Plantar fasciitis= surgery

[Tri Girl]

Bummer! I've been dealing with pain from my plantar fascia for over a year. Extensive stretching, rolling, night splints, and taping haven't been working. Went back to my orthopaedic doc yesterday and he said if nothing has worked so far, nothing will work to fix it. He suggested surgery. He's the running guru of this region- treats thousands of runners (elite/pro and amateur). He knows his stuff. I trust his judgement as he's treated me successfully for other running injuries in the past. He elected to have the surgery twice because of his plantar fascia issues and said he would only recommend it if it was truly needed (and I guess in my case it is).

I have an IM in November, so I won't do it before then. I'll just play through the pain and secretly hope it gets better. Surgery is scary and electing to do it before something HAS to be done is even scarier. Maybe I'll just learn to run 5-10 miles a week and be happy with that. I can still ride and swim without pain so I guess I just do more of that.

I don't know. I'm bummed. Running has been a struggle/painful, and I've put on 15 pounds since I've not been able to run like I used to (that alone is frustrating enough). :mad: I just needed to share with a group that would understand, that's all. Thanks for reading.

[OakLeaf]

(((((TriGirl))))) sending good thoughts for healing and pain-free running!


....just curious though and it really isn't something I know much about. But I dealt with Achilles issues for years (still do to some extent), which seems to be closely related to plantar fasciitis. I tried all kinds of treatments too, but it's only form work, plus changing the type of shoes I wear for aerobics, (re-injury prevention) that's finally got me on the road to recovery. Have you had a PT really look at your form (not just running but in your other sports)?

[KnottedYet]

(((((trigirl)))))

What kind of orthotics are you wearing?

(+1 on seeing a sports med PT for a look at your running)

[Tri Girl]

I haven't been to a sports med PT to look at my form. It's something I'll definitely do before I go for surgery (in fact, I was just googling PT online). You guys were reading my mind. :)
Last summer I had custom orthotics built by Hanger (a orthotic and prosthetic company). I also wear the most motion control shoes out there (Brooks Ariel). My running guru doc has looked at my running and walking stride and has said that the orthotics and shoes totally correct my overpronation and that the biomechanics (is that the right word) of my running look to be OK.

You know the part that bums me out as much as not running (which is a stupid thing to bum me out)? I can't wear cute shoes or flip flops anymore. I'm a flip flop nut in the summer, and I like to wear cute shoes to work. Not anymore. I have to wear tennis shoes with my orthotics, even with skirts and dress pants. It's a good thing I'm a teacher (standing on feet all day doesn't help any), because I can be a little more casual than a regular office job.

Thanks, ladies- I knew you'd have good ideas or words of encouragement. :D

[KnottedYet]

I tell my pf folks who love flip-flops to wear Chaco flip-flops, and walk in them gripping the flip-flop with your foot and holding it close to you. That makes you flex your toes and lift your arch, which strengthens the muscles that aren't doing their job (and leaving all the work to be done by your pf, which just can't)

You can also strengthen the same muscles by curling your toes into a tight fist for 5 seconds, then splaying your toes out wide for 5 seconds, many times a day.

But during the summer, most folks would rather do flip-flops than exercise...;)

Maybe ask your orthopod if you can try that. It would be very good to have a PT look at you, and be sure to have them check your hips and stuff, too. Hip/pelvis/lowback issues can play havoc with feet.

[mimitabby]

I tell my pf folks who love flip-flops to wear Chaco flip-flops, and walk in them gripping the flip-flop with your foot and holding it close to you. That makes you flex your toes and lift your arch, which strengthens the muscles that aren't doing their job (and leaving all the work to be done by your pf, which just can't)

You can also strengthen the same muscles by curling your toes into a tight fist for 5 seconds, then splaying your toes out wide for 5 seconds, many times a day.

But during the summer, most folks would rather do flip-flops than exercise...;)

Maybe ask your orthopod if you can try that. It would be very good to have a PT look at you, and be sure to have them check your hips and stuff, too. Hip/pelvis/lowback issues can play havoc with feet.

oh, Knot, such good advice! I'll tell Raleighdon!!

[pll]

Tri Girl... I second knotted's suggestion of having a PT check for other imbalances. It sounds like you have not stopped running through this. Perhaps you do need to give your feet a break to recover.

I had a bad case of PF about 6-7 years ago, so bad I could not walk for a block without major pain (forget about running). This led me to buy my first bike as an adult! I did stop running for about a year and a half --a total bummer. The pain subsided gradually (night splints, stretching, PT, massage, iontophoresis, taping, icing, pills, you name it). I used over the counter inserts and Birkenstocks. Once the pain went down to just noticeable after walking, I slowly started "running" again: started with 15 min walking, 5 min running, walk back home, stretch/massage like crazy... The pain eventually disappeared, but I'm still mindful of the shoes I wear. And I run pain free or, at least, free of PF pain.

[OakLeaf]

Oh... and Crocs.

Nothing has helped my Achilles so much as wearing Crocs nearly every waking hour. Winter with wool socks, summer without, around the house with or without the fuzzy slipper liner. They are amazing!!! I never thought I could wear shoes without major arch support, but they let me be on my feet pain-free for hours, and help strengthen my foot muscles, too. Around the house they help keep me from overpronating on the flat floors and absorb excessive impact on tile.

Plus the extreme comfort of the Crocs I wear all the time has severely reduced my tolerance for poorly fitting athletic shoes and street shoes. That's always been a challenge since my feet are very hard to fit. But the compromises I make are different now and I think that's helped me, too.

OTOH I have an extremely high ugly threshold :D

[bounceswoosh]

Is there such a thing as a PT specializing in feet?

My hand therapist has been such a godsend compared to a "regular PT" when it comes to my wrist. Actually, she's an OT -- you can get hand therapy certification with either background. Her depth and breadth of knowledge is astounding. She knows a lot more about hands than any of the ortho surgeons I've ever talked to.

If you're starting to look at surgery as an option, maybe first investigate whether there's a PT in your area specializing in feet and lower leg ...

[Tri Girl]

I tell my pf folks who love flip-flops to wear Chaco flip-flops, and walk in them gripping the flip-flop with your foot and holding it close to you. That makes you flex your toes and lift your arch, which strengthens the muscles that aren't doing their job (and leaving all the work to be done by your pf, which just can't)

You can also strengthen the same muscles by curling your toes into a tight fist for 5 seconds, then splaying your toes out wide for 5 seconds, many times a day.


Thanks, Knot. That's great advice! I appreciate you suggesting those things. Crocs and Chacos. I'll look into those for sure. I am a warm weather lover, and the thought of wearing tennis shoes all summer again like last year bums me out.

I've pretty much laid off running. For 3 months I did NO running, then started to get depressed of sorts from not running. Since then, I've only "run" once a week for 2-3 miles for the last 8 months. That is a significant drop in my normal mileage. It's the most break I can give it while not completey losing my mind (cycling and swimming just don't do the same mentally for me and I can't stand the elliptical- I'd rather run in pain). When I do run, we're talking 12-13 min. miles with walk breaks, so it's not like I'm doing much more than a fast walk anyway. I don't think it could get much more rest. :p
Now that I'm IM training, I will HAVE to run (and run in pain if that's the case). There's no option for me. I figure the last 11 months of almost non-existent running didn't do much good, so I'm going to ramp it up since I'm in pain anyway. It may be foolish, but I can't stop living and doing the things I love (are you sensing the stubborness yet? :)).


Thanks again, everyone, for your great advice/support. I just KNEW you'd understand and have lots of words of wisdom and such. You ladies are the BEST!
The PT is the next step.

[spokewench]

Sorry to hear about the need for surgery. I've pretty much got my plantar fasciitis (sp?) under control now. I did physical therapy and I do lots of stretching every day - but I'm not running - I'm just playing tennis. It puts a lot of strain on the foot stopping and starting and going side to side, but probably not as much the repetitive same thing on the foot as running.

My tennis instructor had this surgery after have plantar fasciitis for years and it cured her for good. So hopefully, it will do the same for you.

spoke

[KSH]

WOW, I don't have any wisdom... all I can say is... that sucks! REALLY SUCKS!

Try to do what you can to get through IM training and the IM with it. Maybe you should try a walk/run combo? I'm doing a 5 minute walk, 2 minute run comb on my longer sessions. It's works nicely and I keep around a 11:30 minute mile. Not blazing fast, but at the IM, when others are walking, I'll be zooming by.

So hopefully the surgery will fix the problem. Right? If so, then that's great! I would say there is a silver lining... ya know?

Well hang in there as best you can. :)

[KnottedYet]

Is there such a thing as a PT specializing in feet?


yours truly! :D
Try calling a few podiatrists and ask who they send their patients to for PT. Often the podiatrists will have us come to their offices and meet them, or sit in on an appointment with a patient we are seeing, so the docs really do have a good idea of how well they like the way a particular therapist works. And we in turn have a good idea of how the doc wants us to handle things.

[stacy]

Hi...for what its worth I had a severe bout of PF for about 6 months, I tried everything, custom orthotics, stretching exercises etc. Someone suggested Birkenstocks so while in the mall one day in agony I bought a pair. I wore them everyday from the time I got up til I went to bed. After three months I had no more pain and have not had a problem again (5 years ago). You have my sympathy its a horrible pain, I hope you find relief fast!

[colby]

I have no advice, but lots of sympathy. Around here, that still counts! ;)

Take it easy, keep exploring those options - you know you're not going to have the surgery soon, so keep looking for things to make you more comfortable and successful in the meantime.

[anakiwa]

Just wanted to second the Birkenstock and Chaco suggestions. Earth shoes have also been great for me. Dansko clogs definitely made my PF worse, so I'd be careful with Crocs.

I spent a lot of time reducing my running, and then going nuts because I wasn't running enough. In the end, changing all my footwear, orthotics, and using ibuprofen while my foot recovered was what it took.

Good luck with you foot, and your IM!

[Blueberry]

I had PF, tried stretching, etc. Nothing helped. I got busy with work and didn't have time to address it. It went away on its own. Very strange.

I think danskos can make it worse because of the relatively raised heels. Crocs are flat, and were fine for me. As were Chacos (I live in them).

[Running Mommy]

ohhh TG!!! I sure do feel for you. I've had PF in the past and it is horrible! And having not been able to train at all for over a week do to my back is making me cranky too. So I know how you feel. UGH it sucks!! hang in there, and be smart w/your training.
Oh boy life does hand us lemons sometimes... sigh...
But lets look on the good side. Other than that you have your health, and are able to ride and swim. It could always be worse!

take care

Denise

[IFjane]

TG - I have had PF in both feet; orthotics, Chacos, PT....nothing helped. I eventually had to have surgery on each foot - 2 years apart - and have been perfectly fine ever since. No pain, nothing. And now I'm back to wearing flipflops in the summer! (Never was much of a "cute shoes" person unless you consider Chacos & Keens cute!)

Good luck!

[mimitabby]

so IFjane, what IS the surgery?

[wackyjacky1]

My PF developed several years ago when I was playing tennis a lot. Stretching, icing it down, and ibuprofen eventually took care of it.

Then, a couple of months ago, I bought a pair of Crocs. As a baker, I am on my feet all day, and I'd heard such good things about them. Wouldn't you know it, the PF came right back and is worse than ever! For me, there doesn't seem to be enough arch support in Crocs. So I'd have to give Crocs a thumbs-down for PF.

My Birkies are very comfortable, and I can wear them all day long with no problem. I love my Keens, but if I do a lot of walking in them, my foot will be killing me the next day.

So far the same techniques that cleared it up during my tennis days are not having any effect right now. If the pain keeps up, I'll have to see a doctor, too, I guess.

[IFjane]

so IFjane, what IS the surgery?

Mimi - it's arthroscopic - heavy sedation but not general anesthesia. A tiny incision is made on each side of the heel, one for the scope, and one for all the other stuff :eek: The surgeon clips a tiny hole in the tendon to let the bone spur (cause of all the pain) poke through. I still have my bone spurs but they have nothing to rub against and there is no pain.

Recovery is crutches for a couple days to a week, then a walking-type cast for 4 weeks. I had to take it easy for about 6 weeks but after that was back to normal and had no residual pain once the inflammation in the tendon healed.

[KnottedYet]

We used to treat bone spurs with iontophoresis using acetic acid. One of the podiatrists had us doing it. I must say, it's the only time I've ever seen ionto to be really effective at *resolving* a symptom, rather than just burying it.

(the acid helps the body resorb the spur, and the PT exercises and footwear modifications take the strain off the foot which caused the pf and spur in the first place. Remember, pf is never spontaneous: it is always a symptom of something else awry in the kinetic chain. Gotta fix the original problem, or the pf will come back; acetic acid or no.)

Spurs are never resorbed completely, the periosteum has been pulled away from the bone and the body has responded by building new bone to fill in the gap created. But if you can resorb it enough to take the pain out of the equation, you can generally cope with the remaining spur. (and if that doesn't suffice, surgery is a welcome relief)

[Tri Girl]

The surgery he described is a bit different than the one you had, IFjane. He said I don't have a bone spur, but that the PF is too short and needs to be lengthened. He said they'd cut the entire width of the PF, then set it, cast it, and it would grow back together longer than before. He said I'd have a cast for 4 weeks, then I'd have to use the giant boot for a few weeks. He also said I couldn't run for about 3 months afterward. :eek:
I didn't ask many more details because I wasn't really considering surgery at that moment. I'm all about exploring EVERY other option before I go under the knife (but I think it may come down to surgery in the end).
I ran 6 today because I have a race this weekend that I needed to make sure I could do. During the run no pain at all. The rest of the day; pain on and off. He showed me a different foot taping technique that held my arch much more securely than before. Between the tape, the orthotics, and the motion control shoes: I think I did OK. :)

[KnottedYet]

WAIT! WAIT!! WAIT!!!!!

The pf isn't actually abnormally tight!!!! It's just under abnormal amounts of tension!

Doing surgery to lengthen it is like saying "hmm, my back is sore when I slouch. My spinal ligaments are tight when I slouch. Therefore I must cut and lengthen my spinal ligaments so I can continue to slouch in comfort."

I shudder at z-plasty of the iliotibial band. Z-plasty of the pf is a new one on me!! Oh, please, no!

(PT... go see a PT recommended by a podiatrist... get second and third opinions... find out what is causing the abnormal tension and take care of *that* before you go cutting the structure that is under tension)

Edit to add: sorry if I seem to have overreacted. I have a horror of z-plasties. Unless you have cerebral palsy and need a z-plasty of the achilles tendon. I'm ok with that.

[Tri Girl]

No, Knot, I appreciate your concern!!! I'm not real gung ho on the surgery, so it's why I appreciate any advice from anyone here. It's why I posted in the first place, because I know a lot of you are in the medical field and can share experiences/wisdom, etc. You ladies are indeed my second opinion, and I will certainly explore more. I like your overreaction... kinda motherly instinct and all. :D

[Wahine]

TG - I happen to agree with Knott on this. It doesn't make sense, especially if you are an overpornator. The foot exercises Knott suggested are great. I'd also second the Chakos and emphasize again the need to see someone to assess your running mechanics, including low back and hip flexibility and strength. If the foot stuff isn't working, chances are that you have a muscle imbalance around the hips and pelvis that is contributing to you putting too much pressure on the inner part of the foot. A quick test is to do a half squat and look at how your knee lines up with your foot. Is the center of your knee cap directly over your second toe or are you knees tending to buckle in. If you're buckiling in... you really need to have all that hip and back stuff checked out. There are soooooooo many mechanical facotrs invovled including abdomenal strength that I could never point them all out. Please go see a PT with running expertise, better yet one that does video analysis of gait.

[Tri Girl]

Thanks, Wahine!
How do I go about finding a PT who specializes in sports (or one who could analyze my gait and know all about running)? I've never been to the doc for anything serious, so I don't know how to go about finding a GOOD PT. Do I find a good podiatrist first (ask the running doc I'm seeing for a good podiatrist?), then go ask them for a good PT?
Sorry if that's a dumb question.

[KnottedYet]

Oh, yeah, motherly instinct just went into total overdrive there! :eek::rolleyes:

To push an analogy to its utter limits: if your back were sore when you slouched I'd want to check if the chair you usually sat in gave you inadequate support (better chair = better footwear) or if your core muscles were too weak to support your back in good posture (core strength = lower extremity strength, especially hip external rotators and ironically enough core strength) or if you had overdeveloped your spinal flexors from a bunch of sit-ups and they were overwhelming your extensors and core (extensor/flexor imbalance = hip or ankle imbalance) or if you had a disc out of whack that forced you into a slouch (disc derangement = foot joint derangement) or if you just had bad posture habits (posture education = posture education, same stuff, really!) and so forth.

Edit to add: +1 on everything Wahine just said.

I'm a bit militant about PT before surgery. I freely admit my bias, and accept all consequences there of.

[Wahine]

It's good to call around to different clinics and ask if they do video analysis of running. If you can find a clinic that does that, you'll likely find a PT that is into the whole running thing. It's also good to ask a sports med doc or podiatrist. There is also a sports specialty certification here in the States but I can't remember what the designation is (the letters behind the name). Do you know Knott? I could google it but I'm a bit lazy tonight.

[KnottedYet]

I think it's "SCS". (Sports clinical specialist, or something like that)

An OCS (orthopedic clinical specialist) would be peachy-keen, too.

If they've invested the moola to have a video system, it's likely they have someone who knows what to do with it and what it means. (but not a guarantee. We've got a spiffy video system, but I can never remember which button to push to get the camera to record... Jiminy Cricket...:rolleyes:)

[Trek420]

(but not a guarantee. We've got a spiffy video system, but I can never remember which button to push to get the camera to record... Jiminy Cricket...:rolleyes:)

For watching movies at lunch?

[Tuckervill]

If I recall correctly, you're seeing an orthopaedist for this? I'd definitely try to find a podiatrist who is into running, too, for another opinion. Podiatrists deal with PF issues way more than an ortho who deals with "everything". I worked for a podiatrist, but I have no expertise--I just know PF was one of the most common complaints. An ortho is going to have a way lower incidence of that complaint, therefore, theoretically, less experience with it.

I go to a PT clinic just for exercise, so I would look for a "performance" type PT clinic. They're popping up everywhere.

Karen

[Tri Girl]

Thanks everyone!!! :D I'm on the hunt...