Based on the nature and location of the pain, I’m reasonably confident that I’m dealing with plantar fasciitis. My conclusion is based on a couple factors, including the location of the discomfort (just anterior to the calcaneus, a bit medial to the center line of my foot), and the fact that it’s generally worst when getting up in the morning or after extended periods of sitting.
How Did This Happen?
My first question was how did this happen? (I consider that first – before “how do I fix it?” – because part of the fix needs to be avoiding or correcting the things that caused it in the first place. I don’t want to fix the issue and then go cause myself the same injury right away by doing the same things that caused the problem in the first place.)
One big difficulty is that the term “plantar fasciitis” basically means an inflammation of the plantar fascia. And that’s just a description of the problem; it doesn’t give much insight into how it got to be this way.
The things that brought about my plantar fasciitis are not necessarily going to be the same as what caused a similar problem in someone else. So what were the causes for my particular plantar fasciitis?
- Was it too many miles spent on paved flats, and not enough on the trails?
- Was it too many 10-13 mile runs? (I don’t do a great job at getting in very many long runs, but I can generally get in at least two of those 10-13 mile runs a week.) Or possibly doing those middle distance runs too slowly… or too quickly?
- Was it too much (or too fast) running on rocky terrain with inappropriately minimal shoes?
- Was it too much time spent in relatively rigid shoes?
- Was it a single run where I really overworked myself?
- Was it bad diet?
- Was it too much stress in other areas of life?
Maybe it was all of these things. But then that makes me wonder, is this just a sudden onset condition, or was I gradually working myself towards this state? And if it’s the latter, how close was I to injury, and for how long?
I went back through my SportTracks log to look for anything that seemed out of the ordinary, and tried to remember if I felt “off” after any particular runs over the past few months. But nothing stood out.
So What Do I Do About It?
As I noted above, knowing (or confidently assuming) that I have “plantar fasciitis” doesn’t really give me any specific actionable information. If I had sprained an ankle, I’d pretty much know what to do, or could quickly gain that knowledge by doing some research on the Internet.
But after doing some research on plantar fasciitis, it seems like for some people, engaging in a particular treatment or rehab plan really did the trick for them. But then I read about other runners who found that doing the same treatment or rehab techniques made things worse, and it was only when they did the opposite of what other people did that they found relief.
Since there didn’t seem to be any inarguably clear path forward, and I couldn’t figure out what I might have done to put myself in this state, I decided to seek out professional help. My wife does CrossFit, and knew of an orthopedic physical therapist who goes to her gym and has apparently helped out a lot of athletes. (CrossFit consciously and deliberately identifies its participants as “athletes.” While I have no issues with that, I certainly don’t consider myself an athlete.)
I made my appointment, and had a very productive initial session. After performing a variety of poses, motions, and stretches to rule out a lower back/sciatic nerve cause for my foot pain, and doing some additional detailed examination, my PT came to the conclusion that the problems were likely caused by a combination of: (a) my high-arched/inflexible foot; (b) some inflexibility in my tensor fasciae latae and other hip muscles; (c) my glutes allowing my torso to become really uneven on my stance phase; and (d) really adhered, tight and generally f’d up calves.
I got some advice on how to begin addressing issues (a) – (c). Nothing I hadn’t heard before (since I had done all that Internet research), but the important difference is having someone with expertise and experience saying that those specific exercises and stretches are the things to focus on. There are dozens, if not hundreds, of drills and techniques for runners to use to strengthen themselves, so it’s valuable to have a PT examine me and identify the particular ones I should be doing.
To start addressing the challenges in my calves, we did a brief Trigger Point Dry Needling/Intramuscular Stimulation session.
To oversimplify, the technique uses needles and electricity to stimulate a particular reaction and recovery response in dysfunctional muscle tissues. I found it surprisingly intense and uncomfortable, and the calf tightness I felt later that day was at least as significant as anything I’ve ever experienced after running.
But the thing is, I had a strong sense that the unpleasantness was actually a good thing, and was helping me. This might be something of a strained analogy, but maybe it’s akin to throwing up on the side of the trail during an ultra. The act of vomiting is horribly uncomfortable, and there’s a resistance to doing it (even if you know it’s the right thing to do), but you feel better afterwards, and you wonder why you were avoiding it for so long.
I’ve scheduled a follow up appointment next month to take the next step forward. Nothing is “cured” yet, but I feel like things are getting better… to the point that I’m planning to head out the door later this morning for a run in the 10-13 mile range I love so much.