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many many questions

Posted by Chris K. on 10/25/02 at 22:02 (098357)

I thought I had just posted on here but came back to look for possible responses and couldn't find my post!!! Oh well, here goes again...
I just started taking time off from running to try and get rid of my persisting PF. I've had it since spring, but being the stubborn (and typical) runner, I tried to run through it. But now that I've wisened up, I have many questions to this awesome message board that I've stumbled upon tonite:
What is the single best treatment for PF? Night splints seem to be miracle workers, but I simply cannot afford the 60-80 bucks they cost (darn college loans!). Are there any ways to make homemade ones?
Would heel cushions be recommended for easing the pressure on the Achilles and heel? I actually work at a running store, so I could get them pretty easily.
Is massage good for the PF? I've always thought that gently massaging the tender area would be good for my condition, simply because it promotes blood flow to the area and the breakup of scar tissue. But others have told me that massage to the sensitive area is a definite no-no. Does that mean I should even stop using a golf or tennis ball to massage the bottom of my foot, then?
How about cross training activities? I am currently swimming, but just don't enjoy it very much (I basically stink at it!). I was wondering if biking would be an acceptable form-- would it place too much stress on the heel/plantar fasciitis attachment? I would definitely prefer biking.
I'm so glad that I've found this site out-- hopefully you guys can help me get back into running relatively soon! I'll tell ya, this time off is killing me!
Thanks in advance for your help!

Chris K.

Re: many many questions

Jim C on 10/26/02 at 00:35 (098374)

Hi Chris,

I use the strassburg sock in place of a night splint, you can get them at thesock.com ,30 bucks for two. They come in sets of two but thats not real clear as I ordered two and got four. They are alot more comfortable than night splints, and I have gotten great results from them. I suppose you could build something that would have the same effect, but if your like me it would fall apart or be a pain in the %$#@ and I would end up spending the money anyway.
I used a heal pad early on in my treatment but I don't really think it did that much good other than the lift it gave.(I heard that lift is helpful???)
I wear New Balance 1121 with a powerstep insert with great results. The shoe is pricey but I haven't found a more stable/supportive running shoe which I wear 90% of the time. I found I can slip the powerstep into other shoes for short periods of time with no ill effects.
I do massage my feet several times a day, I don't know if has a long term effect but it certainly feels good.
I highly recommend a good stretching program, but be careful and avoid weight bearing stretches such as the wall stretch and above all the dreaded stair stretch(that's where you stand backwards on a step on the balls of your feet and lower your heels with your weight). Avoid any stretch that isolates the fasciia, such as sqauting down on the balls of your feet, what you want is to stretch the entire complex (hams,calfs and foot)it's all interconnected and has a great effect on the heel. If you are in the accute faze(hurts like hell all the time)I would be very very gentle(do a search on 'Julies stretches' for some great tips.
When your hurting really bad, lots of icing the heel and ibruprofen can be very helpful to reduce inflamation and pain, and above all rest!!!
Swimming seems to be the top choice on this site, I heard bikeing can be good as long as youi use your heel to push the pedals with rather than the ball of your foot(to much stress on the fasciia)
Read the heel pain book on this site(free)losta of info.
Above all, don't resume running until long after your pain free.

Good Luck,

Jim

Re: Re:home made night splint

Ellen J on 10/26/02 at 16:13 (098403)

I made my own night splint because I didn't want to wear something bulky to bed. I put a pair of Superfeet orthotics inside some knee socks. Then I placed a velcro strap around my leg at the top part of the knee sock. I then sewed velcro onto the bottom of the sock under the ball of foot area. I placed another strap around the ball of foot area, which velcros to the spot on bottom of the sock (to keep it from slipping). A strap then connects the strap encircling ball of foot to the strap around the leg at top of knee sock. I won't bore you will all the million details that I added in order to provide for adjustments, but basically my night splints are a cross between the Strassburg Sock and regular night splints. They seem to work fine.
Good luck with your own if you try and make a pair.
Ellen J.

Re: Re:home made night splint

Pauline on 10/26/02 at 19:11 (098412)

Ellen,
Sounds like a really neat and inexpensive solution to night splints. I wouldn't mind seeing a picture of what you've made. The problems I always had with night splints were the tangle and warmth factor.

They always tangled in the bed linens and were tooooo hot to wear. I wore the straps and lining out on two different pair. The ones I got from the doctor didn't have any replaceable or washable parts.

They were awful when I got through wearing them. I'm looking for a new pair to replace the old. I always like to keep a pair on hand because I grab for them first at the first sign of P.F. returning.

I tried sleeping with one but eventually went to two because I would always kick my other foot with the hard plastic boot. When I developed P.F. in the other foot I needed two anyway. By then I was used to sleeping in them. I refer to them as my bed time ski boots. Actually my ski boots are more comfortable.

I remember one of the doctors saying he suggested the Stressburg sock to patients because it was more comfortable. Do you find the pair you constructed comfortable? How warm do your feet get at night? What about tangle?

Sometimes homemade remedies work the best, sounds like you made a gem.

Re: many many questions

R C on 10/26/02 at 23:24 (098417)

Chris,

You are wise to stop running at least until the PF is resolved. The injury needs time off to heal. Unfortunately there is no quick answer to your questions. Each case is different, and as these message posts can attest, people will respond in widely varying ways. Only experience will tell what is effective for you. Very often it is a combination of things that proves to be successful. Success might come in increments with occasiuonal setbacks -- and so patience and a positive attitude are helpful.

Night splint, gentle massage, ice, rest, heel lift are all worth trying. The massage is not likely to be a problem, if it is truly gentle; the really vigorous massage that breaks up scar tissue helps some and hurts others. To your list of things to try I would add non-weight-bearing calf stretches as well as orthotics (here start with inexpensive off0the-shelf models). If the orthotics don't work, try taping. By 'trying' I suggest guidelines (a) if it aggravates the pain (or you sense it is making it worse), then stop immediately; (b) otherwise two weeks is a reasonble period.

I am not a health professional, just a fellow patient. Naturally, you should proceed with medical supervision.

I happen to be an ex-runner. I started swimming just to burn off some fat, but have become hooked. I am still a pretty lousy swimmer, but I've learn long ago that nobody really cares how stupid you might look in the water (or the gym, etc.). Just do what you can and enjoy the buzz from the natural endorphins. As far as biking goes, listen to your feet (if they don't complain, it's probably ok). Swimming is better exercise, though.

Good luck
R C

Re: Re:home made night splint

Ellen J on 10/27/02 at 11:58 (098427)

Hi Pauline,
The pair of homemade night splints feels like wearing plain old socks to bed. The only difference is that I can feel the tension of the strap on my leg and on the ball of the foot. They are pretty comfortable and my feet don't get hot at all--but I tend to have cold feet, so heat isn't as much of a problem for me. So far I have not had any tangling, as there is only one strap on each leg.
If I were to make any modifications (now that I've worn them), it wold be to make the strap that goes around the leg wider in order to distribute the pressure from the foot pulling on it all night. Also, I would make the strap that goes under the ball of the foot wider for the same reason--I could feel a little bit of a pressure point under my foot where the strap is, even though the strap goes under the hard plastic part of the semi-rigid orthotic. Those will be pretty easy changes to make.
I could certainly email you a drawing if you wish. The easiest way to describe them is this: It is as though I took a pair of Strassburg socks and put some semi-rigid orthotics in them. Then I changed the position of the strap that goes to the toe area of the Strassburg and changed it so that it loops under the ball of the foot. I chose semi-rigid orthotics so that the rigid part could distribute the pull of the strap more evenly, to prevent a pressure point. I placed velcro on the bottom of the sock (and on the strap) so that the strap wouldn't slip. The strap, of course, needs to go far enough back that it is looped around the hard plastic part of the orthotic and not the soft part. It took me about 2 hours to make a pair.
Let me know if you want me to send a drawing and I would be happy to. I don't think I can send an attachment to the list (as far as I know) so I probably would have to send it to your personal email address.
Ellen J.

Re: many many questions

Richard, C.Ped on 10/28/02 at 09:22 (098477)

Hi Chris,
You may want to see if your insurance will pay for a splint for night use, as well as other types of orthotics or heel pads. If you need some type of heel lift, there are insurance codes for that. Of course though, that would mean getting a script from your doc.
Richard, C.Ped

Re: many many questions

Leon S. on 10/29/02 at 20:01 (098610)

Hi Chris, I too have sadly become an ex-runner due to PF and have turned to using a recombant exercise bike as a substitute activity. It gives a good workout, preserves your back and with the straps over the pedals, allows you to alleviate some of the extra pressure that you put on the bottom of your feet by allowing you to also pull up on the pedal while pushing down on the other. The other info regarding the Julie Stretches, icing and ibuprofen, etc. also work. The big thing, as I learned thru this message board is to stay off your feet as much as you can to give them the time to heal.

Re: many many questions

John in Santa Cruz on 10/31/02 at 18:07 (098837)

I agree with all the advice Jim C and others have given you and would add this one. Tape. It has always been a miracle worker for me - have had recurring but manageable PF for 25 years - and I can still run about 50 miles a week and do hard, competitive running at age 43. I had PF when I ran my track PR 28:30 for 10,000 meters. PF is not necessarily an activity or even running death sentence. But I will say it is a tricky little goblin.

The tape job I use that works so well is to start with a long strap of athletic tape that is torn longitudinally in half. You start it right at the ball of the foot behind the great toe, run it down the arch, around the back of the heel and back up to the ball of the foot. Then you strap tape in overlapping layers across the bottom of your foot, starting near the ball and working back to the heel. The straps should be about 5 inches long and extend up around the feet, but not far onto the tops. Finally, a single strap that starts at the arch and is drawn across the top of the foot, anchoring on the lateral side of the foot.

My experience is that this tape job works better than just about anything else I have tried, short of the night splints which I have not, but hear very good things about. Cortisone shots seem to work for some, but I would be frightened to try them.

Every case of this seems to be unique. I know there are many who advise NOT running AT ALL until long after pain is gone. This is good conservative advice. However, I will cop to not always following this - I experience some pf pain on a regular basis (everyday when I first wake up, I walk like Fred Sanford), but keep a very watchful eye on it and aggressively manage it. When I feel it getting worse, I knock off for several days and really go after my treatments. My PF will go away if I do not run for a month, but it comes right back when I get back up to what I consider a barely acceptable training load. So, I have to live with it and do.

Massage is good IF you stay AWAY from the heel area - one of the docs here can correct me, but heel massage just further damages/tears the pf tissue. My experience is that direct massage of the inflamed area makes PF MUCH worse. I am currently getting professional massage from arch to toes only, and focussing on trigger points in calf, hammy, and even quads. I have one point on my calf (that thin strappy lateral muscle, talus?) that if you rub across the trigger point it feels like you are rubbing the arch! Have become a stretching convert as well. I think you have to stretch all the leg muscles though, not just the calf/achilles, though that is the most obvious.

My one 'out there' theory (totally unproven and I am not a doc by any means) is that strengthening muscles of the lower leg will help pf in some runners because it gives you better biomechanics. Over pronation is not just a leading cause of pf, but it is inefficient from a 'fast running' standpoint. Strong foot, calf and even upper leg muscles, combined with good flexibility, will help straighten out the biomechanical 'deficiencies' you have that are causing the pf. I know that when I concentrate on strengthening this entire 'lever' system, my mechanics improve and I strike more mid-foot rather than heel. Mid foot striking for a distance runner takes an unusually amount of leg/foot strength, but if you look at the top runners not only are they faster, but they can absorb a level of training that us average citizens would consider mind boggling. They nearly all strike at mid-foot as opposed to the heel. My recommendation is to be careful with this, as you want to maintain flexibility while building strength sufficient to allow for mid-foot striking.

Finally, your running shoes should be very flexible. I just bought a pair of $85 Nike Pegasus 2002, a shoe I have worn since they were introduced in 1983. Normally I like Nike shoes, but this model stinks. Don't think that just because you get an expensive pair of shoes with all the bells and whistles that it will work for you. You want a flexible forefoot and put a good aftermarket arch support in it, if not an orthotic.

Hope to see you on the roads again soon.

-John (still running) in SC

Re: many many questions

Jim C on 10/31/02 at 22:37 (098860)

John,

Great post! You must be one stuborn sob or very dedicated to your sport to continue to run with this condition(PF). I can see how tapeing has been your savior as I have found it very very effective. My only problem with useing it long term is it eventualy rips the skin off my feet, which can be very painful in its self. So I limit it for when I know I'm going to be very active. Fortunately I'm healing up quite nicely in the past months with other conservative treatments. But I assure you I will use tape when I resume running, hopefully in the next couple of months!
I would strongly encourage you to try the night splint or strassburg sock as it was the only thing I have tried that gave me virtualy instant results, I think that you would be amazed, and if your like me 'pissed' that you didn't try it sooner!
I to, am a big air pagasus fan as I have ran thousands and thousands of pain free miles in them but now I'm a NB convert, but we will see when I resume a running program.
I also have gotten great results with a total stretching program, I'm virtualy turning into a contortonist! It amazed me that after I developed a good stretch in my legs, after stretching I would be pain free for short period of time (hope that makes sense).

Again, great post!

Jim

Re: many many questions

Julie on 11/01/02 at 02:05 (098862)

There's no 'best single treatment for PF. I believe that every case is different, and that the important thing is to find the cause and then address it with a treatment programme that targets it. For this you need a full evaluation of your biomechanics (and lifestyle, including your running technique, shoes, etc) which a good podiatrist is best qualified to do. Once the cause is identified, you can tackle it with a comprehensive healing plan.

Like John, I am a devotee of taping. Taping not only relieves pain, it actually 'rests' the fascia by substituting the arch support the injured fascia can no longer provide. If you decide to try it, you may find it's not necessary to use the complex, tape-intensive method John described. Look at part 2 of the heel pain book (which I hope you've read and re-read by now). It illustrates and gives instructions for much simpler techniques. I used the simplest for several months: two strips of tape connecting the ball of the foot and the heel. You need to use a good quality tape that will hold its tension (Leuko tape is excellent) and you need to experiment to get the tension right so that it gives support without hurting (which it will if it's applied too tightly).

As for running, well - PF is the Runner's Disease. Incessant pounding is likely to bring it on in the end, particularly if there are any biomechanical faults in one's gait, and it has, for lots of people. There are many contributors to this site who rue 'running through the pain'. It always makes matters worse, and with some it has resulted in a chronic condition. I really would suggest that you not start running again until you have been pain free for a good while, and then to re-introduce it gradually. At that point, you'll need to monitor yourself mindfully, and back off if pain recurs.

With PF, pain is a sure sign that you're re-injuring the tissues. I know how anxious you are to return to running, but you have your whole life ahead of you and time off now is going to pay huge dividends in the long term. You spoke of grants, so I guess you're young, and you have a good chance of healing relatively quickly if you're sensible now.

To summarise:

See a podiatrist.
Learn to tape.
Don't run.

And - very important - never go barefoot.

Re: many many questions

john h on 11/02/02 at 14:14 (099044)

John: At 43 I was running comptetively 7 days a week and playing basketball 5 days a week. Did not need tape or anything else. Time has a way of sending messages to you and like your car things start to break after a while. the mind and spirit is willing but the feet just will not follow. Be careful out ther John.

Re: John, I am JEALOUS

Mahatmelissama on 11/02/02 at 15:51 (099067)

hehe. But someday I will run here, over the hill...in San Jose.
I am walking now and it HURTS (charley horses sometimes when I wake up in my legs) but my feet are getting BETTER while my legs balk at my new activity.

I also lost more weight! Yea me!

Keep on rocking in the free world.

Re: many many questions

john h on 11/02/02 at 17:04 (099080)

Jim I think the quality of the tape has a lot to do with skin iratation. If you hve not tried Leuko tape you should give it a try. Also make sure you remove all residue. Standard tape also caused me skin problems bu not so with leuko tape.

Re: many many questions

Dave L on 11/03/02 at 10:56 (099156)

Replying with a bias in favour of Ayur-Veda, meditation and panchakarma to Chris and others in this thread. I've had this bias for 10 years, a history of distance running for 20 years, and heel pain for only one year (2002) which has been intense for only the last 3 months as a result of long periods standing on ladders and much heavy lifting. Defense strategies tried so far: 1. Purified, warm, non-edible sesame oil massaged gently into the sore (right only) foot to just above the ankles at bed-time; covering the foot with a sock to contain the oil. In the morning I rinse the foot with a wash cloth. 2. Frequently sitting quietly acknowledging the pain by focusing on and feeling it without judging or interpreting it in any way. 3. Stretching ('flexing'), toes up toward knees.

Are any of you also 'pointing'; pressing toes down away from the knees?

Re: Dave

Julie on 11/03/02 at 11:58 (099167)

I'm glad to read your post. I teach yoga (including meditation, of course) and I believe that sitting quietly and acknowledging 'whatever comes up' is the heart of meditation. When there is pain - physical or emotional - meditation is a lifesaver, for letting it in and accepting it loosens its power over us and helps us to deal with it.

See the yoga foot exercises I've posted - they include the extension of the toes forwards.

Re: Re:home made night splint

Sheridan A on 11/13/02 at 19:06 (100071)

Hi,
Could someone please post a picture and more detailed drawings of how to make homemade night splints. I could really use the HOMEMADE Night Splints for Dummies Version. Thanks
SHERIDAN

Re: many many questions

Jim C on 10/26/02 at 00:35 (098374)

Hi Chris,

I use the strassburg sock in place of a night splint, you can get them at thesock.com ,30 bucks for two. They come in sets of two but thats not real clear as I ordered two and got four. They are alot more comfortable than night splints, and I have gotten great results from them. I suppose you could build something that would have the same effect, but if your like me it would fall apart or be a pain in the %$#@ and I would end up spending the money anyway.
I used a heal pad early on in my treatment but I don't really think it did that much good other than the lift it gave.(I heard that lift is helpful???)
I wear New Balance 1121 with a powerstep insert with great results. The shoe is pricey but I haven't found a more stable/supportive running shoe which I wear 90% of the time. I found I can slip the powerstep into other shoes for short periods of time with no ill effects.
I do massage my feet several times a day, I don't know if has a long term effect but it certainly feels good.
I highly recommend a good stretching program, but be careful and avoid weight bearing stretches such as the wall stretch and above all the dreaded stair stretch(that's where you stand backwards on a step on the balls of your feet and lower your heels with your weight). Avoid any stretch that isolates the fasciia, such as sqauting down on the balls of your feet, what you want is to stretch the entire complex (hams,calfs and foot)it's all interconnected and has a great effect on the heel. If you are in the accute faze(hurts like hell all the time)I would be very very gentle(do a search on 'Julies stretches' for some great tips.
When your hurting really bad, lots of icing the heel and ibruprofen can be very helpful to reduce inflamation and pain, and above all rest!!!
Swimming seems to be the top choice on this site, I heard bikeing can be good as long as youi use your heel to push the pedals with rather than the ball of your foot(to much stress on the fasciia)
Read the heel pain book on this site(free)losta of info.
Above all, don't resume running until long after your pain free.

Good Luck,

Jim

Re: Re:home made night splint

Ellen J on 10/26/02 at 16:13 (098403)

I made my own night splint because I didn't want to wear something bulky to bed. I put a pair of Superfeet orthotics inside some knee socks. Then I placed a velcro strap around my leg at the top part of the knee sock. I then sewed velcro onto the bottom of the sock under the ball of foot area. I placed another strap around the ball of foot area, which velcros to the spot on bottom of the sock (to keep it from slipping). A strap then connects the strap encircling ball of foot to the strap around the leg at top of knee sock. I won't bore you will all the million details that I added in order to provide for adjustments, but basically my night splints are a cross between the Strassburg Sock and regular night splints. They seem to work fine.
Good luck with your own if you try and make a pair.
Ellen J.

Re: Re:home made night splint

Pauline on 10/26/02 at 19:11 (098412)

Ellen,
Sounds like a really neat and inexpensive solution to night splints. I wouldn't mind seeing a picture of what you've made. The problems I always had with night splints were the tangle and warmth factor.

They always tangled in the bed linens and were tooooo hot to wear. I wore the straps and lining out on two different pair. The ones I got from the doctor didn't have any replaceable or washable parts.

They were awful when I got through wearing them. I'm looking for a new pair to replace the old. I always like to keep a pair on hand because I grab for them first at the first sign of P.F. returning.

I tried sleeping with one but eventually went to two because I would always kick my other foot with the hard plastic boot. When I developed P.F. in the other foot I needed two anyway. By then I was used to sleeping in them. I refer to them as my bed time ski boots. Actually my ski boots are more comfortable.

I remember one of the doctors saying he suggested the Stressburg sock to patients because it was more comfortable. Do you find the pair you constructed comfortable? How warm do your feet get at night? What about tangle?

Sometimes homemade remedies work the best, sounds like you made a gem.

Re: many many questions

R C on 10/26/02 at 23:24 (098417)

Chris,

You are wise to stop running at least until the PF is resolved. The injury needs time off to heal. Unfortunately there is no quick answer to your questions. Each case is different, and as these message posts can attest, people will respond in widely varying ways. Only experience will tell what is effective for you. Very often it is a combination of things that proves to be successful. Success might come in increments with occasiuonal setbacks -- and so patience and a positive attitude are helpful.

Night splint, gentle massage, ice, rest, heel lift are all worth trying. The massage is not likely to be a problem, if it is truly gentle; the really vigorous massage that breaks up scar tissue helps some and hurts others. To your list of things to try I would add non-weight-bearing calf stretches as well as orthotics (here start with inexpensive off0the-shelf models). If the orthotics don't work, try taping. By 'trying' I suggest guidelines (a) if it aggravates the pain (or you sense it is making it worse), then stop immediately; (b) otherwise two weeks is a reasonble period.

I am not a health professional, just a fellow patient. Naturally, you should proceed with medical supervision.

I happen to be an ex-runner. I started swimming just to burn off some fat, but have become hooked. I am still a pretty lousy swimmer, but I've learn long ago that nobody really cares how stupid you might look in the water (or the gym, etc.). Just do what you can and enjoy the buzz from the natural endorphins. As far as biking goes, listen to your feet (if they don't complain, it's probably ok). Swimming is better exercise, though.

Good luck
R C

Re: Re:home made night splint

Ellen J on 10/27/02 at 11:58 (098427)

Hi Pauline,
The pair of homemade night splints feels like wearing plain old socks to bed. The only difference is that I can feel the tension of the strap on my leg and on the ball of the foot. They are pretty comfortable and my feet don't get hot at all--but I tend to have cold feet, so heat isn't as much of a problem for me. So far I have not had any tangling, as there is only one strap on each leg.
If I were to make any modifications (now that I've worn them), it wold be to make the strap that goes around the leg wider in order to distribute the pressure from the foot pulling on it all night. Also, I would make the strap that goes under the ball of the foot wider for the same reason--I could feel a little bit of a pressure point under my foot where the strap is, even though the strap goes under the hard plastic part of the semi-rigid orthotic. Those will be pretty easy changes to make.
I could certainly email you a drawing if you wish. The easiest way to describe them is this: It is as though I took a pair of Strassburg socks and put some semi-rigid orthotics in them. Then I changed the position of the strap that goes to the toe area of the Strassburg and changed it so that it loops under the ball of the foot. I chose semi-rigid orthotics so that the rigid part could distribute the pull of the strap more evenly, to prevent a pressure point. I placed velcro on the bottom of the sock (and on the strap) so that the strap wouldn't slip. The strap, of course, needs to go far enough back that it is looped around the hard plastic part of the orthotic and not the soft part. It took me about 2 hours to make a pair.
Let me know if you want me to send a drawing and I would be happy to. I don't think I can send an attachment to the list (as far as I know) so I probably would have to send it to your personal email address.
Ellen J.

Re: many many questions

Richard, C.Ped on 10/28/02 at 09:22 (098477)

Hi Chris,
You may want to see if your insurance will pay for a splint for night use, as well as other types of orthotics or heel pads. If you need some type of heel lift, there are insurance codes for that. Of course though, that would mean getting a script from your doc.
Richard, C.Ped

Re: many many questions

Leon S. on 10/29/02 at 20:01 (098610)

Hi Chris, I too have sadly become an ex-runner due to PF and have turned to using a recombant exercise bike as a substitute activity. It gives a good workout, preserves your back and with the straps over the pedals, allows you to alleviate some of the extra pressure that you put on the bottom of your feet by allowing you to also pull up on the pedal while pushing down on the other. The other info regarding the Julie Stretches, icing and ibuprofen, etc. also work. The big thing, as I learned thru this message board is to stay off your feet as much as you can to give them the time to heal.

Re: many many questions

John in Santa Cruz on 10/31/02 at 18:07 (098837)

I agree with all the advice Jim C and others have given you and would add this one. Tape. It has always been a miracle worker for me - have had recurring but manageable PF for 25 years - and I can still run about 50 miles a week and do hard, competitive running at age 43. I had PF when I ran my track PR 28:30 for 10,000 meters. PF is not necessarily an activity or even running death sentence. But I will say it is a tricky little goblin.

The tape job I use that works so well is to start with a long strap of athletic tape that is torn longitudinally in half. You start it right at the ball of the foot behind the great toe, run it down the arch, around the back of the heel and back up to the ball of the foot. Then you strap tape in overlapping layers across the bottom of your foot, starting near the ball and working back to the heel. The straps should be about 5 inches long and extend up around the feet, but not far onto the tops. Finally, a single strap that starts at the arch and is drawn across the top of the foot, anchoring on the lateral side of the foot.

My experience is that this tape job works better than just about anything else I have tried, short of the night splints which I have not, but hear very good things about. Cortisone shots seem to work for some, but I would be frightened to try them.

Every case of this seems to be unique. I know there are many who advise NOT running AT ALL until long after pain is gone. This is good conservative advice. However, I will cop to not always following this - I experience some pf pain on a regular basis (everyday when I first wake up, I walk like Fred Sanford), but keep a very watchful eye on it and aggressively manage it. When I feel it getting worse, I knock off for several days and really go after my treatments. My PF will go away if I do not run for a month, but it comes right back when I get back up to what I consider a barely acceptable training load. So, I have to live with it and do.

Massage is good IF you stay AWAY from the heel area - one of the docs here can correct me, but heel massage just further damages/tears the pf tissue. My experience is that direct massage of the inflamed area makes PF MUCH worse. I am currently getting professional massage from arch to toes only, and focussing on trigger points in calf, hammy, and even quads. I have one point on my calf (that thin strappy lateral muscle, talus?) that if you rub across the trigger point it feels like you are rubbing the arch! Have become a stretching convert as well. I think you have to stretch all the leg muscles though, not just the calf/achilles, though that is the most obvious.

My one 'out there' theory (totally unproven and I am not a doc by any means) is that strengthening muscles of the lower leg will help pf in some runners because it gives you better biomechanics. Over pronation is not just a leading cause of pf, but it is inefficient from a 'fast running' standpoint. Strong foot, calf and even upper leg muscles, combined with good flexibility, will help straighten out the biomechanical 'deficiencies' you have that are causing the pf. I know that when I concentrate on strengthening this entire 'lever' system, my mechanics improve and I strike more mid-foot rather than heel. Mid foot striking for a distance runner takes an unusually amount of leg/foot strength, but if you look at the top runners not only are they faster, but they can absorb a level of training that us average citizens would consider mind boggling. They nearly all strike at mid-foot as opposed to the heel. My recommendation is to be careful with this, as you want to maintain flexibility while building strength sufficient to allow for mid-foot striking.

Finally, your running shoes should be very flexible. I just bought a pair of $85 Nike Pegasus 2002, a shoe I have worn since they were introduced in 1983. Normally I like Nike shoes, but this model stinks. Don't think that just because you get an expensive pair of shoes with all the bells and whistles that it will work for you. You want a flexible forefoot and put a good aftermarket arch support in it, if not an orthotic.

Hope to see you on the roads again soon.

-John (still running) in SC

Re: many many questions

Jim C on 10/31/02 at 22:37 (098860)

John,

Great post! You must be one stuborn sob or very dedicated to your sport to continue to run with this condition(PF). I can see how tapeing has been your savior as I have found it very very effective. My only problem with useing it long term is it eventualy rips the skin off my feet, which can be very painful in its self. So I limit it for when I know I'm going to be very active. Fortunately I'm healing up quite nicely in the past months with other conservative treatments. But I assure you I will use tape when I resume running, hopefully in the next couple of months!
I would strongly encourage you to try the night splint or strassburg sock as it was the only thing I have tried that gave me virtualy instant results, I think that you would be amazed, and if your like me 'pissed' that you didn't try it sooner!
I to, am a big air pagasus fan as I have ran thousands and thousands of pain free miles in them but now I'm a NB convert, but we will see when I resume a running program.
I also have gotten great results with a total stretching program, I'm virtualy turning into a contortonist! It amazed me that after I developed a good stretch in my legs, after stretching I would be pain free for short period of time (hope that makes sense).

Again, great post!

Jim

Re: many many questions

Julie on 11/01/02 at 02:05 (098862)

There's no 'best single treatment for PF. I believe that every case is different, and that the important thing is to find the cause and then address it with a treatment programme that targets it. For this you need a full evaluation of your biomechanics (and lifestyle, including your running technique, shoes, etc) which a good podiatrist is best qualified to do. Once the cause is identified, you can tackle it with a comprehensive healing plan.

Like John, I am a devotee of taping. Taping not only relieves pain, it actually 'rests' the fascia by substituting the arch support the injured fascia can no longer provide. If you decide to try it, you may find it's not necessary to use the complex, tape-intensive method John described. Look at part 2 of the heel pain book (which I hope you've read and re-read by now). It illustrates and gives instructions for much simpler techniques. I used the simplest for several months: two strips of tape connecting the ball of the foot and the heel. You need to use a good quality tape that will hold its tension (Leuko tape is excellent) and you need to experiment to get the tension right so that it gives support without hurting (which it will if it's applied too tightly).

As for running, well - PF is the Runner's Disease. Incessant pounding is likely to bring it on in the end, particularly if there are any biomechanical faults in one's gait, and it has, for lots of people. There are many contributors to this site who rue 'running through the pain'. It always makes matters worse, and with some it has resulted in a chronic condition. I really would suggest that you not start running again until you have been pain free for a good while, and then to re-introduce it gradually. At that point, you'll need to monitor yourself mindfully, and back off if pain recurs.

With PF, pain is a sure sign that you're re-injuring the tissues. I know how anxious you are to return to running, but you have your whole life ahead of you and time off now is going to pay huge dividends in the long term. You spoke of grants, so I guess you're young, and you have a good chance of healing relatively quickly if you're sensible now.

To summarise:

See a podiatrist.
Learn to tape.
Don't run.

And - very important - never go barefoot.

Re: many many questions

john h on 11/02/02 at 14:14 (099044)

John: At 43 I was running comptetively 7 days a week and playing basketball 5 days a week. Did not need tape or anything else. Time has a way of sending messages to you and like your car things start to break after a while. the mind and spirit is willing but the feet just will not follow. Be careful out ther John.

Re: John, I am JEALOUS

Mahatmelissama on 11/02/02 at 15:51 (099067)

hehe. But someday I will run here, over the hill...in San Jose.
I am walking now and it HURTS (charley horses sometimes when I wake up in my legs) but my feet are getting BETTER while my legs balk at my new activity.

I also lost more weight! Yea me!

Keep on rocking in the free world.

Re: many many questions

john h on 11/02/02 at 17:04 (099080)

Jim I think the quality of the tape has a lot to do with skin iratation. If you hve not tried Leuko tape you should give it a try. Also make sure you remove all residue. Standard tape also caused me skin problems bu not so with leuko tape.

Re: many many questions

Dave L on 11/03/02 at 10:56 (099156)

Replying with a bias in favour of Ayur-Veda, meditation and panchakarma to Chris and others in this thread. I've had this bias for 10 years, a history of distance running for 20 years, and heel pain for only one year (2002) which has been intense for only the last 3 months as a result of long periods standing on ladders and much heavy lifting. Defense strategies tried so far: 1. Purified, warm, non-edible sesame oil massaged gently into the sore (right only) foot to just above the ankles at bed-time; covering the foot with a sock to contain the oil. In the morning I rinse the foot with a wash cloth. 2. Frequently sitting quietly acknowledging the pain by focusing on and feeling it without judging or interpreting it in any way. 3. Stretching ('flexing'), toes up toward knees.

Are any of you also 'pointing'; pressing toes down away from the knees?

Re: Dave

Julie on 11/03/02 at 11:58 (099167)

I'm glad to read your post. I teach yoga (including meditation, of course) and I believe that sitting quietly and acknowledging 'whatever comes up' is the heart of meditation. When there is pain - physical or emotional - meditation is a lifesaver, for letting it in and accepting it loosens its power over us and helps us to deal with it.

See the yoga foot exercises I've posted - they include the extension of the toes forwards.

Re: Re:home made night splint

Sheridan A on 11/13/02 at 19:06 (100071)

Hi,
Could someone please post a picture and more detailed drawings of how to make homemade night splints. I could really use the HOMEMADE Night Splints for Dummies Version. Thanks
SHERIDAN

Re: Re:home made night splint

Janet R on 5/10/09 at 22:58 (257409)

Could you please send a pic of your homemade night splint. I need to make something because I just don't have the money to go buy one of those that are almost $100. I think I can probably make my own though. But I would like a little assistance as far as seeing a picture to get ideas from. Thank you so much. mom_md at msn.com