UPDATE: Coupled with the new insoles and PT that I was doing my foot was at probably 80% leading up to my recent trip... Just days before I left for an AT section earlier this month, I picked up a pair of Hoka Challenger ATX trail runners. As soon as I put them on with my pink Superfeet inside, I noticed a remarkable improvement on how my foot felt--it was like walking on a pillow. I wore them on my trip and hiked 50 miles from Newfound Gap to Max Patch in just 4 days. My plantar fasciitis bothered me LESS than it had before my trip--hardly noticed it at all. My feet and legs were sore from hiking and I was sadly out of shape on the uphills after being idle all summer, but my PF foot was at 90%--at least! When I got back, the Hokas were dirty so I wore my Brooks Cascadias for a few days and my foot got worse. I cleaned the Hokas up and got back to wearing them and doing some of the PT, and my foot's already feeling as good as it did just before my hike. And let me tell you, they make a real fashion statement with a skirt and hose for work! As for the Hokas, they provide good support and held up well on the trail although a piece of the tread is coming off now; they are slightly more narrow in the toe box than the Brooks and slightly less breathable, but overall worked out great and I'll keep using them.
ORIGINAL POST:
Bear with me while I share this story of the dumb foot problem that killed my hiking, and my spirit, for an entire summer…
I never
imagined I’d have a problem like plantar fasciitis that would render me
virtually unable to walk, let alone hike, and especially not at 43 years old.
It started in November 2015 after I spent a day organizing my basement on a
concrete floor in my slippers. It was very, very mild and every few weeks the
bottom of my heel would feel tight—I’d massage it a little, make sure I didn’t sleep
with my blanket mashing my toes in a pointed position, and I’d be fine for another
few weeks. I had been doing some running spring through fall but stopped by
November.
In April
2016, I went to the school track to run with my son. I jogged two laps then got
into a sprint racing him for about 100 meters. I ran flat out, as fast as I
could go (I still lost). During the sprint there was no “injury” that occurred—nothing
popped, hurt, etc. But by bedtime that night the bottom of my foot just in
front of my heel hurt like heck. By the next morning, I couldn’t walk.
This was
pretty upsetting because that weekend I planned to go on an annual off-trail
hike with my hiking club. I spent the day before on the couch, icing my foot
and taking ibuprofen, in hopes I could go. Which I did. I wore my Merrell Moab
hiking boots and made it through the hike okay, although of course my foot
hurt.
Knowing it
was plantar fasciitis I self-treated and hoped it would be better before an AT
section hike at the end of May. I self-treated by taking it easy, massaging my
foot, going to the massage therapist, and doing some stretches on the edge of the
steps. I kept wearing my normal array of footwear—different sneakers at home
and various dress shoes for work (no heels though). I tried to keep walking
almost every day to stay in shape and while it still hurt felt like maybe I
could pull off the 70+ mile hike I had planned from Clingman’s Dome to Hot
Springs.
Fast forward
to hike day and my shuttler dropped me at the Dome. If you’ve been there, you
know there’s a steep, paved path going up from the parking lot. The shuttler
wanted to walk up with me, which was very nice, but with my pack weight I had
to push myself to keep up with him. I suspect the hurried walk up the paved
path with my pack on helped set the stage for what would happen for the next
eight miles…
I hit the AT
and my foot wasn’t so bad. “I can totally do this!” I thought. For a mile. But
by mile number two, my foot hurt so badly it was obvious I would never make Hot
Springs. I was also worried that maybe there was something else going on other
than just PF and didn’t want to make matters worse. I hobbled the rest of the
mileage to Newfound Gap where a friend picked me up. By the time he got there,
I couldn’t put any pressure on my foot and was concerned about a fracture. I drove
home and finally went to the doctor some 6 weeks after the run that seemed to
start the issue.
The doc was
a young orthopedic foot and ankle guy. They did xrays and fortunately nothing
was broken. He was very nonchalant and said just do the typical PF exercises
and wear a night boot. He didn’t actually give me any exercises to do and never
prescribed orthotics or physical therapy. Off I went, and after polling more
friends and the Internet did some of the exercises I found and wore a night
boot most nights (it was so annoying!).
I also led a
group of Scouts on a 20-mile day hike for their Hiking merit badge in June and
did some hiking and cycling on vacation July 4 week. All the while, my foot
still hurt. I have a very high tolerance for pain and especially knowing
nothing was broken, kept doing as much as I could. In the meantime, I started
to get a searing, burning horrible pain in the soft tissue up the left side of
my ankle. I can only attribute this to either wearing the night boot and/or
waling improperly due to the foot pain. At times, I was in agony. At times, I
sat down and cried—although I’m not sure if it was the pain or the frustration.
I went back
to the doc who sent me for an MRI. The MRI revealed a high-density partial tear
in the plantar fascia. I’m still not totally clear, but gather this means
really bad plantar fasciitis. He was kind of a jerk that day and told me he
wanted to do surgery on the PF, remove a heel spur and, oh, go into my lower
calf and hack on my upper Achilles to maybe lengthen that a little bit. I was
shocked, this seemed like premature overkill!
In a panic,
I polled some hiker/runner friends and my massage therapist. Everyone agreed
there were too many missing pieces between “just do the usual stretching” and “let’s
cut up your foot.” Someone recommended chiropractic and yoga. Desperate, I went
to what I used to call a “quackropractor.” After a few visits, outside of a
sheet of foot exercises she gave me chiro didn’t seem to be having any affect
on anything. I did those exercises, along with a couple I found in a very good
article about PF on a running blog. These things seemed to start helping.
Still, I figured
I’d give it a chance for a while and the chiro got a copy of the MRI report
(which I hadn’t even seen yet). She sat me down and explained I have a very
serious foot problem and in no way should I be hiking or waling or doing any
kind of exercise on it, and that I should get a second opinion about maybe
having surgery.
I freaked
out. This was right before Labor Day weekend and I was leading nine people on a
hike at Big South Fork. My foot didn’t feel as bad as it had at times and I
felt up to going—especially with my 22 pound summer pack weight and the easy
terrain. And friends. The chiro told me the tendon could tear completely and I’d
be stranded in the backcountry unable to walk.
I went
straight home to call the doctor and ask why he didn’t tell me what the report
said, but got the doctor on call instead. He was actually incredibly helpful,
looked at my record, listened to my plans for the weekend and said: you’re not
going to do any further damage and while it might hurt, if you think you can
go, it’s ok to go. Huge sigh of relief. I had just gotten a free second
opinion, and I felt confident about it.
Somewhere
along the line I had read about this thing called a Strassburg Sock for PF. I
knew they had them at my local running store, and I knew it was something that’d
fit in my pack for the trip. I went to get one and one of the running store guys (Dave)
saw me with it. He said, sympathetically, “Oh, plantar fasciitis?” A
conversation ensued that would finally, truly put me on the path to recovery…
Dave is a
runner, as is everyone who works at Fleet Feet here in town. He shared his
experiences with PF and the fact that he had met the son of the Strassburg Sock
inventor. He explained how the sock works. He also said if I had time I should
step into the physical therapy place they house and talk to Sean. Hmm, I
thought, PT—something else my doc never sent me to. I had a free consult with
Sean (a runner) who poked and prodded my foot pretty hard. He said “if this
doesn’t hurt you’re not that bad off. We can help you. And hiking this weekend
should be fine.”
I also
picked up a pair of pink Superfeet Berry insoles that day to replace my SofSole
FIT insoles. I emailed management at work and told them I’d be wearing my
sneakers and insoles every day until my foot was well enough for other shoes.
They were very understanding!
I went on
the trip and it went extremely well. I wore the Sock at night and while I
maintained my morning hobble, my foot was very tolerable all weekend. We hiked
6-7 miles each day for 3 days. A few cold creek crossings felt great on it, and
it didn’t really hurt until afterward when we had hiked back out of the gorge
up a very steep, long, straight incline.
Upon
returning I went to PT at Fit for Life in Fleet Feet twice a week for 3 weeks then
once a week. I saw Sean as well as Laura, an avid trail runner and adventure
racer. These were the people I needed to be getting help from: athletes, active
people, people who understood what I was feeling and how much I needed to be
over this mess. They did ultrasound therapy, massage, and made sure I was doing
the right exercises the right way. They explained (which I had a feeling) that
PF isn’t just a foot problem and that it really starts from the hip down—especially
affected by your calf. Maintaining flexibility and strength in all those tendon
and muscle groups can play into fixing the PF.
I also went
to a 4-week beginning yoga class, which was helpful in terms of general
stretching, relaxation and raising an overall awareness about my posture,
stress and breathing. I will say it has indirectly helped my foot issue, but be
very careful about strength or balancing poses that have you on your affected
foot.
At PT they
ask you your pain levels on a scale of 1-10, 10 being the worst. Mine had gone
from 8-10 to, like 1-3—sometimes it even seems like maybe, just maybe, it’s 0.
Here are the things have worked and not worked for me. While everyone is
different, I hope this helps shed some light on what might help others who are
suffering.
Through all
of this I realized that all the suffering, limping around and lack of activity
had weakened my foot, ankle, leg; ruined my balance; and caused a whole bunch of
small peripheral problems that I feel contributed to my inability to solve/heal
the first problem.
The bottom
line is find the things that will help you and do them consistently,
religiously, for a good amount of time. Give them a chance to work. Get help
from people whose lifestyle is similar to yours, especially if they’ve had PF. Fleet
Feet, my local running store, had been my saving grace. I was unwilling to
accept surgery as an option. I was unwilling to accept that this is permanent
or going to take 2 years to get over…
Things
that make my foot feel bad:
· Standing or walking slowly on hard floors (cooking in the kitchen, shopping slowly in a big store or the mall)
· Sitting for too long (unless I sit properly on edge of chair, knees bent and feet under me—kinda like squatting)
· Not walking or walking improperly. The PT and yoga have really helped me focus on the fact I was just walking poorly.
· Balancing on one foot (doing calf raises and descending only on the bad foot, standing on one foot in a yoga pose, standing on one foot doing steamboat exercises)
· Walking a steep uphill and pushing off the sore foot from my toes (use alpine climbing step instead, just on the really steep parts)
Things
that make my foot feel good:
· Proper insoles (For me--Supefeet Berry; Green is also good)
· Proper shoes all day, even at home, no bare feet until you’re healed (Brooks Cascadia is what I had been wearing up until 10/3, then Hoka Challenger ATX)
· Stretches (get up from my desk periodically and squat, then stand and touch toes, 30 seconds each); some of the PT stuff offers immediate relief
· Staying active as much as I can tolerate (found a single-track trail near me and hit it for even just 2 miles a few times a week)
Treatments
that work:
· Strassburg Sock (understand how it works and use it the right way)
· Insoles (Superfeet or custom orthotics; get fitted properly for Superfeet)
· Shoes: A good running/trail shoe that’s right for you; you don’t need the big black granny shoe the doc wants you to wear. It’s the shoe/insole combo plus the PT that works for me. Wear these shoes and insoles all the time, no others, and no bare feet until the foot is better. When my foot is close to 100% I plan to work on strengthening it and going back to barefoot at home.
· Physical therapy (with athletes)
· Daily regimen of PT/stretching/exercises (see list below)
Treatments
that don’t:
· Night boot/night splint
· Rolling foot on frozen water bottle/golf ball/etc.
· Foot massager
· Chiropractor
· Rest (this may be a mental thing but depression doesn’t generally help people heal)
The
PT/stretching/exercises that are working for me:
These will be hard to describe without pictures but here goes… The first two I found in an article on a running blog and they seem to be the biggest help to me so far. Just don’t rush the exercises, take them slow, relax and enjoy the time and the stretching. Rushing doesn’t help the problem and could make it worse. I’m not a doctor or a physical therapist, I’m just sharing what has worked for me so do these at your own risk:
· Standing in your bare feet with one foot forward as if you’re taking a normal step, weight evenly distributed on both feet, lift the toes of the front foot up off the floor as far as you can, hold for 10 sec, then press them down into the floor without curling them, hold for 10 sec. Do at least 5 reps. This works the bottom of the foot and the toes.
· Sitting on the edge of a chair, cross legs so ankle is resting just above your bended knee. Maintain good posture and hold your abdomen in. Interlace your fingers in your toes, allow your foot to be loose, and purposefully manipulating your toes and foot with your hand rotate your foot clockwise at least 5 times slowly, then counterclockwise at least 5 times slowly. Then using your hand press the foot up toward the shin bending at the ankle, hold 5 secs, then bend down to point toes, hold 5 secs, repeat 2-3 times. Then repeat the circles and straight stretched 1-2 more times.
· Calf roller: Sitting on the floor with legs outstretched, run the calf roller between your calf and the floor. It doesn’t make sense to me to use a calf roller without the legs loose like this. Slowly move up and down the calf making sure to get over to the left and over to the right side of the muscles. If you hit a knot, press into it with the roller and hold 10 secs. I roll them for a minute or two each.
· Picking up Legos or marbles / towel scrunches: Get a pile of something small like 8-dot Legos or marbles and with each foot, use the toes to pick up the items and hold each for 10 secs. I do 12 Legos per foot, 2 reps. The same type of exercise can be done by sitting on a chair on hard floor, put your heel on the back of a kitchen or hand towel and use the toes to scrunch and pull back the towel until it’s all kinked up under your foot. This one actually hurts a bunion I have on my non-injured foot.
· Towel stretch (before getting up and also 2x day): Using a small towel or strap, sit on the floor with legs stretched out and put the towel under the ball or your foot. Pull back on the ends to stretch the foot, heel and calf. Hold 30 secs, 2 reps each foot. Do this before getting out of bed and it will help with the morning hobble!
· Alphabet letters: roll up a bath towel and place it under lower calf sitting on floor with legs stretched out. With your toes/foot, slowly draw each letter of the alphabet and then do sideways figure eights and vertical figure eights. Alternate feet and do a total of 2-3 times each foot.
· Slow calf raises (when your foot can tolerate it, up and down on both legs; later, up on two, down on one): With shoes on, stand with your feet a little apart. Stand near a high table or counter or the wall if you need support. Slowly raise up on your toes as far as you can go, then slowly lower. Do 10 reps, breaking between 3 sets. When stronger, do this up on both feet and down slowly on only the bad foot.
· Calf stretches (upper and lower): This is the quintessential calf stretch, stand against the wall with one foot back, hands on the wall at shoulder level, posture straight, back leg straight, foot flat on the floor and stretch the calf. This gets the upper calf. Move your hips in toward the wall to get more stretch. Hold 30 secs. Then slightly bend the knee of the back leg, do the same thing—this gets the lower calf. You can also use a calf stretch rocker for the upper calf (provides a really deep stretch) but it doesn’t do the lower.
