Monday, February 2, 2015

How I Beat Plantar Fasciitis

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How I Beat Plantar Fasciitis
Shannon McGinn, RRCA Certified Running Coach
February 2015
Until a few years ago, I had suffered from debilitating Plantar Fasciitis, on and off, for most of my running life. I started running for a team way back when I was 9 years old, so this has been quite the battle. I visited many podiatrists. I tried various treatments. Nothing seemed to help. Once I understood the function of the plantar fascia, the common causes of Plantar Fasciitis, and difference between treatment and prevention, I was then able to treat it successfully as well as prevent its return.  

What is Plantar Fasciitis?
The plantar fascia is connective tissue that supports the arch of the foot.  Plantar Fasciitis (PF) occurs when there is damage to this tissue. PF is terribly debilitating because once the fascia is damaged, it is very difficult to heal. We use our feet daily, consequently re-injuring the fascia daily. Usually, that very first painful step out of bed tends to undo all the healing that took place over the course of the sleeping hours. 

A Common Big Mistake: Confusing Prevention for Treatment 

The biggest mistake I believe people make is turning to preventative measures when treatment is needed. Prevention of PF involves keeping the fascia flexible. Stretching or using a ball to rolling out the fascia will achieve this goal. Low drop shoes are another way to keep the plantar fascia, the achilles tendon, and the calf pliable and healthy.  

However, Treatment involves the opposite actions. Immobility and stabilization of the foot will allow the fascia to heal. Elevating the heel will help relieve tension. Stretching a torn fascia or using shoes that aggravate the area results in re-tearing the tissue day after day. Prevention used during the acute stage of an injury acts only to prolong recovery. 

Finding Peer Reviewed Evidenced-Based Treatment Methods
I am not a doctor. I am a coach. I advise all of my runners to see a doctor if they are experiencing pain, especially pain that does not improve or worsens. This is no exception. If you have health insurance, some of the products discussed below may be even be covered by your insurance. However, many people prefer to turn to home treatment first. 

There is lot of information and misinformation about treating PF.  I utilized the Cochrane Reviews to identify the most reliable studies about effective treatments. The Cochrane Library contains a database of peer-reviewed medical studies that are analyzed, ranked by quality, and summarized. The Cochrane Library is considered to be a key resource in evidence-based medicine.

Accordingly (and not surprisingly), the most reliable research concludes that PF is very difficult to treat and often spontaneously resolves without clear explanation.  As a result, many people report the last thing they tried was their miracle cure. This leads to crazy suggestions like soaking feet in apple cider (which is a real suggestion, but does not have any merit.) 

The Methods I Used to Successfully Treat and Prevent PF
Below are some proven methods to help manage plantar fasciitis. I used all the methods I will discuss below. I found relief from each of them. 

(1) Try to immobilize the fascia allowing the damage to heal.
If you selected just one thing to do, it needs to be Low Dye Taping for Plantar Fasciitis. This is a specific method of taping the arch with a criss-crossed pattern that wraps around the heel. The tape creates a stable external structural support for the foot, giving the fascia a little vacation from its job and allows it to heal.  See the video link to understand how this is done.

Do NOT tape only when running. We use our plantar fascia with every step we take. Keep your foot taped for 24 hours per day until the pain is gone. I recommend taping before bedtime, so the foot is stabilized and ready for that first step out of bed in the morning. Taping at night, before a morning run, allows the tape to adhere securely before running.  Taping directly before a race or run may result in tape shifting and a negative experience. 

Taping takes practice. You will go through a lot of tape to get it right. A properly taped foot should feel very comfortable with imperceptible tape if you are not in motion and/or off your feet. When your walk on a properly taped foot, you should feel the tape snug up a bit as your foot rolls though a step.  This snugging up prevents the fascia from stretching too far and re-injuring itself. If you feel like the tape is pinching, then the tape is too tight. 

Do NOT use KT Tape or Rock tape. Those tapes are entirely too stretchy and provide insufficient support.  Save your money and use cheap sports tape that has no give at all.  It will be wrinkly.  Do you best to minimize wrinkles as much as possible. 

This link shows the method I used.  I was been able to tape effectively with much less tape than what is used in this video.  I used two long strips to make the X, as seen in the video. I then used three short strips to support the arch area.  I did not need to use the anchoring strips.  I found that with clean dry feet, the tape adhered very well, especially if I taped many hours prior to running (like the night before) to give the adhesive time to warm up and adhere its best. 

Once the pain subsides, I recommend tapering down the slowly taping over time.  Start by taping only when running. If you remain pain free, then tape only for long runs and races. If still feeling pain free, then tape only for races.  And finally try no taping at all. Increase frequency of taping to as much as needed to eliminate or minimize PF pain if it returns.

(2) Elongate the fascia during the healing process to minimize re-tearing.
When off your feet, the foot wants to relax. The fascia shortens without any pressure on it to hold it taunt. When we sleep, the fascia heals in this shortened position. Then we wake up, step out of bed and rapidly elongate the fascia. This tears away the early stages of healing that occurred overnight.  Day after day, this cycle continues and PF becomes a nightmare. 

“The Strassburg Sock” is the second best tool I discovered. The Sock works by pulling the toes up to keep the fascia stretched out. The tears of the fascia heal with the fascia in the elongated position. This means when you stand up, first thing in the morning, you are less likely to re-tear it.  The company recommends sleeping in it the socks. I found that impossible due to discomfort.  Instead, I would wear them to bed for a long as possible and pull them off when I felt they were disrupting my sleep. I set them next to the bed so that first thing in the morning, I could put them back on. This  allowed me to use the mechanism of these sock to passively stretch the fascia in a way that did not rapidly elongate and re-tear the tissue. These socks were not a cure but resulted in 85% relief for me in 1-3 nights. Because the sock passively stretch my fascia, I now use them as prevention, by periodically wearing them even when my plantar fascias feels fine.  

There are other devices on the market that aim to elongate the fascia while we sleep. Some report these devices are more comfortable to sleep in than The Socks.  Here is one example

(3) Elevate the heel to reduce strain while PF heals.  
One main cause of PF is tight calves and achilles tendons, which pull on the fascia until it tears under the strain. There is a unfortunate trend in running shoes where LOW DROP is becoming the norm.  Low drop shoes put more stress and strain on the calves and achilles. Despite rave reviews, angry plantar fascias do not like low drop shoes. To reduce the strain while the PF heals, we need to elevate the heel not drop them down. (Low drop shoes have a place as a preventative tool, but are not effective as treatment).

There are several ways to elevate the heel. Choosing a running shoe with higher drop will help a lot. (I have about 5 different types of shoes with various drops in my rotation just to help keep my feet healthy.) Others get fitted for custom orthotics, but this takes weeks. Some purchase over the counter inserts from the pharmacy that target PF. I find that heel cups are the least expensive way to take the pressure off the fascia. Buy these from your pharmacy.  They are worth it and will keep you heel elevated protecting your fascia from fully extending and tearing and re-tearing. Once the PF is healed, the heel cups or the inserts will not longer be needed. 

(4) Passively Stretch the Calves and Achilles
“The Boot” or Night Splints are a great tool to treat the cause of the PF which is often attributed to tight calves and tight achilles pulling on the fascia. The Boots may seem similar but they do a different thing than “The Sock”.  The Sock passively stretch and hold the fascia in the elongated position. The Boots passively stretch the calves and achilles. I found that wearing the Boots to stretch for 30 minutes at a time a few nights per week was enough stretching for me to notice a difference. I use the Boot now as prevention, by occassionally wearing the boot to keep my calves and achilles flexible, especially when I am in the midst of a training cycle and my investment in my training is great.  

(5) Preventing your first step out of bed from ruining the healing that occurred over night.

By gently massaging your feet in the morning prior to stepping out of bed, you will be warming up the tissue and gently making it more pliable before stepping out of bed. Stepping onto a soft surface helps as well. I used a pillow or a folded towel. This will help to prevent re-tearing of the tissue upon the first step. Do this daily as you work towards being pain free.  Once the PF is healed, you should continue to make massaging the fascia a regularly practice.  Some people also find it very helpful to roll their feet over a tennis ball a few nights per week or in the morning before they stand up.

(6) Pain and inflammation management
Often people recommend using a frozen water bottle to treat PF.  A frozen water bottle is a good thing to keep on hand, but it is not going to heal PF.  Icing is helpful after a run, or after you have done something that has irritated or damaged the fascia. Just like with any other injury RICE is the first line of treatment. But, once damage is done, ice does not speed healing.  Ice is an effective way to manage pain and possibly minimize or reduce inflammation.  A water bottle is nicely shaped to allow you to roll your arch over the bottle, getting the cold ice exactly where the pain is. 

(7) Preventing PF from returning
Once you have use the above methods to get your PF under control your job is to be aggressively pro-active to prevent its return. There is no “Wait and See” with PF.  

One of the best preventative things you can do is stretching. People tend to stretch in an attempt to speed healing. The body does not work that way.  Aggressively stretching a torn fascia does not allow tears to heal.  However once the PF is resolved, then stretching is preventative and should include the achilles and calves as well.  Use the Strassburg socks periodically.  Use the Boot as as well.  Roll the arches out over tennis balls.  Now is the time to return to those Low Drop shoes.  But as soon as you notice the very first signs of soreness warning that PF is on its way, immediately resume taping 24 hours per day until that pain is gone.

Plantar Fasciitis is a heart breaking condition that is so very hard to treat. I hope that these tips here will help many find relief.


Shannon McGinn is an RRCA Certified Distance Running Coach and the owner of Creating Momentum, LLC.  She is a life-long runner, becoming more involved in racing after surviving cancer.  She considers herself a marathon and ultramarathon specialist, earning several USATF National Championship top 10 or better placements in the 50k and 50M distances. She has not missed a day of running since December 2011.