Plantar Fasciitis - ugh

[Traveler]

Somehow in over 40 years of hiking I have avoided serious injury from the activity. Last week I was diagnosed with Plantar Fasciitis in the right foot. The pain in my heel (radiating from the little toe side of my foot) did not follow classic symptoms typically felt in the arch, and is not the result of a stress fracture apparently. The MD gave me a series of exercises to do so the tendon(s) could strengthen, no night brace however.

This all has me thinking about how the condition can develop in people who walk hundreds of miles a year in various foot gear, I thought there may be a pool of knowledge that might provide some answers.

For the past 8 years or so I have worn Asolo 520s for any hiking done in all seasons. In the summer of 2014 I made the switch to trail shoes and found them very comfortable. In spring last year I got a pair of trail runners that were equally comfortable and lighter. Between these two pairs of shoes I have put on about 800 miles over the past year and a half. I use the 520s in winter (typically from December through late March). In July I noticed a minor problem in the outside edge of the forefoot that would come and go. Eventually the heel pain started and has gotten to the acute stage, which led to the above diagnosis over time.

In pondering this ailment, one thought I had was I may have pushed harder with the more flexible shoes (avg MPH went from about 2.8 - 3.2 in the 520s to 3.8 - 4.0 the shoes), though I would think with several thousands of miles over the past decade any tendon flexibility would have been maximized in the foot.

My question is this, does or can the flexibility of footgear cause or otherwise irritate this condition? Does the heavier boot with a higher heel provide a benefit for this condition, preventing its development over time? I never had any foot problems until this past July when this started. Does anyone have any thoughts on this?

I am also curious how long this condition will last (MD was nonspecific with this). I took myself off the trail and basically stayed off my feet since December 11th, but there was no apparent lessening of heel pain after 3.5 weeks of not doing much. My MD did not say to stop hiking, in fact she encouraged it due to its overall exercise value, which goes against some of what I have read about this. I am understandably interested in what worked for those with a similar Fasciitis complaint.

[Old Grouse]

I'm not sure it's directly apposite, but I had to give up my beloved Inov8 trailrunners because according to my podiatrist, their light weight & flexibility were the cause of a Morton's Neuroma. He told me not to go hog wild but to wear something a little stiffer.

[egilbe]

My gf has been battling it since June of last year. We've done a few extended weekend trips of 20 miles or so and it comes and goes. Sometimes she's almost crying and other times she doesn't even notice it. She says its getting better, she doesn't notice the pain when she first gets up in the morning. She's still wearing the same Oboz boots she was wearing when she first notice it flaring up when she did a 15 mile day without me in NH. She won't take any Ibuprofen unless it gets really bad. I haven't noticed her limping much in the last month or so, but we haven't gone on anything longer than a quick dayhike, either.

[burger]

Somehow in over 40 years of hiking I have avoided serious injury from the activity. Last week I was diagnosed with Plantar Fasciitis in the right foot. The pain in my heel (radiating from the little toe side of my foot) did not follow classic symptoms typically felt in the arch, and is not the result of a stress fracture apparently. The MD gave me a series of exercises to do so the tendon(s) could strengthen, no night brace however.

Apparently not a stress fracture? You can't rule out stress fracture without a bone scan or MRI. Most people I know who had stress fractures in their feet were initially misdiagnosed with something else. FWIW, where you describe your pain is exactly where I had pain when I had a metatarsal sfx. YMMV.

[4eyedbuzzard]

Did you get a steroid injection in the foot? That with Ibuprofen (800 mg x 3/day) did wonder for a bout I had with Plantar Fasciitis (most of the pain was toward the heel) last summer. The injection hurts like a *&^%$#@!, but the numbing agent stopped the pain for the first day and the steroids kicked in their anti-inflammatory relief very quickly. Obviously, ongoing stretching exercises as helpful as well.

[colorado_rob]

Somewhat similar, I struggled about 10 years ago with Metatarsalgia, but medical orthotics basically cured me. I wonder if there might be a relief possible from orthotics?
..
Shoes: I used to wear trail runners, but my foot doc (who got me the orthotics) suggested a more rigid sole and I've since switched to "light hikers" that have a more rigid sole than simple trail runners. Seems to have helped my MT, and I know it reduces fatigue.
..
About a year ago I came down with Achilles Tendinosis (some call it tendonitis) in both heels. Horrible. I understand from my doc and a Physical therapist that both PF and AT are aggravated by tight calf and ham string muscles. Since then I've started on a very rigorous stretching and exercise regimen, I've finally noticed some improvement in my AT. My exercises include "eccentric" exercises, but those are for AT, not sure what would be good for PF.
..
So two suggestions: look into orthotics and get serious about the right kind of stretching exercises. Per my doc's suggestions, I've also gone on a fairly high anti-inflammatory (low sugar, mainly) diet plus he suggested I take two supplements, Turmeric and Grape seed extract. I've never been one to believe in supplements, but apparently these things have some science behind them.
..
PF (and AT) are horrible conditions for hikers, I know how badly my AT has affected my lifestyle, but I think finally, after rigorous PT, exercises and diet, I'm getting better with my AT.

[TexasBob]

I had PF cause heel pain in my left foot. I went to an orthopedist who told me to do stretching exercises, take regular Advil and gave me a boot to wear at night. I think the boot did the most good, my foot felt better as soon as I put it on. He told me it would take some time to improve and he was right. It took a few weeks but it went away. My heel gets tender sometimes and I do the exercises, take the advil and in a few days its fine again. I do believe that wearing running shoes aggravates it in my case.

[Coffee]

PF is, by far, the most infuriatingly annoying injury I have ever had and my recovery is still a work in progress. Maybe this description will be helpful but my case appears to be unconventional in some ways.

From taking up backpacking seriously again in 2013 until the end of 2014, I used trail runners exclusively (Cascadia 7/8/9) and had no issues at all with foot problems. From late 2012 up to early 2015, I also trained for and ran six marathons (PR 3:28) and used running as my primarily training for hiking getting up to ~50-55 miles/week at my peak of marathon training. Up to the end of 2015, I had no foot issues at all.

In preparation for a planned PCT thru hike, which ended up being a section of the first 1/3 of the trail, I thought that I should plan for wearing heavier boots in the Sierra in case of snow. I purchased Asolo 535s (the non Goretex version of the 520s) and proceeded to break them in by walking around 75 miles. I noticed some heel pain in my left foot while breaking in the boots but no big deal. I ran a marathon in late January. Then a week after the marathon I thru hiked the Foothills Trail (~80 miles over four days) using Cascadias.

When I returned from the Foothills Trail, I resumed running (using Brooks Adrenalines) and noticed some pain in my left heel but it didn't really bother me that much. It started to get a little more severe in March and I backed off on running given my looming PCT start date on April 12. As I started the PCT, I didn't really have much in the way of issues with the left foot other than a little soreness which was never present in my right foot. In the section from Campo through Kennedy Meadows I did several mid 20 days and three days pushing 30 miles.

Starting shortly after KM, I hit areas where there was recent snowfall. I opted to use the Cascadias and did not ever use the Asolos. My feet were cold, numb, and tingly for a lot of the time while hiking in snow. Additionally, I wore K-10 crampons during an attempted Mt. Whitney ascent and in the approach to Forester Pass, which I opted not to cross, instead doing a hairy descent of Shepherd Pass again using the K-10 crampons. My feet were in rough shape in Independence. I had numbness in both feet but it was much worse in the left foot.

I took a week off after Independence for a previously planned visit with family (nothing to do with foot issues). My left foot kept feeling weird and I started to notice more heel pain. I returned to the PCT and hiked from Horseshoe Meadows to near MTR where I bailed on my thru hike due to reasons not related to health or my feet specificially (it was stuff going on off trail that I had to address). My feet never felt totally right on this segment but I cranked out 20 mile days through the Sierra, and a number of snowy passes, sometimes using the K-10s. My left foot often got numb and stayed numb.

So I returned home. I tried to resume running. It was awful. I had horrible heel pain in my left foot radiating to the side of my feet. I was stupid, didn't consult a doctor, and just thought a break from running would fix things. I applied ice several times per day and massaged the bottom of my left foot using a tennis ball while working at my desk. This helped.

After a few weeks, I tried to resume running. I was not in good shape. My speed was off and the pain kind of came back even at 20-25 miles/week. And by then my hike in the Alps was looming and I didn't want to be injured. I backed off the running again. The Alps trip was fine - just 10 mpd average. Very mellow and feet were ok although in some discomfort.

Over the past three months, I steadily increased my running and I'm now up to about 30 miles per week, with some long runs pushing 11-12 miles. My speed is mostly back. I continued the icing and massaging of my left foot. I started to trail run, which I discovered felt better due to varying terrain. I think that running on pavement tends to stress the exact same point on the foot whereas trail running may have more diverse impacts on the foot which helps. I did a 13.5 mile hike on Sunday.

In any case, my foot is about 90% fine now and I think I should be fully recovered soon. It was a long and frustrating path probably made worse by not consulting a doctor immediately.

I realize this is a lot of stream of consciousness thought but if any of it can help its worth it. PF is so frustrating. Good luck.

[Coffee]

Oh one more thing, I purchase "The Sock" which I think (but am not sure) helped. I used it for a few weeks at the worse of the problem in July/August.

https://thesock.com/

[Traveler]

Apparently not a stress fracture? You can't rule out stress fracture without a bone scan or MRI. Most people I know who had stress fractures in their feet were initially misdiagnosed with something else. FWIW, where you describe your pain is exactly where I had pain when I had a metatarsal sfx. YMMV.

Thanks everyone for such fast response!

I am not sure it has been ruled out formally, however I did see a podiatrist in late July as the symptoms felt identical at the time to hammer toe, which I have orthopedics for. They did an X-ray and felt around in a manner he said "would indicate a bone break", as did my MD this past week, so its less of an opportunity. That said, your post concerns me and will keep that in mind. Was there any specific pain with your fracture, for example, if you probed a thumb into the ball of your foot under that bone did you have any pain? Good spot btw, thanks!

Did you get a steroid injection in the foot?

No, no steroid shots. I doubt I will opt for that unless the pain becomes completely debilitating. Currently the pain builds to a point and stops at what I call a plateau. Gets no worse, but no better, though the last hike I did in my 520s that seemed to be less painful during the walk, but once the boots came off I had to get to ice. The exercises aren't doing much yet, but its not been long since I got them. They have me doing the wall stands (rear foot flat on the floor), crossing legs and pulling the toes toward the knee, rucking a towel on a smooth floor with the toes, and using a rolled up towel to pull and release the foot.

Somewhat similar, I struggled about 10 years ago with Metatarsalgia, but medical orthotics basically cured me. I wonder if there might be a relief possible from orthotics?
..
Shoes: I used to wear trail runners, but my foot doc (who got me the orthotics) suggested a more rigid sole and I've since switched to "light hikers" that have a more rigid sole than simple trail runners. Seems to have helped my MT, and I know it reduces fatigue.

Good suggestion. I have orthopedics for hammer toe and believe in them, but the podiatrist in late July and MD last week didn't seem to think it necessary, that exercise would work it out. The issue of light, flexible foot gear has given me pause though. Your post puts a bit more emphasis on this since we are close in age and probably experience similar chassis issues. The stiffer boots may be what I need to do as well, thanks for that.

I had PF cause heel pain in my left foot. I went to an orthopedist who told me to do stretching exercises, take regular Advil and gave me a boot to wear at night. I think the boot did the most good, my foot felt better as soon as I put it on. He told me it would take some time to improve and he was right. It took a few weeks but it went away. My heel gets tender sometimes and I do the exercises, take the advil and in a few days its fine again. I do believe that wearing running shoes aggravates it in my case.

I do love a successful story, thanks! I am coming to the same conclusion with the lighter foot gear.

[Traveler]

Bah! I didn't get that last post pasted right using the multiple posts, sorry!

[Cheyou]

Try rolling a frozen soda bottle under your food while sitting .

Thom

[Traveler]

Try rolling a frozen soda bottle under your food while sitting .

Thom

I got a tennis ball for that, but good idea, thanks!

[chknfngrs]

I had a bout of it several years ago and it infrequently occurs now. Sorry you are dealing with this. It's annoying more than anything.

[Vegan Packer]

I had PF that was so bad that I was worried that I would wind up in a wheel chair in a few years. I had shots to my feet, wore the boot while sleeping, experimental (at the time) electric shocks to the foot. Nothing worked. They wanted to do surgery.

Luckily, I found two places/people that totally changed the game for me. Believe me, what I am telling you will work, though it will take some time.

First, get a custom made orthotic from a pedorthist. Don't bother with any of the ones off of the shelf. You need to get a custom made set.

Second, you want to find footwear with "stability and motion control" features. This helps control the stress to the part of your foot that is straining. If you get the orthotics, this is not as crucial, but it helps to find shoes with these features.

Third, get a stretch band. You can get them from better pharmacies. Visit with a physical therapist that knows the proper exercises, and learn how to do the exercises using the stretch band. I can't think of a way to describe the exercises in writing, or I would do that for you here. The stretch band and the orthotics are absolutely crucial to your success, so do this step. Just the orthotics will not give you the result that you want.

If you do the exercises at the end of the day, AFTER you have done the thing that causes the pain, this will take the pain away within 10 minutes. The exercises with the band bring blood flow to the affected area, allowing the body to heal itself. They also open the channels to carry away fluids that accumulate and cause swelling.

After the stretch band exercises, ice the bottom of your feet, and then stay off of your feet for the rest of the day. I do the exercises and ice just before bed, for example.

Keep walking. Staying off of your feet takes away the pain, but it slowly weakens your foot, which makes it that much easier for the injury to come right back and get even worse.

Stretch your feet every morning. You especially want to stretch the Achilles tendon. You also want to especially stretch your toes upward while also stretching the Achilles tendon. You also want to do ankle roll stretches. Make sure to do these stretches again before doing your walks/runs/hikes.

After a few years of doing all of this, I am pretty much back to being completely pain free. Between the orthotics for support, the band to promote self healing blood flow, and walking to build strength, I have had no foot problems on the trail, even with up to 40 pounds on my back.

PF is an inflammatory type of thing. Once it starts, it takes a long time to bring it under control. Eventually, it will calm down. If you keep doing the right thing, once it gets to that point, it will almost be like you never had it. Even then, you will need to keep doing the treatment and prevention, but you will be pain free and able to keep doing the things that you love without pain.

[One Half]

Calf massages. Most PF will be relieved by relieving the knots in your calves. Calf muscle shortens, the tendon still attaches to the game two spots but has to actually try to stretch. Tendons don't stretch. Muscles stretch. And they contract. Also, and this is going to sound out there, but PF is often related to lots of sitting followed by activity. The hip flexors shorten, hips rotate forward, stresses the hamstring as it tries to extend to compensate, then the knee, hip and ankle all start compensating and the calf throws in. But being the smallest muscle in that posterior chain, the calf gets over worked and tightens up. Think of your muscles as a chain. When something hurts, look up and down and correct all aspects.

I was a personal trainer for 20+ years and owned my own business until May 2015 with multiple locations and employees.

[burger]

Second, you want to find footwear with "stability and motion control" features. This helps control the stress to the part of your foot that is straining. If you get the orthotics, this is not as crucial, but it helps to find shoes with these features.

This is dangerous advice. I tried motion control shoes for shin splints (from running) years back and got a stress fracture almost immediately. A number of studies have shown that motion control shoes may be bad for various injuries.

My old pedorthist and my podiatrist both told me to wear neutral shoes with the orthotics. The point was that the orthotics should do most of the correcting of whatever's wrong with your gait. So you don't need shoes that are messing with your gait on top of that. Depending on what your orthotics are doing, motion control shoes could totally counteract the correction of the orthotics.

[shelb]

So two suggestions: look into orthotics and get serious about the right kind of stretching exercises. P

FYI: If using ORTHODICS: they must be broken in for HIKING! My friend wore them for 7 months in her regular shoes, put them in her hiking shoes, DEVELOPED HUGE BLISTERS when she never had before! She was told that she should have broken them in for hiking (1 hour hike, 2 hour hike, 3 hour hike, 4 hour hike, etc.). Just FYI.... (She had the strangest blisters on the sides of her feet and toes where the ordotics ended.,,(

[Sir Setsalot]

I had PF and Doc said 35 years working on concrete floors didn't help. It would however come and go. Finally I had enough and had the surgery to remove the bone spurs on the front of the heel which were the cause of my inflammation In the Plantar Tendon. I do not recommend surgery except as a last resort for now after a time it feels like I am walking on a donut because the center of my heel is numb. It will go away and come back another day.

[4eyedbuzzard]

Thanks everyone for such fast response!

You're welcome.

No, no steroid shots. I doubt I will opt for that unless the pain becomes completely debilitating. Currently the pain builds to a point and stops at what I call a plateau. Gets no worse, but no better, though the last hike I did in my 520s that seemed to be less painful during the walk, but once the boots came off I had to get to ice.

Okay. Mine was aggravated by playing 3 hours of tennis twice a week, and got to the point where I could barely walk which I have to do a lot of at work. So I opted for the shot, and some good off the shelf insoles. If your PF ever gets that bad that you can't walk, just know that the shot is an option that worked pretty well. I think the Advil helps a lot also, but you have to take several doses before the full anti-inflammatory effect starts to work. I also used a frozen water bottle like some others have mentioned, which helped, but I had to wrap it in a thin towel for the first few minutes because it was SO cold. I use a towel to stretch the foot as well.

Good luck keeping it under control!