Mt. Whitney Portal Store & Hostel Forums General Mt. Whitney Portal Store Message Board Plantar fasciitis

Recently I have developed tendinitis in my left heal....probably "Plantar fasciitis". This makes walking painfull, especially without shoes with a good arch.

Are my hiking days over? That would be a real drag.

Kent -
I picked up a case of this last year.
Some helpful tips that have been helping - everyone I talked to seem to think that one or more of these suggestions has helped.

#1 would be a good set of arch supports for your boots and shoes. This would include the shoes you wear to work, especially if you stand on concrete floors every day.

Avoid walking in barefeet or flip-flop sandles. Some people even say keep a set of shoes by the bed for when you get up to use the bathroom.

The "footlog" massage. I had reasonable success with this - but others have sworn that this was the saving grace
see product here

During the initial agressive therapy; I would recommend reduce the cross country hikes - especially those involving bouldery sidehilling. You may wish to get a shot(cordozone) - this actually allows the foot to relax and stretch out the plantar bundle. I would also recommend time each evening for stretching the feet( I am lazy about this) So I would say slow down while while you get it under control - but no need to stop. I have continued to get out every weekend dispite my injury.

For me - I wondered how much extra weight is an issue. Within the last 2-3 months, I initiated a diet program to drop the extra weight I have been carrying around. So far I have dropped about 8 pounds, but I am steadily dropping about 3 pounds a month and it does seem to feel better on my feet.

Hope this helps - Tom

Kent:

Over? Good gracious no! There's lots of info out there on PF and lots of ways to treat it, and I think almost all of us have had to deal with this at one point or another. So here goes:

1) Go see an orthopedist about it. Get an X-ray of your foot to rule out bony structural problems vs. the soft tissue inflammation of the plantar fascia. For example, what crippled me was a giant hook of a bone spur in my left heel. Where is your pain located? Front of the heel? Middle? Rear? Inner foot? Outer? That can be an indicator of what tissue may be involved (bone vs. tendon vs. ligament).

2) If an injection is warranted, I might recommend it, but make sure you take it easy for at least a week afterward in order to allow the cortisone to take full effect. You may also feel like the area is sore and bruised for a few days after the injection when the local anasthetic wears off.

3) See a PT (shameless professional plug) about developing an exercise program for postural and balance strengthening of your trunk and legs. Before I helped with custom orthotics for any patient I tried to make sure they could support their own bodies with their muscles as opposed to relying on the orthotic/insert. It's like a brace: if you don't train your body to support itself, it'll just go back to what it was doing before, which led to the breakdown to begin with. They can also help recommend specific stretches (like Tom mentioned) to increase the flexibility of the arch support system.

4) Hot/cold therapy is also really helpful here. If this has been around for a while already (like more than a week), try putting two basins of water in front of your couch while you watch TV: one basin has warm water, the other has cold with about 1/2 tray of ice cubes. While the program is on, keep your foot in the cold water; commercials come on, foot goes in the warm. Switch back and forth for the 30 minutes of the program.

Consistency is key here: PF can be really nasty if you let it get away from you. Good luck!

-L

As an avid runner, I see this in lots of my fellow runners. Most of the time it occurs in people who pronate while running/walking. If you want to learn more about PF, here is a good source: http://www.sportsinjuryclinic.net/cybertherapist/front/foot/plantarfaciitis.htm

Moosie is right on with her analysis of what to do next. The only thing I would add (what works with most runners) is the first thing you should do is rest until it doesn't hurt anymore.

Most cases of PF in runners that I've seen resolve with rest, some PT, and in some cases orthotics or new shoes that address pronation.

Hmmm... foreign concept there... what is this 'rest' you speak of???

Ha ha! I know what you mean. I'm just now resolving a mean hip abductor/groin strain that required me to "rest" for a few weeks.

I've been fortunate that I've never suffered from PF. But, I've heard from folks who have that there is some way to tape the heel to relieve stress on the Plantar Fascia. I think that qualifies as "rest". Also, with most runners, just getting us out of our shoes for a week or two qualifies.

You are right though Moosie - Kashcraft needs to do things to get this under control now. I've seen folks that have had to wear a boot just because they wouldn't lay off and stay off their feet early on.

There are a lot of ways to tape for support of the foot, again, depending on which structure is most heavily involved. PF is often misdiagnosed, since the insertion of the fascia and the tendon of the posterior tibialis muscle are close proximity at the front end of the calcaneus (heel bone). The TP (along with the tibialis anterior on the front of the shin, commonly irritated in shin splints) is the body's braking system during the descent of the foot after the heel contacts the ground during normal walking. The TP tendon can become irritated w/ repetitive strain from walking/running/change in activity regimen. I've often seen patients develop this tendonitis when they abruptly switch from walking on flat surfaces to hills or sand. So, the tape job should reflect an accurate diagnosis of the problem and support the correct structures.

Again, though, the tape is not a substitute for proper muscle strength and coordination and should be supplemented w/ an appropriate exercise program.

Also, evaluating the condition of the shoes is of utmost importance here. How old? Are they providing the right support? Sometimes a simple heel lift (which places the foot in a slightly pointed position, thereby lessening the strain on the fascia) can be helpful.

Okeedokee, off to work... lots of people falling in the OV these days...

Teaching PE as I do, I am on my feet all day and have had cases of PF so a couple of things that have worked for me in the past are using insoles in my shoes. I love "Superfeet". REI sells them for $35 and if you don't like the results, return them within 30 days for a full refund. Another trick that works is to sit down and place a small ball on the ground, place your foot on top of the ball and roll it around on the area that hurts.
Rest is truly the cure all but it's not always realistic.
Good luck.

K.

I am foot pain free now for nearly a year. I attribute the onset of PF to some bad shoes, too much running in them one specific weekend on bad ground, and a little extra weight.

Pain is an understatement, as I continued on my sports schedule for nearly 4 months before I began to affect my other foot and back due compensation issues. Tears after, and the almost inability to walk for a day or two afterwards is still fresh in my mind. I can still almost feel it in my foot like a ghost pain.

Arches/supports are good.
Taping allows for exercise and only holds things in place temporarily minimizing the pain and did not help recovery.
Ice/heat therapy was a blessing.
Stretching was great.
Having to stop all running and stress related activities for about 9 months (for me) was the key to healing.

I did not get shots, did not buy the overnight stretch footstrap/brace.

I did still go out on day hikes but I had arch supports and taped and stretched.

Good luck with this.

Joe

I've probably treated several hundred cases, probably less than 10% needing injections. Lots of spot-on advice given, above. Generally, something I enjoyed seeing, as it was so treatable, and people felt so much better in a month.

BY FAR, BY FAR, the hardest thing, is getting an afflicted person to cut back/stop the offending activity, to allow the area to naturally heal. All the other things can accelerate the process, but it is the body itself, which ultimately does the healing. I've hardly ever seen this develop in folks that were not major exercisers.....can happen, but not as common. It always seems to be a negotiation to get the afflicted off their feet!
The sad thing is that this can go on for years, while it is totally curable.

And having it evaluated if it is not responding in a short while is reasonable. When I, myself, thought I had it, it turned out to be a stress fracture. Man, it's hard to negotiate with yourself!

Here are 2 links containing information about it.

http://en.wikipedia.org/wiki/Plantar_fasciitis

http://www.steadyhealth.com/articles/Plantar_Fasciitis__Causes__Symptoms___Treatment_a183_f0.html

As you have probably figured, it

- often feels worse when you wake up in the morning and step onto the floor in bare feet, although it didn't really hurt during the night.
- It gets worse if you do a lot of standing or walking during the day.
- you feel more pain when you walk around in bare feet, or in slippers or with shoes that do not have a good arch.
- since it is a form of tendinitis, it feels worse after a very hot bath. This is different then muscle soreness, which responds to heat.
- from what you have said before, your favorite exercise to get in shape for hiking is running.
- during the off season, it is compounded by weight gain.


I would imagine it is very frustrating, thinking ahead to the spring and early summer, when you post most of your hiking pictures on the board.

Good luck and let us know how it goes.

NO, NO,,, N O,,, your hiking days are NOT OVER !! I am living proof of that, had a very bad case of P.F. in my left foot about 6 years ago. To the Dr. when the pain/limp got too much, then to the Podiatrist, yielding custom orthotics which I wore for a while then abandoned. Curious recommendation from the Podiatrist, said he liked CHACO sandals because of their instep.etc. so now I have 3 pair and am PAIN FREE from P.F........................steve
edit, p.s., and SuperFeet in my boots

I like Ken have treated hundreds successfully.
Medical opinions are like noses...everyone has one.
2 words 1)Rest 2) ice.
If you can get ultrasound it can be very be helpful. Like most here that have experienced PF themslves, rest of the affected area is key. The problem with PF is that it is an "overuse syndrome". The reason people develope PF is because of repetitive motion ie.standing,walking,climbing,hiking. Great arch support helps many and personally I find New Balance shoes give the best arch support without going into a custom orthotic.
There has been excellent advice here by everyone.

This I was aware of - but I was not willing to give up the conditioning from going out every week. I estimate I would have had a down time of nearly 2 months. That is a lot to give up in mountaineering conditioning. So I chose to scale back and take a little longer on recovery.

The same goes for running. Imagine after 16 weeks into a Marathon training cycle of running 40 to 50 miles a week being told that you can't run for two or three months *and* you can't run your race. One thing to remember - just like turning around at cut off time - the hills will always be there. Plus, your conditioning will come back. But, if you choose to continue to put up with it, the risk you run is lengthening your recovery time *and* not being able to climb.....

Thanks for all of the information. It is really helpful. Since I started wearing good arch support the last week or so it has made a huge difference. I am glad I don't have to throw in the towel.

Although I have not seen the specialist, I am pretty sure that is what is bothering me. Location of pain, and other symptoms match up well. It has been difficult for me to stay off my foot during the last month....got too much to do for that and over the holidays you end up spending more time then usual walking around stores with the family. My wife laughs when I say it bothers me to walk around a lot. It seems out of character for me.

I just wanted to get a head start on my treatment. Other then knowing what it is, I had no way to put it in perspective and know exactly what it would mean and how long it would last.

And besides....I have too many hikes I want to go on this summer. How can I retire before I hike with Moosetracks and Tomcat RC and the other members of the board I hold in great respect.

Thanks a lot. You are all the best!

Kent,

I had a severe case a few years ago and in short REST and TIME were my cure. I altered my training for 3 weeks and when I went back to my normal routine I ramped up the intensity slowly. I have not had a recurrence.

Try to avoid the cortisone (if used too much it will break the tissue down). Orthodics were recommended but there is no guarantee and they are expensive.

I know what you mean wondering if your hiking days are over because it is one painful itis but it will get better if you are patient.

Good luck.

Don't know if it is practical for you, but 2 ideas for continued
training: I was a strong runner for over 30 years and found that alot of leg/foot injuries could be helped by 1) riding a stationary bike and 2) running in a swimming pool (wearing a flotation vest/belt some of the time) or even swimming to keep cardiovascular conditioning. I must admit I never had Plantar F
but knew runners and coached runners that did have it and all seemed to be helped by the 2 mentioned above.

one other thought: The majority of the cases are in very physically active people, often folks who are training for something...which means that they are pushing their bodies to extremes.

It seems extremely common for there to be some problem, which, when training at a lower level, doesn't matter. However, when the person pushes, particularly over time, it is enough to tip into the syndrome.

Probably the biggest offender is shoes. I'm amazed at how many people are made better, as in Kent's case, by orthotics or a change of shoe.....which means the original shoes did not quite fit perfectly. Also, people often don't appreciate that shoes break down pretty fast, in their cushioning and protective aspects. Top level athletes change shoes every hundred miles or so. I've seen presentations out of UCLA orthopedics, where they'd documented that top athletic shoes lost about 1/2 half of their cushioning effect after something like 200 miles. Very few people change shoes as often as they probably should, and very few people get shoes properly fitted, if at all.

I may have posted about it before, but the book "Fixing your feet" is wonderful, in terms of helping with getting the best performance out of one's shoes...a real "owner's manual" for feet!

hang in there. it's pesky but can be overcome. rest, anti-inflammatories, orthotics, hot-cold therapy, getting rid of the current inflammation, massage, maintaining flexibility in the calf muscles, low-impact cross-training (as opposed to only running) for aerobic fitness are components of the strategy. i've used sorbothane ultrasole inserts on top of orthotics for decades, though podiatrists scoff, and think glucosamine-chondroitin can help. also i took up indoor cycling many years ago which also helped with a knee problem, but i avoided the overly stiff special cycling shoes. don't do too much too soon. this problem will pass, eventually.