Bodyworks: Plantar Fasciitis

How to recognise it, how to overcome it


Posted: 5 June 2000
by Patrick Milroy

Symptoms
Pain under the heel centre at the origin of the plantar fascia. This is a fan-like web of tough fibres which spreads across the underside of the foot and attaches to the origins of the toes, and its main purpose is to maintain the shape of the longitudinal arch. (This arch, along with the transverse arch which stretches across the metatarsal heads, allows proper pronation, which helps to absorb landing forces and provides some elastic recoil as your foot pushes away from the ground.) The pain is worse when running or walking, and often particularly bad first thing in the morning.

Signs
You won’t experience any swelling, but press the underside of your heel and you’ll probably feel acute pain. A flat longitudinal arch (or a high, rigid arch – both are at the limit of their elasticity) that is suddenly stretched when the whole length of the foot falls on uneven ground, can induce acute pain. New shoes or inappropriate orthotic support can also cause pain which will appear after a long run. Although x-rays may show a calcaneal spur, this is irrelevant as many that are found accidentally are not associated with plantar fascia pain, and many with pain have no spur.

What else could it be?
Other causes of the pain could be a fracture or stress fracture of the calcaneum (heel bone), bone disease and local infection, or simply bruising of the heel’s fat pad.

Self-treatment
Rest aside, ice packs, good heel cushioning and a heel cup to firm up and thicken the under-heel fat pad, may relieve symptoms. Massaging the area by gently rolling the heel on a golf ball is popular in the USA. You should ensure that your shoes have good midfoot flexibility and an arch support.

Medical treatment
Supporting a flat foot with a proper orthosis can bring relatively dramatic improvement, but you should be professionally assessed first. NSAIDs (non-steroidal anti-inflammatory drugs such as ibuprofen) can ease, but not cure, the condition. Physiotherapists can use exercises to improve the intrinsic or small muscles of the foot to ease the condition, and interferential or other electrical treatments may reduce the pain, though not affect the cause. If there’s any evidence that your condition is becoming chronic, you should quickly be given an injection with hydrocortisone or a similar appropriate steroid.

Can you run through it?
If you change your shoes and use an arch support, you may find that some running is possible, but you should not run through any pain that’s severe enough to cause you to limp.

Recovery time
One week to two years! Ignoring the condition initially is asking for long-term pain, so take steps to stop it early!


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Plantar Fasciitis
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Help

My Doctor says I've got Plantar Fasciitis. He's refered me to a podologist and suggested a seroid injection if it gets really bad.

I'd rather try to get rid of it without taking too much medication.

I've had to stop running and it's driving me nuts. I'm supposed to be training for the GNR.

Anybody got any tips for getting rid of this thing?

Thanks
Jo
Posted: 20/08/2002 at 12:55


Guy
If you want to read a very long (and slightly depressing) article explaining what plantar fasciitis is, and exercises designed to avoid/cure it, have a look at http://www.pponline.co.uk/encyc/0180.htm.

Other than that, I can't really help you with getting rid of it. My only experience of it is that for the past few weeks I have had discomfort in my foot that seems to match the symptons of plantar fasciitis, although it isn't bad enough to stop me running or affect my pace. It seems to have been caused by doing a fast 5k in thin racing shoes. I have found that it virtually disappears if I don't run for a day, and is only brought back by doing a long run. It seems to come back at about 10 miles as a discomfort which doesn't get any worse, but causes pain after the run. My plan (not entirely consistent with the advice given in the article) is to run as much as I can for the next few weeks without making it worse, and then give it a rest for a few weeks after the New Forest Marathon (22nd September).

Personally, I would be very cautious about having injections, unless someone could persuade me: (i) it was absolutely necessary; and (ii) it was going to do more good than rest or exercises.

If you have not done so, you also need to give some thought to what is causing it. Otherwise you might cure it, and have it come back as soon as you start upping your mileage again.
Posted: 20/08/2002 at 16:31

Joanne

I had quite a bad case of PF about 18 months ago and it really is depressing. I was training for London at the time and had to take about 8 weeks out COMPLETELY!. If you haven't done so already you must change your shoes, make sure you get them fitted properly at a specialist sports shop. I took Ibuprofen which helped but the thing that really helped was a foot massager. It was just a piece of wood shaped like a rolling pin but with grooves cut into it, its easy to use and you can even use it whilst watching the telly!!

Is it painful even to walk on? I know its depressing but you really need to get off your feet for a while. I didn't completely get rid of it before I started to train again but with the new shoes it just seemed to finally go away of its own accord after running again for a few weeks. Try to keep your fitness up by Cycling and or swimming.

Hope this helps - keep smiling!!
Posted: 21/08/2002 at 08:41

Thanks fellas

I did keep running on it for a while after visiting my GP. I decided to stop when the pain after each runs was getting progressively worse. Now it hurts even when I walk.

I recently purchased some new shoes, Brooks GTS, from Northern Runner, they said I was over-pronating. At first I thought it was the shoes as I'd had no problems with my old shoes, so I went back to my old Nikes, but that made no difference

I've tried stretching, ice, heat and massage, but from what you say it's just going to be a matter time and a bit of trial and error.

I'm either swimming or cycling everyday but its just not the same as running.

Thanks again, it's encouraging to hear that it does go eventually.

Jo
Posted: 21/08/2002 at 09:37

Hello Joanne,

I got Plantar Fasciitis earlier this year. I visited a sports injury clinic and had some physo including ultra-sound. The physiotherapist said I was over-pronating and sold me some shoe inserts (for my ordinary shoes) to correct my gait. This, along with stretching and ice helped to cure it in a couple of months. I started training again in June and have just done a 6k race today! No problems.

If you haven't seen one yet visit a physiotherapist - BUPA or a sports injury clinic usually charge around £30 for half an hour.

Good luck

Posted: 28/08/2002 at 01:10

Thanks Percy

I'm off on holiday next week so I'm hoping some aggressive chilling-out and sunshine will help! I'm going to see a podologist when I get back so I'll let you know how I get on.

How did you know it was safe to start training again?

I'm not running at all and it's after a run that it's most painful, so it's hard to tell what's going on. There is a dull ache with each step I take and after a periods of inactivity it's sore but I can walk it off in a couple of minutes.

I did a circuit training class last week, but didn't run much, and it was OK afterwards, not perfect, but OK.

I have resigned myself to the fact that I might have to miss the GNR and I feel better about taking the time out, but I still get a little pang of jealousy when I see folk out enjoying their running!
Posted: 28/08/2002 at 09:27

Extracorporeal Shockwave Therapy (ESWT)
- like what they use for kidney stones and gallstones.
Not that widely available I'm afraid but you might be lucky depending on where you live
Posted: 28/08/2002 at 11:01

Joanne,

After 3 visits to the physio the pain had started to ease so she suggested I start gently jogging 1k on grass every other day for a week to see how it reacted. It seemed OK so I gradually increased.

At the same time I was doing 3 types of calf stretching twice a day because, believe it or not, tight calf muscles pull the fascii (that's why it often hurts 1st thing in the morning). I was also putting ice on it for 5 minutes after a run and last thing at night and rolling a golf ball over the sole of my feet midway through each day for 10 minutes.

It took about 2 months for the pain to gradually decrease, but at times I thought it would never go.

Hope this helps.

By the way there is info about Plantar Fascii on this site.

Percy
Posted: 28/08/2002 at 23:06

I've had plantar fasciitis now since March and haven't run since and am getting very pessimistic about getting rid of this condition. I've seen several physios and have recently been to see a podiatrist. I have had ultra sound and have been told to do at least 25 mins of calf stretching each day. I'm also rolling a frozen tin of beans under my foot each night to stretch and reduce inflammation of the plantar. The podiatrist has also just prescribed night splints to stretch the plantar overnight. Does anyone have any experience of this working? I have also been told I overpronate too and have changed my running shoes. And the podiatrist also suggested undergoing a course of rehabilatative physio to help address my gait. Is this something anyone else has experience of ? Any advice gratefully received. Is it normal for it to go on so long?
Posted: 12/08/2003 at 13:19

Hi Vicky

After visiting a podiatrist, getting physio and ultra sound treatment I eventually gave in and had a steroid injection at my GPs.

I had the injection in March and I've had no bother since then...touch wood.

I'm not training as heavily....it's just good to be back out there!

Good luck with the treatments, they didn't work for me but they seem to work for plenty of other folk.
Posted: 12/08/2003 at 13:32

Thanks Joanne. Out of interest, how long had you had PF for before having the injection?
Posted: 12/08/2003 at 14:29

It started end of June 2002, went to see podiatrist September, physio January thru February 2003 and I had the injection March...9 month.

My GP said the condition had become chronic because I didn't rest it when he'd told me to...ooopps!

It got to the point where it hurt just walking. I haven't had any pain since the injection...but I am expecting it to come back at any time!

It's not fun, I really feel for you.
Posted: 12/08/2003 at 14:41

Try strapping it up - you can get instructions how to do it on the internet somewhere.
Posted: 16/08/2003 at 22:34

2 PF strapping links
one in the Best of the forum
and this one from another magazine
Posted: 17/08/2003 at 08:35

Thanks for the links to the PF strapping sites. I have been taping my feet following a visit to a podiatrist and it does seem to help a bit. But, I find that this condition is so variable. Some weeks I think I'm really making progress and then my feet will get really sore again.

What I'm wondering is whether I need to do even less on my feet than I am currently. I have stopped running completely, since April, but find I can only be on my feet for about 4 hours max doing shoppping, chores, cooking etc. before they get bad. Do I really need to take to the sofa? Does anyone have any experience of this condition clearing up by literally keeping off their feet for a period of time?
Posted: 18/08/2003 at 10:31

I've also been suffereing from the dreaded PF for some months now and \i'm in my eighth week without any running whatsoever. After two months of physio (useless) and a steroid injection two weeks ago (more painful than child birth!)I visited a podiatrist today and was told my PF was caused by an extremely tight "gastocnemius" muscle. He said he had performed surgery on less severe cases (hes also a surgeon) and that stretching was all I needed to do (I had gone armed with cheque book for a set of orthotics)The stretch in question can be found on the RW website article "The RW Complete Guide to Stretching" Whether this works for me remains to be seen but it may be worth considering. Having looked it up in my anatomy and physiology books it appears to make sense.


Posted: 19/08/2003 at 21:31

My previous (abortive) attempt at taking up running in 2001 was stopped due to PF (and laziness) but it got worse even when walking. I had a series of ultrasound treatments during last summer and, combined with rest of true couch potato proportions it seemed to go away.

Anyway, it's now September 2003, I'm 3 1/2 stone lighter than I was earlier this year and I've been running at least 9 miles a week since July.

The problem is that the twinges in the heel are starting to reappear and my worst fears are coming true - the ultrasound (as has been suggested) only helped ease the symptoms. The difference this time is that I don't want to stop running - I love it and have set myself the goal of doing a half marathon next year.

So I want to try and get to the bottom of the problem, which the doctor/hospital/NHS physio weren't too great at last time. If it's my gait, would a well-equipped specialist running shop help? (There's a Sweatshop locally with various fancy bits of analytical equipment). Yes, of course they'd want to sell me running shoes, but I'd be happy to pay if it addressed the problem.

So, to summarise, will staff in a specialist running shop be able to help or am I going to have to find a decent private physio?

Any answers welcomed...
Posted: 12/09/2003 at 14:05

I had PF a couple of years ago. Not knowing what it was I tried resting it for a few weeks, but this didn't work. Went to the doctor who diagnosed an inflamed Achilles tendon!!!! and prescribed a course of anti-imflammatries. These didn't work, so he followed this up with an injection, which also didn't work (but hurt like hell). Went back to see another doctor who diagnosed PF and referred me to a physio.
The physio strapped my foot up as a short term measure, and got me to do a series of calf stretches. My over-pronation and tight calf muscles wer causing the PF. I also did a series of exercises to strengthen the calf muscles. I also used the physio's advice to buy a new pair of trainers.
Eventually the pain just faded away over time, I occasionally get twinges, but this is usually if I don't warm up and stretch the calf muscle correctly. As the doctor said the plantar muscle gets very little blood flow and because it is used constantly when walking, running etc it takes a long time to heal, it can take a year.
My advice is to see a sports physio and give it time.
Posted: 30/09/2003 at 09:11

Well, similar story to Darren. I had my gait analysed at Sweatshop, got some stability shoes to replace my cheap cushioned ones and have done plenty of calf-stretching and foot-massaging since.

And the pain does seem to have faded away.

There is hope!
Posted: 01/10/2003 at 19:44

Since recovering from PF late year I have taken some preventative action. The large Boots in my town (the chemist not footwear!) have a footcare department which gave me a biomechanical assessment. They found I had one leg shorter than the other by 1cm. This was causing the overpronation which had caused the PF. They took a cast of my feet and made orthotics (£150). I have had no problems at all since then. It's an expensive option, but I think it's worth it.
Posted: 02/10/2003 at 07:58

Six weeks since I last posted on this thread and I'm up 'n' runnin again !
The calf stretches have worked and I ran a half marathon on Sunday (albeit a little slow !) I still have to stretch religously though or the pain sneaks up on me again but it appears to be improveing. Im back up to mu usual 25 - 30 miles a week with caution.
So all you PF sufferers out there - dont give up like I nearly did. Just seek good advice and be patient !
Posted: 02/10/2003 at 20:42

Hey Guys, It has taken me a year to get back out there running again after getting plantar fasciitis and the most reliable people who helped me get better from being unable to walk without bad pain were the GP with a steriod injection (after I put up a fight for ages against it), the podiatrist for correcting my orthoses and giving me appropriate exercises and stretches to do, and lastly my sports massage lady who found tight areas not only under my foot but on the inside of my calf going down to the ankle. Sports massage now keeps it in check. I'm back smelling the flowers again!

To the despondent - take up cycling, rowing, upper body strength training at the gym and swimming (not breaststroke and without kicking off from the side) and the healing process can take place without you aggravating it.

If you find a good sports masseur, once a month session for everyone is a good injury prevention method as most twinges and worries can be resolved and you get good advice too!

I'm doing triathlon training as it less pressure on my foot than pure running and if I've done a bit much running I ease off and bike and swim more. It ain't easy getting over this.
Posted: 31/10/2003 at 13:32

Reading all these messages makes me think there is hope. I was ecstatic last week as i had just returned to running after 5 weeks total rest (swimming only) with PF. Two runs of 1.5 miles and a 5 mile bike ride and my feet are really aching today. I'm seeing the podiatrist this afternoon so i'll see what he has to say and probably return to the sports injury clinic later in the week. Despondency is settling back in.
I'm missing the cross country, i'm having running withdrawal symptoms.

Posted: 03/11/2003 at 12:22


FAJ
Dangly Spice - ooh, I feel your pain! Figuratively and literally. I've had PF for yonks and it's stopped me running. I'm off to the podiatrist on Wednesday and I'm going to ask about night-splints and a steroid injection. Might seem a bit OTT but stretching alone aint helping.

Hope it goes well at the pod this aftie (let us know how you get on) and that you're better soon.

Posted: 03/11/2003 at 13:03

Oh noooooooooooooooooooooooooooooo

I have just been told by physio I have Tibialis Posterior Syndrome and Plantar Fasciitis. I ran Amsterdam, 2 weeks ago and had a couple of runs which have left me with very sore ankles and above which is the first injury (above).

He said total rest for 2 weeks and I should be sorted....

Is he being over optimistic?????

Didn't appreciate I had PF until he told me today but I have had lots of pain and aches since the marathon.


Posted: 03/11/2003 at 18:28


FAJ
RRCR - what is Tibialis Posterior Syndrome?
Posted: 04/11/2003 at 08:52

http://www.sportsinjuryclinic.net/cybertherapist/front/ankle/tibialisposterior.htm
Posted: 04/11/2003 at 09:34


FAJ
Thanks, Popsider. Looks grim - ooyah.
Posted: 04/11/2003 at 10:20

Hello, I been running for over 27 years and never had this much problem before. It all started to hurt after I did a 1.5 mile run for work in Feb 04. I run a 2:36 marathon last year in the states and that iswhen my feet started to hurt. I went to a Foot Dr. and he told me that I had one leg shorter that the other and he made me orthotics. That seem to make my foot problem worst. Now he said I had PF and he gave me a steroid injection. That only help a little. Then he gave me another injection and I think he hit a nerve when he did it. Time goes on and my foot started hurting on the other side so what did the Dr do he gave me another injection. Now I have a lump on my arch and I go back to the same foot Dr and he tood me it looks like a trap nerve causing the lump and he gives me my #4 injection of steroid and that willbe the last one. I steel have the same pain in my foot that they call PF. I see a new Dr and he tells me I need to keep my foot from bending and he put me in a cast. My foot blows up and I have them take the cast off. Then he put me into a foot brace which is like a cast and he said I should wear this for the next 2 months. The point is my foot is no better then it was back in Febuary. I need help. Jeff
Posted: 16/09/2004 at 09:57

Jeff, You have been through the mill and back! I'm sorry you've had so much aggravation. I can recommend an excellent podiatrist (depending on where you live) but I would suggest that you take time out and plan yourself a recovery program starting with a good gym program. There is a great deal of variety at the gym for cardio vascular fitness as well as weights and a good gym instructor is a breath of fresh air! Please consider sports massage which will help reduce the tightness in the foot. I had two lumps in my foot - one at the heel and one in the ball and my podiatrist showed me how to gently massage these to reduce the pain and these gradually resolved. After what you've been through I recommend you stay away from needles!
Posted: 16/09/2004 at 11:30

Help!!Supposed to be doing my first marathon in Dublin in Oct, Had to cut short a 20 mile training run at 13.5miles pain under arch of my foot.Have rested it for two weeks now (missed GNR!).Physio been massaging/ultra sounding it, going to try a short run next week.
Problem is one day seems fine , then can hardly walk , feels like there is a large stone being jammed into the arch of my foot, each time I put my foot down.
Any ideas as to what this may be??!! No heel pain though.
Posted: 02/10/2004 at 20:17

I've had PF since Dec 04. I stopped running and rested,iced, stretched and got Physio(ultrasound etc) for 6 weeks. Then I saw a Podietist and had casts made, which hurt my good foot more than fixed my bad one. After 8 weeks of more treatment I finally saw a Doctor and had a cortisone injection, yes it hurt for 4/5 days but after 2 weeks I have no pain. In about another 4 weeks I will start to jog again to test it then hopefully build up. I had still trained swimming, cycling and rowing. As I was training for Ironman UK I replaced the running with rowing on a Concept 2. The time for distance were very close to my running. I rowed the marathon and now I'm hooked and building up to a MILLION METRES. Don't let an injury stop you training, you may find something new to enjoy.
Posted: 18/06/2005 at 18:10

Totally agree with ref to steroid injection. Suffered from PF for months - foot fine as long as I didn't run on it. Had injection as last resort as was desperate to start training for 2007 London Marathon. No pain during injection or after and pain free 2 months and lots of training later. Am careful to build rest days into programme and very aware that over training may cause problem to reappear but so far so good.
Posted: 02/01/2007 at 16:16

Tina - very interested in your comments about swimming with PF ie don't do breaststroke or push off from the side as this is exactly what causes my foot to start aching. Oh for the carefree, injury free days that I took for granted in the past!!
Posted: 02/01/2007 at 16:23

Had 2 jabs. First one hardly hurt but didn't make any difference. Second one, 12 months later, hurt like mad, and screwed the sole of my foot for about 3 months. Didn't cure my PF either. The right custom orthotics have got me running regularly again and I'm in training for a half-marathon in Feb, the first since my PF started nearly 3 years ago.

Different things work for different people...
Posted: 02/01/2007 at 20:10

Hi,
Just after a little advice from you please since im new to running. I started around August last year and run about 2-3 times a week, usually up to 5 miles each session, doing it more for keep fit than marathon training. I have, however, just signed up for my first 10k in April and would very much like to do this ( more of a personal challange ).
Just this week though I have developed very much what you are discussing here, heel pain which spreads to my arch. Not in pain when actually running, its the rest of the time. I have read with interest the suggestions both here and on medical websites about the stretching, the massage, getting better fitted shoes ect and I am certainly going to try all those, but did wonder about the "resting" it issue. I work a couple of days a week in a job that i am on my feet the whole time and I do go to the gym about 4 times a week. I do cardio such as bike, rower and stepper and also weights. Which of those do i need to be taking a rest from ? I understand the bike and stepper...but the rower and weights too ?

Any more advice or suggestions would be greatly accepted, I dont want to do anything to injure myself seriously and being new to it all, I havent a clue.

Thanks.
Posted: 11/01/2007 at 09:06

Hi Judith, in response to your question about pf and gym work; I found that the rowing machine, the leg press and the stepper all exacerbated the problem. Since concentrating on the treadmill, the bike and the Nordic skiing machine my foot has got a lot better. Finally got round to getting fitted with decent shoes and I can't tell you the difference! Tried them out for the first time this morning and felt as though I was flying. Wish I'd done this months ago (couldn't bring myself to part with all that cash!)as I'm now convinced that overtraining in badly fitting shoes is what caused the problem and prevented it clearing up. Saw physio yesterday (fellow runner) and she suggested regular calf stretching and rolling affected foot backwards & forwards over a coke bottle filled with water and frozen.Hope this helps and good luck with the 10k. H.
Posted: 11/01/2007 at 09:40

Hi, and thanks for getting back to me so quickly.
My gym is well stocked with equipment so I will try your advice and give my usual cardio routine a rest and concentrate more on the machines that wont aggrivate the condition.
As for the shoe advice, i have found a runners shop in my nearest city and spoke to them. They measure and fit you with the correct shoes so will be paying them a visit on Saturday.
I didnt really think i would take this running thing so seriously, but i love it, and thought it such a shame if i just gave up without a good fight.

Thanks also for the good luck with my first 10k...im determined to do it, but i suppose you have to take the good with the bad. I enjoy the running, the fresh air and it also gives me some quiet time to myself...but with that comes the injury side also...but will definately give those things a go. Thanks again.
Posted: 11/01/2007 at 16:14

Hi Judith - it's interesting that you're another person who spends all day on their feet. There's a big PF thread on here and most of us on that are on our feet all day too. I work in quite a small room and got some anti-fatigue matting for the floor. It's very much like this stuff at Argos (also seen in a recent JJB advert)

Matting

I found it helps me loads, and I now wear trainers for work instead of shoes. I don't know if either of these are an option for you but worth suggesting.

I've cycled all throughout my PF but treadmill and cross-trainer aggravated it.

The benefits of running far outweigh the injury side. I'd be a proper stresshead if I couldn't run! I bet you'll love your race - you'll get home and start scouring RW for your next one :o)
Best wishes for your recover, Debbie
Posted: 11/01/2007 at 19:38

Debbie,

In one way its refreshing to hear that so many people suffer from this complaint, makes you realise you are not alone.

I actually work as a hairdresser, so alternative flooring for me isnt an option, but i can, and will, try your idea of wearing trainers for work...I definately think they will be more support than the shoes I do wear.

Resting it again today and tomorrow but eagerly awaiting my return to the gym on Sunday...thats as much a habit to me now as the running is becoming.
Never thought i would hear myself saying that...I was an over weight 40 something year old about 4 years ago and between Weight Watchers and the gym Ive gained back my confidence and the whole running thing is a progression from that. So doing this 10k is the next step on...who knows what next, as you say...maybe just the start.

But thanks again to you both for the good advice and concern, and i suppose these things just make you feel like a "real" runner :)
Posted: 12/01/2007 at 11:54

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