Injury: Plantar Fasciitis

Plantar Faciitis is what I have been suffering with in my feet for a while now. The first occurrence was back in 2007 before the Cayman Marathon and was one of the reasons I was then out for a year afterwards.

I had been fine again until last October time when it flared up in my left foot initially, but by the time the Goofy Challenge came around it was in both feet, and I have been suffering with it since.

The basic problem is the material that forms the arch in your feet is being pulled too tight, this causes inflammation which causes the pain. The root cause for me appears to be short calf muscles and also injuries to my Achilles Tendons which have left them inflexible which is putting the pressure on the fascia in my feet.

Stretching can help reduce the pain a bit, but it isn’t a long term solution as I was spending over 30 minutes a day stretching at one point and it wasn’t giving me 100% relief.

The first incident of this caused me to head to the physio, and that helped. This time, however, after 10 trips the pain was worse and no sign of improvement, so off I went to see a Podiatrist.

The first thing he made me do was increase my stretching and also put some heel lifts in. Apparently I have a problem where the balls of my feet are naturally lower than the heel so that if I put my foot flat on the floor it stretches the arch out and puts even more pressure on the fascia. It is referred to as Forefoot Equinus. This also leads to another problem; there is limited movement in anyones ankle in terms of it moving back towards the shin bone, with the Equinus issue that was taking up most of my limited movement just to stand up straight, which left none for actual walking. This results in my heel lifting before my other foot has touched the floor and leaves me open to more calf and Achilles injuries due to the extra strain I am putting through that area of my body.

All in all not great for a runner!

The initial heel lifts helped a bit, and the pain reduced slightly, and I felt a bit better running.By putting a lift in, it negates the equinos issue and thus gives me some movement back into my ankle to allow me to walk normally. These were replaced by solid heel-lifts which in-turn were replaced by custom orthotics which have a 12mm lift in them and complete arch support and are actually very comfortable. At one point I had nearly 20mm of lift and I was just about falling out of my shoes my heels were so high.

All of these things have helped with the mechanics of the problem, but none  of them have removed the pain. The pain is worse when I first get up in the morning and about 20mins or so after I exercise as during those times the fascia stiffens up and contracts, so when you walk on it again it stretches out and gets sore again, thus causing more inflammation.

In an attempt to combat this I had both feet injected with steroids last week. The procedure only took 10mins or so, and whilst not exactly pain-free was not too bad. I was able to walk out of the hospital with nicely numb feet for the first time in months. The problem was that was only the local anesthetic that was mixed with the steroid. 3 hours later and the anesthetic had worn off and I could feel the areas that had been injected. The next couple of days were rather painful. However, after 2 days I jumped out of bed on Sunday to find that, although the injection sites were still bruised and a bit sore, the normal foot pain was absent! It has now been another couple of days and my feet feel great!

One of the nice side-effects of the steroid injections is that as well as reducing the inflammation the steroid also makes the fascia more pliable. This means I have been back on the Achilles and Calf stretches for the last couple of days giving it everything I have to try and stretch the fascia as much as I can before it hardens again in a few days.

So far it seems to have been a success, I have a follow up with the podiatrist at the end of next week to see how I am getting on, and if there are any points that he missed initially I will get another round of injections to make sure everything is 100%. If by next week the pain has come back though, he will try another set of injections before I am sent off to surgery to get the fascia cut to remove the stress on my feet and hopefully cure this once and for all!