New Remedies for Plantar Fasciitis

scenarioPatients were scattered in the cool, wet grassy area just outside the classroom. Half the students pretend to be wounded, complete with fake blood and bruising, while the other students exercise their newly learned wilderness first aid skills. I was casually roaming between medical catastrophes answering questions and asking in return, “Are you going to touch that patient without your gloves?”

This was the day I felt the short-lived, but unmistakable, sharp pain on top of my right foot – it had stress fracture written all over it.

If I know how to react to anything in life, I know how to react to that sharp, little pain on the top of my foot. Action, or reaction, is swift and aggressive: a continuous dose of herbs, the offending area is taped, and extra days of rest added to the schedule. Preventative measures escalate every few days until the issue is resolved; my focus so intense on this little pain that I totally ignored the soreness in the arch of the same foot.

After several weeks of denial, I announced to my husband, “Its plantar fasciitis.” Swift and aggressive reaction finally began.

Last June, Dr. Thomas Michaud wrote an article, New Techniques for Treating Plantar Fasciitis, and updated it this month, as if on cue for me to discover it on running.competitor.com this week – just in time research.

Predicting Plantar Fasciitis

running.competitor.com
running.competitor.com

The plantar fascia, connective tissue that runs from the heel to the base of the toes, stabilizes the inner forefoot as forces peak during pushoff (runners expose the plantar fascia to up to 7x their body weight during the pushoff phase). The plantar fascia passively stores and returns energy, while another lesser known, small muscle that goes to the toes (the flexor digitorum brevis muscle – FDB) plays a more dynamic role in variable load sharing.

When tension in the plantar fascia gets too high, the FDB muscle tenses to distribute pressure away from the overworked plantar fascia. Latest research confirms the best predictor of the development of plantar fasciitis is not actually the height of the arch (specialists have commonly believed most plantar fasciitis cases are due to excessive lowering of the arch), but rather the speed in which the toes move upward during the propulsive period (which occurs when the FDB is weak).

Treatment….

There are several tests that can be performed to confirm you have plantar fasciitis (and not heel spurs), but the most common indicator is a sharp stab or deep ache in the middle of the heel or along the arch – worst during the first few steps of the morning or after sitting for awhile.

Injuries in general will almost always respond well to stretching, massage, or both. For example, it is my experience that IT Band Syndrome (ITBS) responds best to massage, especially the jiggling motion favored by a good massage therapist. Stretching does little, if anything, to resolve ITBS.

pt3Plantar Fasciitis responds well to stretching. Pull your big toe back for 10 seconds, repeated 30 times per day. It has proven effective in relieving the pain in my heel after only a few days of consistent stretching –  no heel lifts, no night brace, not even massage.

Aside from the fact that athletes often do really stupid things when it comes to training and recovery, there are lessons we can all take away.

When I finally owned up to my injury, my husband reminded me I have been on the verge of plantar fasciitis many times. For years I maintained a stash of tennis and golf balls to massage the arch when I felt that tinge of tightness. At one point, he went so far as to buy the night brace for me, which I hated.

Every athlete’s body has certain weaknesses. Mine happens to be my feet – possibly because of my Morton’s Toe, which makes me susceptible to stress fractures, tight calves and apparently plantar fasciitis. Your issues may be with your knees, hips or lower back. We should pay attention when our body speaks, and become well versed on how to resolve the issues specific to our body. Better yet, be diligent with injury prevention that is especially specific to your issues.

Resolve issues with a swift and aggressive reaction. Think of the days of pain I could have avoided had I not remained in denial.

Recovery, after all, can only begin when we acknowledge the problem.

Do’s and Don’ts for Plantar Fasciitis

  • Avoid a mid- or forefoot strike pattern in favor of a heel-first strike, and don’t run hills until the injury is resolved..
  • Reduce stride length and increase cadence.
  • Build up gradually to minimalist shoes, especially for runners with tight calves.
  • Avoid corticosteroid injections; surgical intervention should be a last resort.
  • Use trigger point massage.
  • Consider taping the arch for support (visit kttape.com for one method)
  • Pick things up with your toes / strengthen the FDB muscle (see article below)
  • Maintain calf flexibility
  • Pull your big toe back for 10 seconds 30x/day

Read Dr. Michaud’s article: New Techniques For Treating Plantar Fasciitis

August Injuries

It is with great trepidation that I write this post today. If I tell you my hips are sore but I’ve had no problems with my knees, those knees will lock up in pain before bedtime. August is a common time of the year for a fall marathoner to experience a few aches and pains. I am no exception.

If you run 50+ miles every week of the year, perhaps you are exempt from these problems…or maybe you have different issues altogether. Peak mileage varies throughout the year for me and it is not uncommon for my body to adjust to the ramp-up with the same issues year in and year out.

In Hal Higdon’s book, Marathon, The Ultimate Training Guide, he talks about one of the bulletin boards on his website that runners use to ask questions. He says, “Traffic remains relatively light to Body Shop for much of the year, but August brings with it an explosion of calls for help.”

In this book, he devotes an entire chapter as a review of the various runners who write to him with August injuries. We don’t need a forum of runners – a recap of my ailments will fill the post.

IT BAND SYNDROME

The Problem: Several weeks ago, desperate for a change of scenery, I decided to run down the mountain from my house…..and back up again. The back up again was, of course, the problem. I knew this hill would be too long, too tough but decided I could take it slow and be ok. My IT bands were screaming by the end of the day.

Solution: Not everyone agrees on the correct remedy for ITBS and I didn’t pay the $19.95 one author wanted to charge for his secret cure. From what I read (for free), he and I agreed that stretching does no good. It may eliminate some of the discomfort down the side of your leg, but does little to actually resolve the issue.

This band of fascia can be as tight as a guitar string when aggravated. The best remedy I’ve found is to get it loosened and relaxed: massage. I alternate a firm, jiggling motion on top of the band with long, sweeping motions that relax and move the energy down the leg.

Sometimes I do this while I’m driving and keep at it until the IT band has relaxed. This time it quieted down within just a few days. If the pain goes down the leg and across the knee cap, say good night Irene. Rest is the only solution.

image

SORE FEET

The Problem: During the research I did for the post I wrote on Morton’s Toe, I discovered this toe may be responsible for many ailments, including tenderness of the Achilles Tendon. Recently, I have suffered with this tenderness around my left Achilles – worst at the start of a run and better after it has loosened up.

The Solution: Several years ago a therapist suggested I do gentle stretches of the tendon for minutes at a time as opposed to the 30 seconds of a typical stretch. Stretching the Achilles too much can make it inflamed but this long, gentle stretch seems to do the trick.

If the pain creeps down the outer bottom edge of the heel, stand on the outside edges of the feet. Some doctors suggest that you should walk on the outsides of your feet from time to time anyway.

A pain on the top of the foot always scares the life out of me – as does a pain through the arch, which reads plantar fasciitis. Massage and stretch your arch once or twice a day and pick things up with your toes; a towel or a wadded up piece of paper.

image

It was not uncommon for me to sit on the couch after a long Sunday run rummaging through my running books and every website I could find to diagnose what ailed me.

Over the years, I have learned where my body breaks down and how to clear up these issues before they become more serious.

Your injuries might be different: strained hamstrings, knee pain, back pain, sore hips or shin splints.

Catch them early and avoid the dreaded four letter word: REST.

The Normal Variation: A Lesson on Morton’s Toe Syndrome

I have been equipped with two narrow feet, high arches and a fairly neutral foot strike. I have also been given Morton’s Foot and Morton’s Neuroma.

The “condition,” Morton’s Foot or Morton’s Toe Syndrome, is caused when either your first metatarsal (the bone which the big toe attaches to) is either shorter than the second metatarsal bone or is not stable; has too much mobility. A functionally shortened toe behaves just like a structural short leg, unbalancing the pelvis by dropping one hip lower. Physical stress from the abnormal posture can cause tiny knots in the muscles of the lower leg and calf, which cause similar pain as Achilles tendinitis and plantar fasciitis, among other ailments.

imageAlthough many people associate the condition to having a longer second toe, it is entirely possible to have Morton’s Toe without the presence of a longer toe. It is the bone of the first toe being shorter that causes the problems regardless of the length of the second toe.

Dr. Dudley Morton (1884–1960) was the first to identify the problem and a solution, the toe pad. He was granted a patent for the toe pad in 1932. Maybe like you, I had never heard of this before.

Thru out history the long 2nd toe was referred to as a “Roman Or Greece Foot.” Before Dr. Morton ever wrote about the long 2nd toe in the 1920’s it was written about for some time in various places. One of the most interesting of these publications is the U. S. National Park Service pamphlet about the Statute of Liberty. In it, the history of the Roman and Greek foot, and the Morton’s Toe is given in regard to the feet of the Statue of Liberty. Fredric Bartholdi, the sculptor, was influenced by his classical training and gave the Statue of Liberty the Roman/Greek Foot.

My first knowledge of Morton’s Toe came about as I was training for my first marathon. My toes kept going to sleep or going numb. A little research finally revealed Morton’s Neuroma, a condition that may occur as a result of irritation, injury, pressure – such as from wearing tight fitting shoes, or repetitive stress. Bingo. Runners get all the “repetitive stress” issues.

Morton’s Neuroma manifests itself between the third and fourth toes most commonly and results in numbness or tingling around these toes or sometimes a sharp, burning pain in the ball of the foot.

Somehow my research led me to the conclusion that one vitamin B-12 tablet each day would alleviate this condition….and it has completely. Once in awhile at the peak of training I may feel a pain in the ball of my foot but nothing a little rest or massage doesn’t alleviate.

But now I’m realizing there is more to learn from Dr. Morton, unfortunately.

In addition to the pain sent to the ankles and Achilles tendons, Morton’s Toe is claimed to be the culprit for everything from knee, hip, lower back and neck pain to fibromyalgia. Most distressing to me was that it is also possible it causes stress fractures of the metatarsals.

What I have considered to be overuse and training errors explaining my numerous stress fractures over the years, may actually be the result of how God made me: a normal variation in the structure of the human foot eventually named by this man, Dr. Morton.

Its ok. Imperfect doesn’t mean incapable.

If you are one of the roughly 25% of the population who have Morton’s Toe Syndrome or 80% of the population that may have an elevated first metatarsal, check out some of the websites below for more information.

http://www.triggerpointbook.com/mortons.htm

http://www.footcare4u.com/mortons-toe-what-is-it-what-causes-it-how-to-treat-it/

http://injuryfix.com/archives/mortons-neuroma.php

http://www.mortonstoe.com/index.html