Plantar Fasciitis Treatment And Tools

Wednesday Night Edits: I prolonged this post hoping to include Shockwave therapy, however I decided I'll save that for another day when I have some video and some more treatments under me to give better description of my experience. Scattered in this post you will see links to various products that I reference that I have used or have read about. If you purchase directly through one of the links provided, it supports this blog in a small way and I appreciate that! I also, of course, hope it can help you (even more than it helps me!)

I'm hoping to start a segment called “Tuesday Tips” where I can review products, or talk about drills, or share life experiences to not only reflect for my own personal gain, but also to help anyone out there that might be going through something similar to me.... of course I’m sitting here Tuesday night realizing I probably should write on Monday’s... but... you can expect “Tuesday-ish” tips moving forward.- Today I’m doing a quick review on some of the tools I have tried to combat Plantar Fasciitis. Yes, I’m still somewhere in between injured and healthy... If you’re reading this, you want something that is Guaranteed to Work, and unfortunately I don't know anyone that can provide that (if you do know someone, tell them I'll pay a lot of money for their Guarantee!). BUT since I have been dealing with some form of lower extremity injury for nearly 2 years now, I have tried a lot and have my experience to share. While none of these typically "fix" a problem, they can give you relief and still help you achieve your goals. Everyone is different, so what didn't work for me might work for you and vice-versa. Note: I am not a doctor, a PT, or have any certification to give medical advice. I am simply sharing the pro's and con's I experienced in case they can serve you in any way.

First, you need to know what Plantar Fasciitis is:
From what I understand as someone who has it and has asked a million questions to various experts, The Plantar Fascia is a band of connective tissue that basically connects from the ball of the foot to the heel of the foot. It has the job of supporting the arch, taking some of the force while landing, and also aids in take off. It's pretty damn important for running! The "itis" is swelling. So you need to consider what is causing your itis. Small microtears can happen when the Plantar Fascia gets overstretched. Often the pain is worst in the morning because it's tried to do some healing at night and has shortened and then BOOM! first step out of bed you fully loaded it and all those microtears that were trying to heal at night are rehashed. Some common related injuries are achillies tendonitis, calf strains, shin splints, and peroneal tendon injuries. Are you so shocked? Literally every injury I've had for 2 years! 

With 20 years of running experience I've heard about this monster but never experienced it for myself. Pregnancy and postpartum hormones completely changed the structure of my feet and my body has not adapted. Add in the fact that I began working on concrete floors 8 weeks after I delivered the baby, and you've got a recipe for disaster. I continue to work to improve it each day, and hope my experience can help you make decisions for what is best for you.

PHYSICAL THERAPY
Whenever you have an injury, Physical Therapy is a good place to start. In fact, even if you have an injury that is likely to end up needing surgery, most of the time you will be referred to PT by the Orthopedic first to ensure it can not be fixed without less invasive means... I'm extremely fortunate to live in an area with some of the best PT's out there and one of the best PT schools in the country. I have been going to the same Physical Therapy Facility for a really long time and have a really good rapport with everyone there so it makes it easy to come back. One of the best indicators of what causes a runners injury is their previous injury so going to (and sticking with) a physical therapist is important. Just like anything else, there is a learning curve so don’t be quick to throw in the towel.

THE PROS:

• It is usually covered by insurance
• They have access to many different methods of treatment in one visit (dry needling, graston, cupping, KT taping, cold laser, ART)
• They are often runners or endurance athletes themselves so they understand the need to not take time off and often do everything possible to keep you running
• Many PT practices have classes you can take to target common weak areas and make the work a bit more fun
• If you stick with it you get results

THE CONS:

• It can be time consuming
• Results are slow and so no instant gratification makes it hard to trust and stay with it.
• Sometimes it feels like the "root cause" is being focused on more than the actual pain you are feeling... and it can feel like you are not being heard (I love my PT's dearly, and this is not a reflection of their care... it's just the reality of how it feels to be injured. I don't care about my glutes when my foot is in pain! )
• Sometimes you do a lot of PT just to find out that you need something more invasive. Been there, done that... but as mentioned above, often the Ortho (and your insurance company) want to see that you tried PT first anyway. 

​KT TAPE:
Speaking if KT tape, lets talk about that for a moment. From what I understand (again, not an expert) KT tape is designed to lift the muscle away from the bone and blood vessels etc. under it to allow more blood flow and also to take pressure off of the pain receptors. More blood flow promotes more healing, pressure off pain receptors means less pain. I have also read that it can add some proprioception to sort of “remind” certain areas to do their job. It also can offer some support, just not in the old school method of taping (which restricted both movement and blood flow)... 
PROS:

• For mild strains or semi-injured questionable areas, I find it really effective. When my plantar first started acting up it made the training I did get through possible.
• you can maintain full range of motion while doing using the tape as opposed to the old school method of taping that limited mobility.
• water resistant
• easily accessible in running  specialty stores and even Walmart so if you run out you don’t need to even wait for Amazon Prime (but you CAN get it there! LINKS BELOW!)
• lots of colors to match skin tone and every outfit under the sun
• It is pre-cut and has a few different designs 

CONS:

• Many studies still show that it is no different than a placebo (but if you have been following me, you know what I always say "the placebo effect is still an effect" but my own personal research says it's not a placebo (n=1)... pretty much every time I don't wear it I get hurt) 
• It’s an expensive tool to keep throwing away after one application- it can stay on for maybe 4 days max but for me it never lasts that long. Most applications require at least 2 pieces... so I always have to decide what workouts are most likely to need it.
• The adhesive causes skin irritation. This could be just a personal issue, but I can’t leave it on for longer than my workout because it causes me to get itchy welts anywhere that starts to peel off
• It's Pre-cut. I know this is in the PROS section, but it can also be a CON. For example, My physical therapist uses a roll of tape that is not pre-cut, and applies it from under my foot all the way up my calf (Like the plantaris tendon). With a pre-cut piece I can't do the full length that the PT can.
• It's not going to fix your problem. This is a tool to use, It got me through a marathon training cycle but ultimately, I did that training cycle injured... and I"m still injured. It's a temporary tool to relieve pain but it will not fix​ you.  

Those are some pretty heavy hitter cons but I keep getting the KT tape so that's how much I believe I works for me. Unfortunately I am still injured, but again, I believe it's most effective for mild cases or temporary injuries... and I'm not that. 

​FOOT ROLLERS
I don't think I need an intro for this one. I do not know a single runner that doesn't have some sort of roller for their foot. I do not discriminate with rollers. I will buy every single one on the market and have no loyalty to a single brand. Just take all my money foam rolling industry! 

PROS:

• It hurts SO GOOD!  Do I need to go into any more detail on this? These foot rollers get right into the area that hurts and they feel really good and often things that feel good are helpful. 
• They aren't that expensive.... well... if you only buy one. Again take all my money!
• They work well on the calf, too. Traditional foam rollers don't those trigger points in the calf that well, and guess what calf tightness is a trigger for Plantar Pain. 
• They are portable and easy to hide. You can take them everywhere and no one will ever know you're that weird runner. Have a desk job? I suggest keeping one of these bad boys under there so you can roll while you work. 
• Some reflexology articles suggest that a foot massage aides sleep. Sleep is the number one most effective mode of recovery... so if that's all it does it could be worth it!

CONS: 

• This is just a personal theory, but sometimes when something gives a new sensation we assume its working, but if something is swollen (itis) you need to be cautious of how much rolling you do. I, truthfully, have not rolled my foot on a ball for two weeks and feel better walking. Of course, I'm also not running so... there are many variables... but intuitively, I felt like the ball was only adding to my problem at this phase in my recovery. I think it's best to use the ball in the early stages before it gets as bad as mine.
• Your dog or child might think it's a toy. I'm not sure what is worse, your foot on a ball a dog has had in its mouth, or your dog putting a ball in it's mouth that had your foot on it... but the worst is probably your toddler putting a ball in her mouth that your dog has also put in its mouth. I don't have a dog... but I can see this happening!
• Ah, I'm having trouble coming up with cons... Just ​take all my money!  Rolling can be addicting and whenever you see something new you're going to want to try it and it's only $20 so why not? New stuff comes out all the time. Hide your wallet! (but here's some links to my favs)

​SPENCO
Spenco is a brand that makes "over-the-counter orthotic" or an Arch Support as well as other products such as sandals that offer that same level of support. I was on a run once and over heard a guy walking in flip-flops say to his wife "I wish I could have insoles for my sandals"... and I turned around to tell him about Spencos. My husband worked many years in the Spenco booth at the Boston Marathon and absolutely loved the products and got me some sandals the year I was pregnant. I wore them everywhere and it is probably the only reason I was able to run pregnant. I wore sandals all summer. When I returned to work I went back to cute flats or unsupportive boots and I've been injured on and off ever since. I wear Spencos in my shoes now that I wear sneakers at work, but I do feel like a lot of damage was already done and I've been trying to correct it ever since. For me, personally, it's a very small price to pay to try it out and see if it works. 

PROS

• You can't beat the price. Custom Orthotics are north of $300, and these are $40. 
• They come in varying degrees of hardness
• Instant Gratification. If you use these to help support your arch, your Plantar has less work to do which gives it a chance to rest and if it's not able to collapse and flatten, those mircotears can start to heal. 

CONS

• They only last for about the same length of time as a shoe... so if you require the support long term, a custom orthotic actually ends up cheaper as they can last for years, maybe even a decade.
• Some people (possibly me) just require something a bit more drastic and specific to address the issue so a custom orthotic may be the way to go. 
• It doesn't fix your biomechanics, so if poor running form and various imbalances are the root cause of your plantar fasciitis, these are just a tool to keep you going while you address all the other issues (noticing a trend?). 

​NIGHT SPLINTS
Some people swear by them, some people swear against them. Night splints are basically a boot or a device that keep the foot in a particular angle overnight to prevent the fascia and achillies from shortening overnight. So that first step out of bed is usually a lot better since that shortening didn't happen so the sudden overstretch doesn't occur either. 

PROS: 

• If this is something that works for you that is awesome. You don't need to do much, just wear the damn thing at night. 
• ​They are relatively inexpensive (although some can get pretty steep)
• THOUSANDS of reviews on Amazon for various different over night splints claim it was instantly effective... this is primarily why I got one because there were so many reviews on all the various types that were five stars.

CONS:

• Sleeping with something keeping your foot in a position it doesn't want to be in is hard. Sleep is the number one most effective recovery tool... So if you are spending less time in REM sleep, you might be limiting your bodies ability to heal and prolonging the agony
• There's not much quantitative evidence that says it is actually working. I have a hard time believing that thousands of five star reviews are all placebos, and even if they are "the placebo effect is still an effect" but do you want to lose sleep for a placebo. 
• Another personal theory here, but "stretching" the fascia over night seems like a long term problem waiting to happen. If you stretch a rubber band and let go it springs back. If you stretch a rubber band over night every night, I'm assuming it loses some elasticity... which I can't help but think is there for a reason... so the night splint weirds me out a bit since there's not huge evidence to support it. 

So there are some tools for you to consider and some Tips for Tuesday... (err.... Wednesday/Thursday)... Leave a comment below if you've tried any and have had success so future readers can see, Or if there are other treatments and tools out there that were effective for you LET ME KNOW! I will hopefully post about Shockwave Therapy soon. I had my first treatment today and PRO: It definitely did something to the painful spots CON: It didn't hurt so good. It just HURT! But some good research I've looked at supports it! More soonish!

Check Back soon for a Throwback Thursday. Haven't decided what I'm sharing from my old blog yet. Stay Tuned! ​