Plantar Fascia Issues-a new plan

[GinnySellars]

I know we have many BPR members with PF problems. This thread is to share ideas.

I personally hit rock bottom with my feet about 6 weeks ago. The heel pain was so bad, I was hobbling around at work and home. I cannot play running games with Madeline, and it's un-acceptable.

I have had PF issues for nearly a decade, and it comes and goes. Over the past few years, I have been wearing orthotics and shoes in the house non-stop, and my feet have gradually become weaker and weaker. I have worn a 'PF sock' at night to keep dorsi flexion in the ankle overnight.

So.....I have decided it can't get much worse, and nothing I've tried has worked. Over the last few weeks, I got rid of all my orthotics, and I'm using 'barefoot science' inserts in my shoes. They add pressure under the middle of the foot to encourage the foot to redevelop an arch. I'm going shoeless at home, and doing some barefoot running on the treadmill. I'm balancing on one foot in barefeet with my eyes closed, 1 min per foot 4 times. I'm stretching hip flexors and piriformis to get more mobility through the hips. It got a little worse for the first 2 weeks, but I can see that I'm gradually gaining strength. I'll let you know how it goes.

[Tamara Dantzer]

I am glad to see that you feel you are improving strength- I'll bet you will see some improvement wrt the pain as well.
How do you like the barefoot science orthotics?-
It sounds like you are doing tons of exercises for your feet but I have one that I'd like to share- you can let me know if it works at all for you.
I start with two feet on the ground- I try to lift my arches- particularly the med( inside) arch- sometimes I need to scrunch my toes ( using the flexors) to do this- the exercise is to actually maintain the arch without scrunching the toes- in other words letting the toes relax while holding the arches up..
I start sitting ( less load- then to standing then finally on one foot.

good luck and have fun with it:)
Tamara

[GinnySellars]

That feels about as successful as wiggling my ears! I have no idea how to do that without scrunching toes....but I'll keep trying.

A question for you....about the "barefoot science" shoe inserts. For those of you who don't know what they are, they are a simple thin shoe insert with a place in the middle to place increasingly big pieces of foam that press up under the middle of the foot. My understanding is that the pressure is supposed to make the foot react and try and create a higher arch. How would it work any differently than an orthotic where the foot actually relaxes and uses the support? I don't feel my feet working in them. I just feel the pressure under the middle and actually like the support.

[Andrew]

The "science" behind the barefoot science inserts relies on the increasing stimulus under the middle of the foot. The "irritation" of the insert is supposed to ellicit a reflex contraction of the intrinsic muscles of the foot. If the muscles have been underutilized for so long that they do  not respond, or are unable to contract on their own, you may not feel this reaction. Or, the stimulus is not enough to create the reflex in the first place.

Here are a couple of suggestions.
1) Perhaps some neuromuscluar stimulation from a good physio might help "wake up" the muscles involved. I would welcome Tamara's comments on this.
2) Perhaps a larger insert is required due to yoru naturally high arch, though I realize this will cause some discomfort when initially using it.
3) You may find more stimulus once you have been able to develop the reflex with Tamara's suggestion of teh isolated foot exercises.

Some readers may wonder why I am writing this to Ginny, rather than talking about it over dinner. Turns out we don't have much time in our lives for open communication about details like this. Both of us need to work a bit more on the Work/Love/Play balance.

[Tamara Dantzer]

Hi Ginny and Andrew:
Actually Andrew just beat me to this- when I read your post Ginny i had a feeling your poor intrinsics may have just been inhibited for so long they have forgotten how to work- this can happen with pain or inflammation with many stabilizing muscles- the VMO at the knee or transverse abdominus/ multifidus at the lowback are other examples.
There are two options you may want to try- the  first is what Andrew suggested- a muscle stim
I would use two small electrodes at the bottom of the foot- the frequency should be set fairly low- 30-50 so as best to stimulate a muscle contraction, and I would set it for about 5-10 sec on and 30 sec off. The intensity should be either strong enough to elicit  a contraction or as strong as you can tolerate.
The other option is an semg- ( if you want you can borrow my home unit) this way you can see if you are contracting the appropriate muscles even if the contraction is not strong.
Hope that helps-
( maybe we can teach you to wiggle your ears next:)
Tamara

[GinnySellars]

Thank you Tamara and Andrew!

I'm feeling very motivated and hopeful about change these days. My pain levels are up and down, but I'm asking more of my feet.

I can now do 1min walk/1min barefoot jog pain-free, with variable discomfort later in the day.

The heel pain seems to come on un-expectedly. For instance, zero pain walking barefoot around the house, then suddenly so painful that I can't stand comfortably. I am then putting on my extra supportive inserts for the rest of the evening. I see this as progress. I'm able to operate without the inserts for a longer chunk of time. In my day shoes, I'm wearing only 'barefoot science' inserts.

Tamara, I'm going to book with you to 'wake-up' the intrinsic muscles of the foot.

Thanks for the feedback you two.

[Andrew]

Just another on-line thought, seeing as how we are having to rely on this method to continue this conversation.

Is it possible the sudden increase in pain corresponds to the sudden collapse of the foot as the intrinsic muscles finally fatigue after a day of supporting your bare feet?

If this is the case, it might be better to go barefoot for a set amount of time, and put your feet into the supportive orthotics before the pain develops. For example, if the pain comes on after 8 hours of "barefoot science" and barefoot walking, then switch to the orthotics after 6 hours this week. That way you would minimize the painful period in the afternoon. This will only work if you continue to challenge your feet by steadily increasing the time spent barefoot each day.

You can use pain as the stimulus for going back to orthotics, or try to avoid the pain by preempting this with a planned approach that builds a specific amount of time into each day without the orthotics.

I have been proud to see how you have tried some enw ideas, and think Tamara's offer is a really great potential solution to speed your recovery. Anyone else with similar issues shuld know that Tamara works in Vernon at the Kal Lake Physio next to Kalpuccinos.

[Tamara Dantzer]

Thanks for the plug Andrew but hopefully everyone will stay healthy so they won't need to visit their local friendly physio:)
It would be great to see you Ginny, I had the muscle stim on my foot the other day- it definitely wakes up the muscles:) ( I was using it for the bunion I am now developing(arrgh) Much like you with the intrinsics to support the arch, my great toe add is weak and I can't seem to make it work with my brain only...I was happy to see with a  little stim it works just fine ( yae- the muscle does exist!)- again it doesn't take long to fatigue it either- so it is all about finding the balance...That theme seems to recur doesn't it:)

wrt to the pain.. it may seem to come on completely unexpectedly but likely it it just a bit latent (coming on after the aggravating stimulus)- I like Andrew's idea of preempting it- because pain can inhibit those instrinsic muscles- so as much as you are able, try and walk that fine line of adding enough stress to strengthen but not so much as to break down, keeping in mind the line will likely be moving depending on your activity. ( there is also some evidence that chronic pain can be exacerbated by the stress hormones (cortisol etc) it can keep certain ion channels active in the nerve that make the nerve itself a pain source- ( under normal circumstances nerves are not sources of pain )- The good news is- the ion channel that are sensitized by the stress hormones will only stay "open" if they are activated by the hormones..another good reason to find the balance and "breathe".
Keep up the good work:)

[GinnySellars]

A quick update on the foot pain...

Progress!
- I'm still without orthotics in all shoes.
- I wear shoes with as little structure as possible.
- I wear 'barefoot science' inserts about 50% of the time to put pressure under the middle of the foot to stimulate the arch.
- On the weekend I was able to do 2-two hr skis pain-free, and 10min of barefoot jog/walking. The pain increased when I went out to play with the kids in Andrew's boots, but recovered by the next day.

Yesterday, I had my first outdoor jog in 5 months!! We had a plan to pick up a movie at the store, which is probably 1.5 miles from home. As usual, the heel pain was twinging near the beginning of the walk. I wanted to turn back, but didn't want to disappoint Andrew and Maddy. Andrew began to jog, and I thought I'd try 1min forefoot intervals as I do on the treamill for 10min total. Well, the jog on the forefoot eliminated the pain I was feeling walking, so I just kept doing it. It was more of a light lope than a run, but it felt great. We did this for more than 30min! My feet and legs were tired when we got home, and sore heel. I wore orthotics for 30min in the house, and woke up this morning, with no more twingy pain than usual.

I realize this is long-winded, but for those of you that struggle with a chronic injury, ANY progress is exciting.

[courtney.rennie]

Glad to hear that all of your hard work is paying off!  Unfortunately I decided to try the barefoot concept after all of the excitement.  This was about 5 weeks ago now.  After our ESS session I did one 3 min session on the treadmill.  I have never had plantar fascia issues but after three minute session I have been having huge heel pain.  I am not sure that is is plantar fasciatis as it does not have all of the  classic features.  Whatever it is it's painful.  For the first week after the session I have trouble walking at the end of the day (and still do from time to time on longer days).  Things have slowly improved but not completely gone away.  So five weeks out after one 3 minute session I still am having daily troubles.  I understand the benefits of doing such training but have decided that with IMC just over 6 months away that now is not the time for me to try it. 

[Andrew]

You may have inadvertently bruised your heel, which would give you similar symptoms. Sorry to hear you had a negative first experience. We should take a look at your running form the next time we see you. Please keep us posted on your recovery.

It is good for everyone to hear the good and the bad feedback form the experience. I can understand your concern about hurting yourself, and hindering your training for IMC. Keep a close eye on things, ice lots, and see if that helps take down the discomfort.

Keep in mind, that if walking on your toes makes it worse, it is more likely plantar fascia than a heel bruise.

[Daniel Auger]

What I have learned with my own heel problems is to be patient with the recovery. I do not think there are quick recipes. What worked for me were deep massages of the soleus (spelling?) muscle. Those were painful sessions l but I believe those muscles had a role to play with heel pain. I wore my orthotics 50% of the time and the barefoot technology insole the other 50%.  I also rolled my calves on a roller and my feet on a ball a couple of time per day. Lots of ice complemented all this work.

I am no longer using my orthotics and only wear the barefoot insole. I have been pain free in the heels for a couple of months now (I keep my fingers and toes crossed to keep it that way).  I have worked on my running style and now landing on my forefoot. I have started some barefoot running on the treadmill and so far everything is holding good. I now look forward for my first run in the sand in Mallorca .

I do not think I can single out one particular thing that I have done that I would consider more successful than the other. I think it is the combination of all the above that somehow brought success to the healing process. The main important point is patience. Sometime we lack some of it. Good luck with your recovery.

[GinnySellars]

http://www.tptherapy.com.au/foot/

There is a really good description and visuals of muscles related to foot pain in here.

Courtenay perhaps some of these muscles were already 'sticky' when you attempted 3 minutes of barefoot running. The additional workload may have resulted in tightening a bit more, then pulling on this place in the heel.

I bought my TP therapy kit through Fresh Air. I don't know if they have it ready for spring yet.

Good luck!

[GinnySellars]

I'm feeling pretty stoked today. Yesterday Andrew and I did a mountain bike/run brick at Ellison Park. I was able to do 2 intervals in the Vibram barefoot shoes on the trails:16min and 14min. It was totally pain free.

What I'm learning:
-my heal pain is multifaceted
-I sometimes have pain from plantar fascia type tugging on the heal
-I usually have pain from the peroneals attaching under the heal
-I can have pain while riding from these peroneals, but it does not mean it'll hurt running
-I have pain running in a shoe because the heel is higher due to the padding of the sole. This causes my heal to jam, and then the foot rocks/slaps forward and it hurts.

So...with cautious optimism, I'm LOVING my short intervals in the trails. I think once my feet get strong in these Vibrams, I'll be able to run in a light soft soled runner too.

Yahooooooo!

[kiwichris]

Glad to hear it is going well Ginny - keep a positive outlook and love running when you can - you will still kick my butt

C