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I went for a trail run not long ago and logged almost two hours through the tall grass, wildflowers, and absurdly steep hills in my back yard. That I was running at all felt like a miracle. That I woke up the next morning with no pain anywhere in my body felt even more like one.
In December 2011, I was skiing down College at Sun Valley at a rather high rate of speed when I caught an edge, tomahawked, and my binding didn’t release. My right tibial plateau shattered into pieces, my fibula broke, and my MCL tore. The multi-year journey of recovery was a nightmare of slow progress, setbacks, crazy amounts of titanium screws, ever-present pain, and more surgery—my friends eventually stopped asking how the leg was, ha. But through it all, I was determined to get back to skiing at a high level and, to my surprise, to something that felt even more important: trail running.
Deep in the middle of this interregnum, 2013, I think it was, I finally got clearance from my trauma orthopedist to start running again, but only on the treadmill. Then I got the green light to ramp it up, still on the treadmill. One day, I ran with what passed for hard effort at the time. The next morning when I got out of bed, my left heel was so sore I could hardly walk. It got better as the day went on, and the next morning repeated the same pattern.
Figuring I’d bruised the bone, I took time off and just rode my bike. But the pain never went away, and when I’d walk or hike it would come roaring back. Maybe it was a stress fracture. I went back to the doc.
His diagnosis was plantar fasciitis, which afflicts about 10 percent of runners. The plantar fascia is a thick band of tissue that connects your heel bone to your toes, and as the “itis” suggests, fasciitis is an inflammation. It can cause severe pain, which typically manifests itself right on the bottom of the heel itself, rather than along the length of the fascia. An easy way to diagnosis it is through the symptoms I experienced: The fascia tightens at night while you sleep, is excruciating when you first start walking, and then loosens and mellows out once you use it.
That’s the conventional thinking, anyway. It turns out this simple explanation of plantar fasciitis is overly simple. One post-mortem study of people who’d suffered from plantar fasciitis showed they didn’t actually have inflammation. Bone spurs may play a role, fallen arches, even tight calves. If that’s the case, what’s causing such gnarly pain—and how do you recover from it?
A WINDING PATH
My journey to pain-free running took me several years, beginning with visits to well-intended medicos who clearly didn’t have the answer. The first doc—every doc, actually—gave me a squishy pad to put in my shoes under both heels. This alleviated the pain slightly, but had no impact on recovery. We tried a cortisone shot (three months of relief, but the pain came back). One doctor suggest eight weeks in a cast with the toes pulled back to stretch the fascia, followed by another eight weeks in a cast if that didn’t work. Another suggested surgically cutting the fascia to relieve the strain. Um, no.
The internet, that Horizont Alley of medical advice, had all sorts of suggestions. For months, I slept with the Strassburg sock, which pulls your toes to stretch the fascia. Or tried to sleep, anyway—my foot cramped, the sock got tangled in the sheets, and I had crazy dreams about being in a medieval traction device. I spent a couple months performing a strengthening exercise recommended by the New York Times, claimed as the only routine you need to cure the ailment, but only got chiseled calves and really strong toes out of it. I stretched, I taped, I never went barefoot. I bought a Sharper Image massager and used it twice a day. I rolled my arch over a golf ball while I at my desk. Nothing worked.
By this point, I was a year into it. There had been the delay when I thought time off would cure it, then the bouncing from doctor to doctor, the self remedies, and skeevy internet rabbit holes. A friend’s daughter, who runs track and suffered from PF, found relief from something called Transverse Friction Massage therapy, and I spent $600 over four sessions—subjecting myself to the indignity of paying for the worst noogies I’ve ever had. That only made the pain worse, and it was accompanied by the sharp tang of foolishness.
A SOLUTION AT LAST
Finally, I turned to the deepest source of collective wisdom there is: Amazon customer comments. Yeah, I know. But it was there on Amazon that I found the answer.
The reviewers—maybe bots, maybe sweatshop workers—raved about a product called Heel That Pain Plantar Fasciitis Seats. They cost $25 and look like every other of the 101 bajillion insoles, wedges, and gel pads sold on Amazon, except for one thing—they have a slightly more rigid plug of rubber that sits just in front of your heel, where the fascia connect to the bone. This had the effect—I’m assuming—of supporting, pressuring, and stretching the fascia.
User comments warned of days of pain, as if a massage therapist was working a pressure point without mercy. For me, it didn’t feel that bad—it hurt initially, but the fascia seemed to chill out within a few hours. The next day was slightly uncomfortable, but by two three I didn’t notice it any more. Within a week, 90 percent of the pain was gone. It was as if someone had spun the dial from 11 to 1. After all I’d been through, it seemed nigh on a miracle.
Over the next year, I slipped the inserts into every shoe I wore. I never went anywhere without them. And over time, slowly—very slowly—but surely, the pain went away.
Eventually, I had all the hardware taken out of my leg. It had affected my gait and was excruciating inside a ski boot. When the surgical wounds had healed and I was able to walk, I felt like me again for the first time in years—a weaker, older me, but still. For most of 2016, I hiked and hiked and hiked. My knee creaked and swelled from time to time, and the left heel let me know it was there, but only occasionally and it never debilitated me. By fall, I started running—slow, short distances, as low impact as I could. At first, I experienced minor pain in the heel, perhaps from the bone spur that X-rays revealed, but then less so and now never.
So, here we are. It’s been a hella long journey. I’m years older than when I got hurt, and I wasn’t young then. I was never a fast runner and I’m sure not now. But I don’t care about that–if I can hang on for a couple hours and do it without any pain, other than the expected and deserved muscle soreness, I’m on top of the world. Skiing has been the center of my life for so many years, but trail running feels like life itself.
Will those wedges help your plantar fasciitis? Heck if I know. My personal experience suggests to me that no one really knows whether you have plantar fasciitis or even precisely what it is. Paul Ingraham of Pain Science isn’t a doctor, but he’s right when he says, “Unfortunately, there are so many possible causes of plantar fasciitis — probably several of them happening at the same time — that it is effectively impossible (or just extremely impractical) for therapists to make any confident biomechanical diagnosis. It’s simply too complicated an equation, and the scientific literature is riddled with contradictions.”
That means you have to take responsibility for your own recovery, and it probably won’t happen without trial and error. So maybe you can learn from my errors—and one great success. Good luck.
Here’s that link again: HTP Plantar Fasciitis Seats.
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Really well written article. As someone who has dealt with calf pain from running for the last 10 years; in and out of podiatrists, heel inserts, PTs, stretchers, running form clinics ,massages, etc… two of your points ring home. The first, “That means you have to take responsibility for your own recovery, and it probably won’t happen without trial and error.” I finally found a running coach who has worked with me to clean up my form, and I am running more miles in a week than I have been able to in a long time. Also, I am able to run back to back days, which I never thought I would be able to do. The second point, ” trail running feels like life itself.” Everyone asks me what I am training for? Why do you have a coach? My response is always the same, “I just want to run as far as I can through the woods without pain.” Trail running does feel like life itself! Gives me goosebumps just typing it. Thanks!
John—my pleasure!
I went the “born to run” route and ditched the shoes for a while… barefoot – then vibram five fingers, then when I came back to shoes – went with Altras and haven’t looked back… glad you found something that worked for you! It is a PITA if you can’t figure it out!
I am a life long competitive runner, with dozens of marathons, 6 X Ironman, etc. etc. I agree with all of Steve’s observations. One thing to add to the mix….My last bout with PF was cured by two week’s rest and acupuncture from a very experienced practitioner. I now advocate an Eastern approach (Heat and acupuncture) vs Western (ice and rolling on a spiked ball).
Never go to a doctor for a problem with human biomechanics. A good physical therapist, one that works with athletes in this case, is what you needed. No shots, no gimmicks, just a solid analysis of how you are moving and how to get you moving better through daily corrective exercises and lifestyle changes.
How is your ankle range of motion? Can you hang out in the bottom of a deep squat. You should be able to do that. https://www.youtube.com/watch?v=7XwKnk16Zbs
Finally, when you correct the problem, which may take a long time, get a coach to help you perfect your running technique. This will help you become a better runner who can enjoy running for years to come rather than someone who runs between injuries.
Good luck!
I wouldn’t say never go to a doctor—it can and should be part of the information-gathering process. But otherwise, yes. Joni had some hip pain the doc diagnosed as arthritis; four weeks of PT and all pain was gone. Wasn’t arthritis. I’ve had hip pain for two years and put off dealing with it because I figured it was arthritis. Doc diagnosed it as a sartorius strain. I went to a PT who took one look at my legs and realized one had gotten shorter from shattering my tibial plateau. A quarter-inch heel lift, stretching, strengthening, and therapeutic massage, and I’m finally on the mend. If you’ve had the good luck to find a PT you trust, gained from the bad luck of injury, I would definitely lean on them when needed.
Yeah, maybe “never” wasn’t the right word. But general practitioners are not specialists and this often shows in their diagnosis. For some insurances you might even need that referral for coverage.
Steve, great article! I’m excited to give it a try. Thank you so very much for sharing your journey. Praying to the trail g-ds for some relief, haha.
Fingers crossed! I’ve heard from 4-5 people who tried the inserts and got relief, so I hope it works for you, too.
I completely agree. I found these on Amazon about 2 years ago and my foot has never felt better.
after years of excruciating pain and no real solutions i’m giving these a try after reading this article. They came today in a smiley box.
Let’s see how it goes…
YOU have plantar fasciitis?
Nearly same story here. I had it for two years and rolled out on a golf ball, wore the sock, wore the boot, had ortho tell me about cutting fascia, even went under and had electro shock treatment. Nothing worked. I then visited an ART specialist (active release technique) who literally diagnosed my problem in 60 seconds by having me walk barefoot and stand on one leg in her hallway. I have super high arches and was gripping the floor with my middle two toes when I walked and ran. After unlocking all of my posterior chain, I had to re-learn how to run with my toes relaxed. Totally gone now. Find out the source which is usually somewhere else on your body.