Plantar fasciitis – how it's been for me

This post is about my experience with plantar fasciitis and some of the stupid things I did about it and some of the good things.  It is also about the other things I did, which ultimately improved my life and my running.

This definitely isn’t a medical post.  I have no qualifications that mean that I should be listened to in the treatment of this injury – it’s just about me.

Plantar fasciitis struck me in October 2014.  I was on a fairly long road run and felt sore on the sole of my right foot.  I went to the physio and they diagnosed it.  In November 2014, I had an ultrasound, which confirmed the diagnosis.  There were micro tears and some swelling in the fascia tissue in front of the heel and lateral side of the tissue.

I had made two changes to my normal routine in the lead up to that run which probably contributed to the injury.  First, I had been doing some short, sharp 5km races.  This type of high intensity running involves loading up the body, but it was great going fast.  The second thing I did was I bought some Hoka road shoes and had started to run in them.  My normal running shoe was Asics, a completely different type of shoe.  My mileage hadn’t increased very much in the lead up to the injury and there were no other changes.

The plantar fascia is a thick fibrous band of connective tissue, that runs from the heel bone that sort of splays out to separate strands attaching to the base of the toes.  It was described to me as like a thicker version of that milky film of tissue that wraps around a filet steak.  In fact, the muscles all over your body are wrapped in this sort of tissue.

Plantar fasciitis involves micro tears in this fibrous band.  Because there is little blood flow in the plantar fascia (like the Achilles tendon), healing can be slow.  Plus, you walk on them every day, which can’t help.

The conservative school of thought seemed to be that the fascia needed to be rested and supported to allow it to heal.  This may include arch support in your shoes and donut padding in the heel area to relieve pressure.  You stop running and you avoid walking around the house barefoot.  A more radical school of thought is that the fascia needs strengthening and that it is the weakness in the fascia that is the cause of the fasciitis.  A stronger fascia will aid healing.

Impatient to return to running, and attracted by the apparent logic, I followed the more radical school of thought.  This involved wearing minimalist shoes when not running (I was wearing Vivo barefoot), which, because of their complete lack of support, would strengthen the fascia.  At work, I even swapped out my leather work shoes for the leather low boot style of Vivo.  I was also going into summer, so I spent a lot of time actually in barefoot.

I avoided physio (due partly to lack of confidence they could fix it, but I felt like I was improving) and I sought out evidence online to support the course of action I was taking (confirmation bias).  I laid off running.

I took the opportunity to make several other changes in my life.  I focussed on my diet, by reducing sugars and fast carbs.  My weight stayed off, even though my exercise workload reduced.  I also picked up yoga.  I was inflexible in all sorts of ways and this has helped a lot in improving my flexibility, which will help my running.  I still do some yoga every day and I’ve continued my improved diet.

So, fast-forward 12 months.  I had another ultrasound towards the end of 2015.  The news was there had been no healing and the tears were worse than before if anything. 

My conclusion from all that is the more radical approach of strengthening the fascia does not assist healing.  It may be helpful after healing, but not as a means of healing.  The conservative approach would probably have been better for me.

I then stopped wearing the Vivos and went to see a physio.  She undertook a programme of deep tissue massage on the fascia.  She described it as taut and rigid when she got started on me.  The deep tissue massage hurts like hell, but it promotes alignment of the collagen fibres.  I had deep tissue work for about 3 months and the fascia softened considerably over that period.

The other thing I did was stretch the fascia, which I did by sitting back on my heels, with my toes straight out in front.  It’s quite hard to do this on a hard floor, so I do most of it on a pillow or on the sofa.  I hold it for about 30 seconds and try and do it about 3 or 4 times a day. 

These two things, the deep tissue massage and the fascia stretch, were key to my improvement I think.  I have ditched the Hokas and back to the Asics and I avoid high intensity runs.  Now, I’m running about 8-10 hours a week – mostly off-road.  I still think its not 100% healed, but its manageable and it’s not getting worse.

This injury is unlike any other that I have experienced before.  The sheer length of time that it took to get back to close to normal means good strategies are required to get you mentally and physically through.  It took me about 15 months, which is horrendous, but I didn’t help myself in some of the things I did.  The good news for most people is it should take a lot less time than that to heal.