ARTICLE: Cracking the Plantar Code

My Plantar hasn't gone away completely in recent weeks, but it's almost dead.

What's more important, I now have it under control. I can flare it up a bit, and beat it right back down again. Here's what to do.

Quick Background
Dennis Dreyer, the ChiRunner, says that Plantar is one of those things you won't wish on your worst enemy because it's so insidious, it just won't go away!

What makes it so frustrating, though, is not the healing time per se (even though, in the worst case it can stretch to 18 months or more), but the fact that you feel perfectly normal most of the time, unlike when you have a torn cruciate ligament or a fractured bone which may easily put you out for as long.

The fascias muscle runs beneath the foot and connects to the inside of your heel. It's made of collagen, the body's major protein used for connective tissue. It looks like fat (if you cut your foot open), but it's not.

Before you ask, Shark Cartilage and other collagen rich products will not help you, as collagen is broken down into its core components upon ingestion and there's no guarantee it will end up in your fascias.

The problem with the fascias is it's inflexibility, meaning minute tears can easily occur, and these tears, like all ruptures are prone to inflammation. Flexibility in your hamstrings, Achilles and calves is essential to keep stress off the fascias. So if you don't have this, you'll need to start building it now.

Step 1: Kill the Infection
If your Plantar is not recent, the inflammation in your heel will have reached a level where it will not go away by itself, no matter what you do.

Omega 3 and other natural and unnatural Anti-Inflammatory drugs will help you along, but will not give you enough of an edge. The inflammation will most likely build up stronger than you can repress it.

Solution: Electro-needle therapy, cryotherapy, or similar treatments targeted at restoring bloodflow to the Fascias. After about 2-6 months of repeated pain from an area, the brain will ignore pain impulses from an area of the body and will take no further steps to heal it.

Restoring bloodflow not only reinvigorates an area of the body that has little bloodflow as it is, it restarts the brain's "repair programme". A special advantage of cryotherapy is the release of multiple enzymes conducive for overall bodily repair.

Dangers: This is the critical stage of Plantar, if you don't get yourself out of this stage you will either stay in it indefinitely (minus improvement), or your body will start moving more calcium into the bottom of your heel to protect it. This leads to the dreaded heel spur.

Step 2: Eliminate the Root Causes
The root causes for Plantar are simple, and should be addressed as your first step, as the injury will just keep renewing itself otherwise, despite your best efforts:

1. Flexibility (do stretches specially for the hamstring, achilles, and calves). Do them every day. Having a step or similar that you can "hang" from with the tips of your toes on the step and heels pointing down is THE EXERCISE for addressing Plantar.
2. Strength: Weak muscles lose flexibility, tighten up and leave your foot vulnerable and alone to absorb punishment. You need to find out your weakness, most likely your calves, and do special exercises such as calf raises to strengthen them. Again this needs to be every day.
3. Diet: A healthy diet is a must for any healing process. Omega 3 supplements and Glucosamine have both proved to speed up recovery from Plantar Fasciitis, these are affordable, so go get them!
4. Running Style: Excessive heel strike as well as supination are both major causes of Plantar, and you may benefit from a course based on ChiRunning or the Alexander Technique to get your running style fixed. The easy option is to make sure you shoes minimise your tendency towards either, but why wouldn't you want to run properly by yourself?
5. Shoes: Throw out those old shoes you've have been lying around for ages just because they won you your first race, or whatever. Bad footwear is an absolute killer on this injury. Sadly this also means minimising your use of specialised, low-cushion, footwear such as fell-runners, racing flats, and spikes.
6. Running: If you Plantar is heavily progressed, you need to take 4-8 weeks off minimum, as pounding re-inflames the area. Once under control normal running should not do you much harm, but avoid sprinting and uneven surfaces (e.g. steep descents/ascents)

Step 3: The Daily Fight
Dennis Dreyer set with Plantar you need to promise yourself: "I'm going to be more tenacious than this injury". You can never stop fighting it.

Follow these simple rituals to get better:

1.
Stretching and Strength:
As above, every day!
2.
Icing: Ice your heel in a bucket or cold water or on an ice block for 15 minutes every morning and evening (no more!). Will it hurt? Hell ya!
3. Massage: Get a deep sports massage on the area, or massage it yourself with a golf ball. 12 minutes every day should be minimum. Don't do this while the area is still heavily inflamed (it'll be too tender). The positive effects of ultra-sound are negligible on this injury.
4. Insoles: Hapad and other producers make specialised insoles for your shoes and runners. Wear these particularly at work and in your daily life. It won't eliminate the root cause (bad walking/running style) but will give your foot rest to heal.
5. No extra step: Walk and run as little as possible when you're not training. Avoid all stairs and other uneven surfaces. Even sand beaches are terrible, so no romantic strolls! (get it!)
6. No plyometrics: This means, try to avoid any jumping exercises that will force your foot into weird twists and extensions.

Loose gravel is your friend, walking across it is one of the best massages you can get of your foot and to keep the fascias flexible.

That's the lowdown on Plantar, hope it helps you, it hasn't healed me yet, but it sure means I can control the extent of the injury pretty much when and how I want to. This doesn't mean you won't feel it in a race until it's healed (we shouldn't be racing in the first place), but it will significantly lower your pain during and speed up your recovery after.

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