over the last few days I've found that I can run OK off-road, but tarmac triggers recurrence. I have a new theory that the cushioning in my road shoes isn't good enough, and am off to buy a new pair tomorrow. I've partly tested the theory already though - I was talking to an O/70 runner before the West Yorks five mile race yesterday and he commented that his physio had told him to throw away his shoes (which were the same model as mine). This got me thinking and I immediately went and changed into another pair of shoes - my gym shoes - which I happened to have in the car and which have heavier duty cushioning. I also added a sorbothane layer under the insole.
I managed the race without aggravating the plantar fasciitis at all.
So I'm hoping I've got it cracked this time, but as you say, it's something of a detective exercise. I don't think orthotics are always necessary, or that the problem is inevitably one of gait or anything else.
I've just managed 3 races in 4 days, and although I'm aware that the pf hasn't completely gone away, it's feeling better than it did last week. My fingers are still crossed though, and I may not have escaped from this thread yet!

[lilactime]

physio ian . what are your thoughts on surgery for pf ? my doc says its a curative , apparently they now do it endascopic ? ( sorry for spelling ) , and it is very succesful . in and out of surgery same day.

[lilactime]

physio ian , agree about the injection , have the dreaded feeling sooner or later mine will wear off , doc says 3 injections max . had the injection not to resume training but to get me through the working day . still stretching and have appointment for insoles .

[Physio Ian]

Hi Tussockface

First, it came on after I'd resumed running too quickly after an ankle sprain. Tight calves/ankles are always an issue for me and my whole lower leg had even less flexibility after the injury. This put more strain on the foot structure. When I upped the pace on tarmac (a road 10k) it gave up.

A classic example of returning too soon, because PF is a non-contractile tissue, it is greatly influenced by the contractile tissues which attach to it, therefore if these tissues become tight such as gastroc (calf) or soleus, it can have a knock-on effect and irritate the PF

Over the last few days I've found that I can run OK off-road, but tarmac triggers recurrence. I have a new theory that the cushioning in my road shoes isn't good enough, and am off to buy a new pair tomorrow

Sounds a good idea, if you have a particularly high or flat arch, then having the right pair of road shoes is paramount, far more so than fell running. Lets say you're high, but your shoes support are 'flat', then with repetition on tarmac, your PF will be subjected to a greater degree of 'bowstringing', which if this is coupled with tight calfs will almost certainly lead to problems for the PF.

I don't think orthotics are always necessary

I agree. I use 'off the shelf' as well as custom made orthotics, but they are never my first port of call. Muscles in the foot can become 'lazy' just like muscles in the lower back, but I wouldn't put someone with low-back pain into a back brace or corset unless muscle strengthening exercises had failed and it was the last resort.

Good luck with it, it sounds promising, just make sure you get a good assessment before purchasing your road shoes.

Hi lilactime

physio ian . what are your thoughts on surgery for pf ? my doc says its a curative , apparently they now do it endascopic ? ( sorry for spelling ) , and it is very succesful . in and out of surgery same day.

Of all the surgical options for the feet, this is one I'd be in agreement with, obviously when indicated. As previously mentioned, PF is non-contractile, and therefore if it is a chronic problem that has been developing for sometime, possibly undetected for many years until one day pain comes on for no obvious reason, it will have become exceptionally tight and 'shortened', and a release of the tension within the affected area should work well, as is the case for the ITB.

However, it would be a last resort, therapy consisting of rather unpleasant manual, direct pressure to the affected area should always be attempted to its optimum, as although it hurts lots, it can work amazingly well.

As you mentioned, you'd probably have a maximum of 3 injections, which will hopefully help to settle the pain, but it won't be a cure. I've only just picked up this thread so I don't know what has happened previously, but if your pain has calmed down, i'd take advantage of the 'window of opportunity' to get thoroughly assessed to try and identify the underlying cause.

Good luck!

[lilactime]

thanks ian , surgery would be my last port of call . pain was getting less before injection , but would be bad after a day at work in steel toecaps , injection has helped me there , but do think the off shelf insoles and stretching ( my physio reccomended the toe to wall stretch ) has helped a lot , still doing all the stretching , " in my window of opportunity " hoping it will not come back .

[IanDarkpeak]

I've a question can you get PF under the ball of your big toe. I've had a ache-tenderness between the ball of my big toe and the second toe. It's come on in the last three weeks since upping my training, It always seems to be worse after hill session (running on my toes up hill) or on the road.

Stretching is no problem and my heel is fine.

Any thoughts?

[BLUEBIKE]

Unlikely as PF is a heel thing, a little spur. More likely to be overuse, bruising etc at joint area more so if your working on forefoot - sprints or increasing pace through forefoot - on hils for example often causes this....but if your aiming for sub 3.45 on Tankys it's worth it!

[BLUEBIKE]

...the other way to tell if it's PF is that the pain in the heel area will be worse in the morning when you first get up and on your feet - if it is PF...then that's a big recovery job!

[IanDarkpeak]

Unlikely as PF is a heel thing, a little spur. More likely to be overuse, bruising etc at joint area more so if your working on forefoot - sprints or increasing pace through forefoot - on hils for example often causes this....but if your aiming for sub 3.45 on Tankys it's worth it!

...the other way to tell if it's PF is that the pain in the heel area will be worse in the morning when you first get up and on your feet - if it is PF...then that's a big recovery job!

No heel problems so doesn't look like PF phew! the pain comes and goes so I'll see what happens.

sub 3.45 would be a dream but unless the sun comes out and dries out the hills it's more of an impossibility.

Yesterdays Triple crossing was really tough under foot but knocked 7 minutes of my PB when others struggled to get near theirs. fingers crossed

[BLUEBIKE]

Sounds like your in good shape - holding it together off Alport and down snake is the critical moment for me tho', all the effort can get lost if you blow on the last climb
Take it easy on the foot! Watch those hill reps.