Plantar F-cking Fasciitis

Got Plantar Fasciitis?

It's a weird-sounding condition, and it has nothing to do with fascism or containers in which to put your geraniums. A medical dictionary describes it as "inflammation involving the plantar fascia especially in the area of its attachment to the calcaneus (heel bone) and causing pain under the heel in walking and running."

It's gotten very popular, at least in my neighborhood. The Lobster has dealt with this particular brand of foot pain; so has my sister; and so have a number of our other friends. The bad news: everyone said it was painful and they all had to cut back on their favorite forms of exercise for a while.

Photo: mikebitton

The good news: everyone I know eventually got better! Some got better slowly, and others got better even more slowly. But eventually, everyone seemed to return pretty much to their normal activities.

So one would think that when my the heel of my right foot started getting increasingly sore, oh about 2 months ago, it would have occurred to me that I might have it too.

Actually, it did cross my mind for a second, and so here's how I investigated the matter:

"Hon," I said to the Lobster, "When you had that plantar f.. fasc.. fash.. whatever the hell it's called, that foot thing, how did it start?"

"I think my foot started getting sore and then it just got worse and worse."

"Where did it hurt?"

"Mostly in my arch."

"Not the heel?"

"No, I don't think so. I think it started in my arch."

"Oh good! My foot's been a bit sore, but it's the heel. Probably just need to buy some new shoes. I'm sure it will just go away on it's own."

Of course, as it turns out, I never got around to buying new shoes, or cutting back on the running, and the pain just got worse and worse until I started limping and hobbling and cursing. Last week it got so bad I had to abort a neighborhood walk after two blocks, and I thought it might be time to consult Dr. Google.

And damn! Had I bothered to do that months earlier, I would have quickly discovered the likely source of my trouble. Heel pain is the most common symptom of plantar fasciitis--the Lobster's arch was a less common variation. And my heel hurt like the dickens first thing in the morning, but then got better throughout the day, but then worse again if I went for a long walk or hard run--pretty much a classic presentation.

Of all the things you can do to treat plantar fasciitis? Ignoring it until it gets a lot worse is not actually the best one to choose.

(Note: do not follow my example. I still have not been to an actual doctor, the foot kind or any other kind. Visiting a medical professional is the smartest thing to do when you have foot pain. I, however, prefer to go on the web and attempt to treat myself whenever possible because I'm cheap, lazy, stubborn, and foolish cautious about using up precious medical resources that someone else might need.

So what did I find out from Dr. Google about how to prevent and deal with plantar fasciitis?

Well, first off, courtesy of the Mayo Clinic, here are some of the risk factors, so you can figure out if one day you'll be hobbling and cursing like the crab:

Plantar Fasciitis Risk Factors:

Age: It's most common between the ages of 40 and 60.

Sex: When I first saw this heading I thought: What? Sex? How does having sex make the bottoms of your feet hurt? Have I been doing it wrong all these years? But reading a little further, the explanation was far more boring: "Women are more likely than men to develop plantar fasciitis."

Heel-Pounding Exercise: Yep, all that virtuous exercise you've been doing in order to treat your body well? It can come back to bite you in the ass. Or, more accurately, in the foot.

Apparently doing things that stress the heel, like long-distance running, ballet, aerobic dancing or playing professional football can be problematic. (And yes, weren't we just talking about the need for higher impact activities like jumping in order to prevent bone loss? Damn those trade-offs!)

Screwed Up Foot Mechanics: Flat feet, high arches, or walking in an unusual manner can put added stress on the plantar fascia.

Obesity: Yeah, it's yet another annoying complication--which then makes it hard to get enough exercise to lose weight!

On-Your-Feet Jobs: Factory workers, teachers, waitresses, street-corner drug dealers, prostitutes, construction workers and others who have to stand or walk on hard surfaces are at extra risk.

Note: Soft surfaces can pose certain risks as well.
Photo: TranceMist

However, the consolation prize of a stand-up job? Your feet may hurt but you live a lot longer if you don't sit on your ass all day!

Silly Shoes: Apparently, you should avoid shoes that are thin soled, loose, or lack arch support or the ability to absorb shock don't protect your feet. And don't wear high heels all the time either, because it shortens your Achilles tendon, causing strain on the tissue around your heel.

How To Treat Plantar Fasciitis

Here's what WebMd had to suggest, so I thought I'd give some of these a try:

Rest: OK, I'm having a hard time getting this one into my thick skull, but numerous sources of advice seem to confirm: to the extent it's possible, you're supposed to STOP DOING THE THINGS THAT HURT. I'm trying to keep in mind that I will get better faster and get to do much more running and walking over the long haul if I chill on my normal routine for a while. I'm relying on the elliptical machine, and I'm hopping on a bicycle and pedaling up some hills in order to try to replace my normal foot-pounding cardio options. (Pity the poor Lobster, because as you might imagine, these modifications are generating a LOT of whining and griping).

Stretch: Stretching the achilles tendon and plantar fascia is supposed to be a really good idea; for example there's the towel stretch, the calf stretch, and what I've always called the heel drop. This arch stretch in particular gave me almost instant relief from the "first-few-steps-in-the-morning ouchies." I make sure to do it before getting out of bed or after sitting for an extended period of time. (However, stretching did not seem to work as magically and instantly on the "long walk" kind of pain).

Strengthen: Exercises to strengthen the muscles of the foot and ankle are supposed to help too; however, fewer people seem to swear by these, either because they're tedious or maybe the impact is more subtle and long-term. You can try the towel curl or the marble pick-up.

Wear supportive footwear. Normally, this is no problem for me as I conform to stereotype and tromp around in super-supportive trail runners and other clunky athletic wear whenever possible. However, over the summer I fell in love with a nifty pair of shoes meant more for splashing about on the beach, not walking endless miles on roads and sidewalks. But they were so cute and light and comfy! So I started wearing them all the time. Now I'm paying for this summer fling, big time. My advice: flirt if you must, but don't have an extended affair with a flighty, flimsy pair of shoes no matter how adorable they are. Eventually they'll just hurt you and make you cry.

Oh, and lots of people emphasize that to get better, you gotta wear supportive shoes almost ALL THE TIME. Like even when you're just getting up in the middle of the night to pee! Barefoot is Bad, unless you're doing one of the tedious exercises listed above. On the other hand, some hold a contrary point of view, and say that running barefoot (or in those funny-looking vibram things) can strengthen foot muscles and actually help plantar fasciitis.

Consider Shoe Inserts. So I actually already have some prescription orthotics, which I got for my crappy knees, though this did not prevent me from getting plantar fasciitis. Meanwhile, all my friends are running out and getting these non-prescription (but still insanely expensive) inserts from a place called Good Feet, and finding them helpful. I scoffed and muttered and shook my head as all my pals went out and got these things... and then the Lobster joined the Good Feet cult too so I had to put a lid on it. (But inwardly, I still scoffed).

Well, now who is asking to borrow the Lobster's magic inserts? Yep, in another probably bone-headed, "don't try this at home" move, I'm wearing her orthotics, though in my defense, we have the same size feet and often borrow each others' shoes. Unlike my regular, mellow orthotics, these Good Feet inserts feel pretty much like you just stuck a giant golf ball in the arch of each foot. Yowza! And yet... they do seem to help. It makes no sense to me that these would work better than my carefully-fitted prescription orthotics, but they seem to stretch out my arch and keep me from putting as much pressure on my heel. Or, another theory: maybe they just feel so obnoxious I don't even notice if I have heel pain or not.

Ice: So I already ice my knees after running, and thought this would be no big deal. But wtf? Feet are more sensitive and icing them HURTS!! I blunt the effect by keeping my socks on, which may make it less effective, but what the hell, it's the only way I'm gonna stick with it. As far as I'm concerned, Bag of Ice Directly on Feet=Torture=Screw It, I'd Rather Have Heel Pain.

Anti-inflammatories: Yep. I do naproxen (Aleve) 'cause you don't have to take it as often as ibuprofen, aspirin, or tylenol.

Night Splints:

(Photo swiped from Orthotics and Beyond)

I'm not resorting to one of these things unless I get really, really desperate. They're designed to frighten small children stretch the plantar fascia ligament and achilles tendon during the night.

I've seen other suggestions online too, like massage, or rolling tennis balls or frozen juice cans or golf balls under your foot, taping the arch, getting acupuncture, wearing Birkenstocks, getting cortisone shots, or shockwave therapy, or evil-sounding surgery, or finding a cute little monkey and training it to do all your chores so you won't hurt your feet. (OK, perhaps I made that last one up, but wouldn't it be kinda cool to have a pet monkey?)

How about you guys? Have foot pain or other injuries that are complicating your fitness routine? Finding any good solutions?

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