Almost Better - A Treatment Saga
Well, after more than 8 months I am almost better. To the point where I am starting to
run on the treadmill in preparation for running on the road soon. I hope Bob G. is around.
I know he is back at it after his long saga.
After all of my experimentation and reading (here and elsewhere) I thought I would pass on some opinions and descriptions of what worked for me. This will probably be longer than anyone wants to read but maybe it will give some hope and ideas. First, I think that PF is highly individualized. Mine came about from running barefoot on the beach (pulling on the fascia) and then not heeding the symptoms and trying a long run about a week later. I think that my age (55) contributed because I don't have the padding in my heels or the flexibility that I did when I was younger. I never had very severe pain and seldom had the classic "get out of bed and fall on your face" early morning pain.
I had one cortisone shot, early on. It didn't hurt too much and made my heel feel much better but it lasted only about a month and then I was back to where I started. My reading indicates that one should be careful with cortisone because it can actually weaken tissue.
I have read the "PF Book" many times and there is a lot of good information but it is not the prescription to recovery. I think that one should try as many of the dtreatments as work. Understanding that different ones will work for different individuals. I was unsuccessful with taping, in spite of Julie's encouragement. It felt good on my arch and heel but really hurt the skin on the bottom of my feet. Several people suggested pre-taping with special tapes, etc but I didn't have the patience. However, I think I learned that I needed more support. I have used a variety of over the counter orthotics. I have a narrow foot and high arch and my favorites are Sorbothane and SuperFeet and I have a Spenco that works OK. For me, the best ones are those with lots of arch suport. The Sorbothane orthotic that I use in my "athletic shoes" has a lot of cushioning and not as much arch support as some of the others. I also found Birkenstocks to be very, very comfortable from as soon as I put them on. Both for the support as well as the fact that they make me exercise my feet. But, I am a big believer in orthotics...if you have any other biomechanical problems then custom orthotics may be indicated.
Rest!!! This is probably the most important. I am still not sure if PF is simply an inflamation or if it really includes tears and microtears of the fascia but I stopped all exercise that put any stress on the fascia and tried to minimize time on my feet.
Icing: I am not as certain of this. I continued aerobic exercise (stationary bicycle and elliptical cross trainer) and often ice after working out. It does feel good at the moment and may have some placebo effect but I am less convinced of its real effect. But it certainly can't hurt and it certainly reduces pain for an hour or so.
NSAIDs: I have taken more ibuprophen and naproxen (at different times) than I care to admit. As pain killers, they work for me and I think that they help in recovery but I am not 100% sure. I have a good stomach so no side effects I suppose that someone will bring up liver problems but I was not convinced of the severity from my reading. Certainly worth trying for most PF sufferers.
Stretching: This really works for me. As I said, my PF wasn't severe so I can do the weight bearing stretches but I also have a suite of non-weight bearing ones. It might be worth starting a whole separate thread on stretches. One at a time with their effects, pro and con. If I don't stretch, I can tell the next day. Through these 8-9 months I have really increased flexibility because I do a bunch of stretches (not all for PF) so there is a positive result!!
night splints: Another one that I really recommend. I was very skeptical at the beginning and only purchased one because the online running store where I do business told me that I could return it at any time up to a month if it didn't work. Well, it did work. It took a couple of nights to get used to. It makes it hard to turn over in your sleep at first but I got completely used to it. Even took it on vacation to the Carribean with me. My right heel was much worse than my left so I only use one night splint. At this point, I have quit using it unless I have a twinge or some sort. Maybe it is a placebo effect now.
Other drugs or dietary supplements: I take chondroitin sulfate and glucosamine for mild arthritis in my hands and that may have helped. I also think that MSM is worth a try. I was just too lazy to get it until recently but will try it for a couple of months now. Other than that I didn't try anything.
Physical Therapy: This has been another of my favorites. I am receiving ultrasound with cortisone cream and foot massage. I started with 3 sessions per week and then because of travel, etc kind of dropped it for a month and am now doing two per week. I understand that the cortisone cream is much less intrusive than the injections but that it can relieve swelling. Mine is a pretty mild PT regime but it worked from the very first treatment. It has also helped me because I really like my physical therapist and she has given me lots of encouragement, discussions and trials of different stretches, and just generally aided my recovery psyche.
Exercise: This is probably the most difficult. I have run for over 25 years and really enjoy it. I have missed it severely over the last 8 months. I am not overweight and so didn't need the exercise to take pounds off, though it makes weight control pretty easy for me. I was unwilling to give up aerobic workouts so I started almost daily workouts in the gym, using a stationary bike and an elliptical cross trainer. I am careful not to put stress on the fascia when I use these. The elliptical cross trainer may be close to the danger zone for PF sufferers but I really enjoy it. I try to keep my feet fairly flat on the foot plates, i.e., I don't come up on my toes. It may have prolonged my recovery but it kept my head screwed on right so I think it was worth it. I also mixed in a bit of weight training with the aerobic so have probably benefited in my overall physical health in spite of the PF.
Well, that is about it for me. I hope I didn't bore anyone to tears. (Those are the ones that flow from your eyes, not the ones that can hurt your plantar fascia!) I guess I am on track to run a half-marathon in the Fall but I will pay very careful attention to little pains and not try to push too hard. I'd be willing to discuss any specifics that anyone would like. Since there seems to be a real controversy over stretching this is one place we might start a new discussion.
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