Plantar Fasciitis:
How To Fix YOUR OWN Foot!

Coach RJ’s Battle of Chronic Foot Pain

More than one person I’ve heard of has said the doctor recommended severing their Achilles’ tendon to “fix” their plantar fasciitis pain.  Surely, there is something more reasonable than whacking one of the strongest tendons in your body!  Ruining your Achilles’ tendon will permanently affect the kinetic chain of movement all the way up your body with each walking stride and step.  People used to get their Achilles’ cut for torture and punishment—now we call it health care?  I think NOT!  Other sources recommend a partial severing of the plantar fascia which sort of acts like a guide wire for foot biomechanical structure...let's think about this...what happens to a bridge when you cut one of its cable guide wire supports?  The structure is weakened and might collapse.  Still want to whack on the bottom of your foot?  Think again--then let's try something a little less invasive first! 

If the true "root cause" is something tearing because it is too tight, then yes, something needs to be done to relieve this pressure or excessive tension.  However, rather than "cut" something in half, I would rather stretch out what is tight in the first place so it doesn't tear and cause pain!  I always try to keep backing up until I have the true root cause.  I don't think people do enough of this whether it's an individual patient or clinical professional.  Rotator cuff and shoulder jacked up?  Fine.  We'll just reattach everything.  Does this fix the real problem?  No.  The real problem is probably the shoulder being out of balance and "too tight" where it needs to be stretched and "too loose" where it needs to be tightened.  Most often this can be fixed with FITNESS better than surgery from my client experiences!  I look at the foot and plantar fasciitis the same way.  Let's fix what is truly broken instead of fixing something downstream from the actual root cause.  It's a simple way to look at a complex problem.  Usually, the simple "Jack LaLanne" approach is always better, so I'm sticking with it!

After nearly two years of pain and struggle, and investigative internet research, I finally fixed the worst of my foot pain with a $25 therapy device ordered off the web and NO surgery…and now the rest of “my” story…

Other than some occasional heel pain and the orthotics I had made for collegiate cross country, I really haven’t had any ongoing issues with my feet—that is until a couple of years ago when I developed plantar fasciitis.  Until recently, my frame of reference with plantar fasciitis was my college track coach talking about his steeplechase runners getting it from crashing down into the water pit after jumping off the high hurdle.  Other than that, I really didn’t know much about it or care.

A bad case of plantar fasciitis feels like this—try getting out of bed first thing in the morning, stepping onto the floor, and having someone drive a nail through your heel with a sledgehammer.  At some point, this was about what it felt like for me.  The pain was so intense, it was all I could do each morning was to not to fall on the ground.  I suffered.  I hobbled.  I cursed.  After a while each morning, the “nail-driving pain” would fade slightly allowing me to walk with just a slight limp—still in chronic pain though with occasional sharp jolts of the sharp pain like present each morning.  My right heel pain completely screwed up my active lifestyle to the point where I couldn’t even walk without intense pain let alone run a few miles.  I had to stop hiking with my family and avoided walking to the store—even my corporate hiking trip to Yosemite Falls Summit was in question earlier this year…a frightening scenario for someone like me.  I took a full two months off running to no avail.  I thought for a while that I might not ever be able to run normally again—or maybe at all.  Was this the end of the road for distance running Coach RJ?  No.  However, it was a long and frustrating journey to figure out how to fix my foot, and once again, the best treatment option was very simple and not invasive.

Coach RJ @ Yosemite Falls Summit
Plantar Fasciitis BE DAMNED because I MADE IT!

To keep it simple, the cause of plantar fasciitis is lack of flexibility in the bottom of the foot which leads to tearing of the plantar fascia which is like a rope of fibrous tissue running along the center bottom of your foot.  You can read hundreds of web pages about it, but that was my basic summary after months of exploration.  The more clinical explanation is "injury to plantar fascia from cumulative overload stress."  As a fitness pro, I look at "overload stress" differently.  I want to go in and condition the body in a way so it can handle the overload stress without injury rather than just defaulting towards ceasing to participate in the activity...follow me with this line of thinking for a moment...

When trying to determine a root cause for my own foot failure, my best guess was my lifestyle change about two years ago when I became a full-time corporate Wellcoach.  My Wellcoach duties require me to drive—A LOT!  I can spend up to 3-4 hours a day driving.  When I started in June 2005, I had a truck that forced my accelerator foot and leg into external rotation.  My foot became “fixed” in this angled and poor ergonomic position.  I didn’t get the regular amount of movement I was used to with my foot…and the cycle of pain began…slowly at first, then intensifying.  So, this is what I learned through the process of pain the last couple of years on what works and what doesn’t work.  I’ll leave you to decide your best treatment options, but I think I learned about as much on plantar fasciitis management as anything I’ve read on the internet and beyond.

There are numerous treatment options for plantar fasciitis.  Most are clinical, and a few are more natural or holistic methods.  It was very difficult to find any fitness solutions on the web for fixing your own foot!  Most of the recommendations were: anti-inflammatories, cortisone, rest, splint boot, and cessation of foot challenges like running none of which I was much interested in trying.  Let me assess each that I used in the basic order that I used or considered them over the last two years along with a couple of points of reflection.

Your Podiatrist:  For serious cases of plantar fasciitis I recommend using a podiatrist instead of a general practioner.  I use a podiatrist that is not only a foot doctor, but he’s also a wellness guy, distance runner, and cyclist.  He wants to keep his patients active because he knows how important that is to their health.  Most doctors are NOT fitness and wellness people!  Too many of them just tell you to stop doing the activity that you were doing when you got hurt and take drugs.  Take it from me—find a doctor that actually exercises and eats healthy, and you’ll be miles ahead! J

Orthotics:  For some, these foot inserts might help.  I had some made by a podiatrist for college cross country running.  I can honestly tell you that my foot felt like it was going to break in half before I got them.  The first day I ran with them, the pain started dropping out of my foot.  Results vary.  Some have told me podiatrist orthotics made their feet worse.  Others say they really helped.  They helped my bone alignment pain, but have not helped my plantar fasciitis.

Acute vs. Chronic Plantar Fasciitis:  My podiatrist helped me to understand the difference between the two.  At first, I could manage my foot with stretching, but at some point, he convinced me that my foot was so inflamed that even my stretching was making it worse, and that in my best interest, I needed to STOP stretching.  (Thanks Dr. Miller!)  When plantar fasciitis goes chronic, it’s bad news, and virtually impossible to manage without some very assertive measures.

Rest:  This helps, but it didn’t fix my foot.  If you have an acute case of plantar fasciitis, then resting for a few days is more effective.  If you develop a bad case like me that was chronic, then resting probably won’t be enough.  Even though I rested from running for two months, I still had to get up and work everyday!  You really cannot totally rest your foot unless you mount a scooter or stay in bed—those were not options for me!

Aggravating Activities & Positions:  What bothers my foot is longer runs over 30 minutes, plyometric jumping, and interestingly--doing nothing with my foot while I keep it in a static position.  On actual running surfaces, not being able to run on dirt is harder on my foot.  Always look for the "softest" surface; concrete being the LAST surface you ever want to run on and especially with plantar fasciitis.  Hiking is not too bad as long as I go into the hike without my foot being irritated from longer runs  the prior week.  I adjust my runs to give my foot a chance to hike without pain...it's a give and take relationship with my foot now.  I just can't ask too much of it with this condition because I'll pay for it.  Sitting at the computer and sleeping make my foot really tight too along with driving.

Splint Boots:  You can buy or have custom splints made that keep your foot in a flexed position while sleeping; however, research shows mixed results for night splints. I have concerns with the boot because the foot and ankle complex is NOT supposed to be immobile for 6-8 hours per night.  I would suggest using the boot if other methods failed like the static plantar stretch and FootLog.

Ice Therapy: I think this helped at times although after 20 minutes of icing your sore foot it is VERY hard to walk for a while!  The best way to ice feet is to use frozen peas.  Take a bag of frozen peas, place into a gallon Ziploc freezer bag, then label the bag “FOOT!” so the family doesn’t eat them!  The small round peas will conform nicely to the foot without hurting the sore spots like hard ice cubes do.  With the actual pea bag covered the by Ziploc, you can re-use the peas over and over.

Elevation:  Forget it…who’s got time to put their feet up these days?!

Dynamic Stretching:  When my plantar fasciitis was acute and just flaring up and down, all my cool dynamic stretches kept the pain at bay.  As my foot got worse and the condition become chronic, not only did the stretching NOT work, but the deeper stretching even made it worse!

Static Stretching-Old School Methods:  Forget about the old-school leaning calf stretch into the wall because it won’t do a damn thing.  One of my clients had chronic plantar fasciitis.  When I asked her what the doctor told her to do, she showed me the leaning calf stretch.  When I asked her how the doctor instructed her to do it, she was basically told to lean into the wall.  Even the simple calf stretch was jacked up by the doctor because he never told her how to properly position her rear foot and leg!  Why?  The doctor probably did not know how to properly do the stretch he was recommending!  It is rare for a doctor to know fitness.  When it comes to exercise solutions, you’d be better off to get on the web and find out how to stretch yourself than listen to most doctors!

ProStretch:  Before my inflammation became chronic, the ProStretch tool did an awesome job fixing my foot.  The problem was that because of my excessive driving, even the ProStretch could not keep up.  More specifically, the ProStretch is really more of an Achilles’ Tendon and calf stretching tool.  It doesn’t do a good job for the bottom of the foot which is where the plantar fascia is located.  In fact, the ProStretch made my foot worse at some point because it put too much of the wrong kind of pressure *(See Foot Log section on corrective pressure recommendations) on the heel where the plantar fascia is attached—OUCH!  If you only have Achilles’ problems, then the ProStretch works much better than the standing heel stretch against the wall.  It’s a great tool.  I’m glad I have it, but there are better options for “chronic” plantar fasciitis.

Anti-Inflammatories:  Over-the-counter NSAIDs are helping me now to manage slight flare-ups in my foot, but they did not help my foot when it was chronically inflamed.  When my foot was really bad, I even tried prescription grade anti-inflammatories, and I don’t think they made that much difference.  Additionally, I do my best to eat foods that do not "create inflammatory responses" in my body such as fresh fruits and veggies, whole grains, with as little processed foods as practical.  I'm also using more spices now like turmeric which has anti-inflammatory benefits.  Just "food for thought" on the nutrition and spice tips...

Cortisone Injection by Podiatrist:  Here’s where it helped to have a great podiatrist that I trusted because he was a wellness advocate and endurance athlete.  I am not fan of cortisone shots as a Wellcoach.  Too many times my clients get talked into these for pain, but the shot only masks the pain and does not fix the root cause.  I spoke with my doctor in detail about this.  He finally convinced me of the following—I now believe it to be true based on my experience. 

By the time my foot inflammation had become chronic, I was not able to manage it through rest and easy stretching.  In fact, even with rest, ice, and no stretching, my foot was still on fire and extremely painful.  He made me realize that even stretching was making it worse because my foot was so inflamed and irritated; therefore, cortisone needed to be considered for knocking down the chronic inflammation.

Basically, there are three levels of cortisone injections to consider for plantar fasciitis.  One is very short acting and peaks in a few days.  This one was not strong enough for my condition.  The second is medium acting and peaks within two weeks.  The third is long acting and hangs out in your foot for a few months.  The long acting cortisone does the most joint damage.  From what I have read, you should never have more than three cortisone injections within a 12-month period because of joint deterioration from the cortisone.  I finally opted for the medium acting cortisone—just one injection was able to knock down the sharp excruciating pain that was always present first thing in the morning.  My podiatrist never wanted to use more than one injection--two at the most.  Fortunately, so far only one injection was needed.  Did the one cortisone fix my foot?  No.  Did it help?  Yes, because it allowed me to get out of bed without worrying about falling on my ass!  It also reduced the inflammation enough so that I could get back in there with my stretching to fix the true root cause of my foot pain which is lack of flexibility.  The mechanism of injury still existed—my excessive driving.  My new car helped with my driving ergonomics, but I still had foot pain from driving.

Driving Ergonomics & New Car:  One of the reasons I bought a new car was to get a better ergonomic position for my foot and upper body.  With the Z car and six speed, my foot gets to rest in a more neutral position along with getting more activity from shifting.  This definitely helped my foot, but in no way fixed my foot.  The Z car is more fun though, so I try to forget the foot pain and at least enjoy the ride! J

Yoga:  This might have helped a bit, but I only did yoga a few times a month at best.  With my foot pain, it was very hard to do the yoga at times with my bare heel pressed into a hard floor and thin mat.  I had to modify some of my positions because my foot just couldn’t handle the intense pain.  Talk about Holy Mother of Buddha suffering!  OUCH!  The price you have to pay for enlightenment! [

Static Stretching-New Methods:  I read about a “new stretching protocol” in the LA Times a few months ago called the Plantar Fascia Stretch.  It reminds me of some yoga foot positions, but unlike a 1.5-hour yoga class, the study showed significantly better improvement with just ten seconds of stretching in this position repeated ten times first thing in the morning before even stepping out of bed.  I tried five of the ten second stretches before getting up and thought that it helped my foot a little bit—not a lot—but there was enough improvement for me to continue and to pass this along to my corporate clients with plantar fasciitis issues.  I do the stretch in various angles and variations beyond the basic stretch given in the article.

Plantar Fascia Static Stretch

 Foot Log Therapy Tool   Behold!  The Holy Grail of Foot Fixes!  The $25 dollar solution to my chronic pain that has allowed me to get back my active lifestyle!  I was telling one of my X-Country coaching friends about my plantar fasciitis, and he asked me if I had heard of the Foot Log.  I had never heard of this device.  It’s a simple contraption invented by a San Diego podiatrist that resembles a kitchen rolling pin except that the log is not flat like the rolling pin.  The Foot Log is filled with small rubber bumps in the shape of a pencil eraser.  I think it works like a “Sheep Foot” roller used by excavation and grading contractors.  When trenches are dug for pipeline, the dirt must be replaced with compaction after the pipeline is installed.  These “foot projections” sort of tamp down or press deeper into the ground enabling higher levels of soil compaction.  I think the Foot Log works the same way.  The little rubber feet or bumps do a better job to press deeper into the foot thus breaking up the scar tissue binding the foot.  Here’s an incredible story on my own foot.  I had a very hard projection on my right heel from the plantar fasciitis.  I thought it was an actual heel spur or calcium deposit that would eventually have to be surgically removed.  Within two days of using the Foot Log, the hard bump causing so much pinpoint pain on my heel was essentially GONE!  I was amazed!  $25 bucks and two days and dramatic improvement in what I thought was the end of my normal walking days!  I now travel with it everywhere--The Foot Log is mandatory equipment for Coach RJ!  Thanks for the tip Coach Weinmann!  *Note: I get no financial incentives for recommending the Foot Log.

The Foot Log is also being used for diabetic foot conditions.  I'm not knowledgeable about how well it works for diabetes; however, I think in general, it would be great for just about all feet based on my results.  There are still things about the Foot Log I don't completely understand.  There are some references to "Reflexology" in the Foot Log Manual.  I've never bought into Reflexology, but I'll say this, the first few times I rolled my "foot," I felt a very strange sensation in my lower right "abdomen."  This tells me something is connected somewhere!  Maybe there's more to the whole Reflexology thing...you decide...

www.footlog.com

Using the Foot Log:  It comes with a cool booklet with good information—read it.  They recommend rolling both feet at the same time.  I found that this method did not get into my foot deep enough.  I actually stand with nearly all my weight on the affected foot.  The harder I press into my foot, the better the Foot Log works.  If you have bad plantar fasciitis, I can hear you now, “Coach RJ completely lost his mind!”  If it hurts to even walk, how can you mash a Foot Log into your heel?  All I can say is what I have learned through experience—go hard and walk away with less pain.  I use my Foot Log twice daily for 3-4 minutes per session.  Once in the morning before work and once at night before bed.  By the second day of use, I had significant improvement in my foot and a major decrease of foot pain—in just two days!  My corporate clients have also said the Foot Log helped their feet.

I have three phases for using my Foot Log:

1. Roll entire foot from toes to heel starting with light pressure increasing to medium pressure for about 10-15 seconds.  (Speed=Slow & Constant)

2. Begin rolling mid foot with medium to hard pressure.  Spend more time at base of heel where plantar fascia starts to attach to heel—hit that angle hard!  (Speed=Various)

3. Grind it into your whole heel at a various angles and pressures but mostly with hard pressure—yes, I said GRIND!  I know!  Your foot hurts like hell, but I’m telling you, the more I work the Foot Log into my heel, the better I feel the next day. I will also hold and press right into the most tender spot on bottom dead center of my heel--this is where I originally had the heel spur or hard knot.  I let the pinpoint spot on my heel sink into the Foot Log then VERY carefully adjust my heel to hit the spot in as many different angles and positions possible.  (Speed=Various to None)

• I go back and forth between Phase #2 and Phase #3 after the initial light pressure phase.  For a while I'll work the arch then the heel until the heel says ENOUGH then back to the arch.  Usually, after about 3-4 minutes, my foot basically tells me that is enough and to stop.  This is what works for me.  You might want to experiment with various times and pressures that better suit your foot and current condition.

Driving Barefoot:  I have also started driving barefoot.  For reasons of compensation, I have developed some secondary pain in the top outside of my midfoot.  This midfoot pain seems to be aggravated when driving with shoes but is not nearly as bad without shoes.  You would think that the heel pressing right into the floor of the car would make the pinpoint heel pain worse, but it does not.  I don’t know how to explain this.  All I know is that my foot doesn’t hurt as bad if I drive barefoot.  I "think" I am straining the tendons on top of my foot from my efforts to "lift off my heel" and relieve pressure on sensitive areas.  What puzzles me is that my naked heel directly on the floorboard with no shoe protection puts less strain on my plantar fascia.  It seems like my foot would prefer the soft running shoe heel support while driving, but it does not...I'm still trying to figure this one out...

Strassburg Sock: Pending

eSoles: Pending

Calf Trigger Point & Soleus Muscle:  I recently learned from Gray Cook, nationally known physical therapist and training guru, that many times plantar fasciitis can actually be caused by tightness on the back of the calf muscle in the area of the soleus muscle.  Using trigger point release, one can alleviate the plantar pain.  The trigger point link above goes back to a great handout by Dr. Laura Perry in Texas.  I've tweaked the massage points a bit.  Instead of using the golf ball and knee she mentions, I use the Foot Log for the bottom trigger point near my heel and The Stick massage tool for my soleus on back of calf.  For calves, the short 17" stick is just fine.  Use about 5-7 lbs. of light to medium pressure and roll back and forth over about 6-8" surrounding the sore "trigger point" areas.  For me, it's the inside belly of the calf muscle--when I'm there--I know it!!!  Both of these tools are easy to use and not very expensive.  Her suggestions are fine as well.  You can also use a Biofoam roller--find the spot that is the most sore and let the roller sit on it for at least 30 seconds to release the trigger point on the back of your calf that can be affecting the plantar fascia.  I tried the Biofoam roller, but for me, I don't think it worked too well for my particular problem.

Birkenstocks: I had a few clients tell me that Birkenstocks really helped their plantar fasciitis.  I used to wear them years ago and always liked them.  I bought some news ones (just like my old ones from back in the day!), and they make my feet feel good.  I don't seem to have any problems walking in them.  They seem to make my foot a little better; however, I don't get a chance to wear them much because of my work requirements.  I'll probably get some Birkenstock dress shoes as well so I can keep my foot into this style of foot bed more hours per week.  They feel a little weird at first, but after a while, your feet sort of make an impression into the soles--a custom-fit if you will.  The company claims their products are used extensively by people suffering from plantar fasciitis with great results.  You might want to check them out.

TOPAZ Procedure: This is a new surgical procedure for plantar fasciitis that is far less invasive than other surgical procedures I've researched.  Initial results seem VERY positive.  I'm still investigating this one...Check out the link and video for more info.

Good Feet Stores:  I've had a number of people tell me that inserts from Good Feet have significantly helped their plantar fasciitis and other foot problems.  This store uses some computer-based assessment technology to analyze foot biomechanics and walking gait.  I'm always concerned when people just go to the store and buy a generic insert then throw it into their shoes.  Whatever you put under your foot changes the mechanics of everything above!  You have to be careful about what you place under your feet!  From my feedback, this store has done a good job with assessing which types of inserts would be appropriate for certain conditions.  I see Good Feet as a intermediate step between buying a generic insert with no clue about whether or not you need it and going to the actual podiatrist for a complete assessment.  To be honest, I've had "many" clients tell me that the podiatrist orthotics made their feet worse or did not work at all, so just going to a doctor is not always the absolute foot solution.  A few people told me the Good Feet helped them more than doctors!  I don't know what the exact solution is--if there even is one!  But if your feet hurt, and you're looking for some options, you might consider visiting the Good Feet and see what they can do for you.  I have not used them personally yet, but I think I will go in and see what they can do for me.

Changing Shoes:  I've had many people tell me changing into different shoes throughout the day helps relieve plantar fasciitis pain.  I have no idea why, but I have noticed that when I get out of my day shoes and into my running shoes that at times my foot will feel a little better--even though the day shoe was also a running shoe of the same brand but not the same type...still trying to figure this one out!

Rubber Mallet!  I actually had a person tell me that some people have used a rubber hammer, or mallet, to pulverize the plantar fasciitis scar tissue.  They basically break up the tight spots with the hammer blows over a period of a few weeks.  Please!  I'm not recommending this procedure, so don't sue me!  I'm just reporting on some feedback that claimed this somewhat radical method worked to fix their plantar fasciitis issues.  I must admit though...at times, I got so sick of my own foot pain, that I felt like grabbing the hammer myself!

References:  I found these sources to be helpful for explaining plantar fasciitis and summarizing treatment options and their effectiveness.

• Overview (American Academy of Family Physicians)
• Plantar Fasciitis: Evidence-Based Review of Diagnosis & Therapy (American Academy of Family Physicians)

Summary-My Bottom Line:  I’ve got to say after all this that your first step to manage plantar fasciitis would have to be using the Foot Log twice a day for at least 3-4 minutes per session.  The book recommended 10 minutes twice per day but with the softer approach.  I opted for less time per session but with much more pressure.  It works for me.  You specific application might be different.  I encourage you to experiment a bit on your own using my recommendations as starting points.  If you can't manage your foot pain yourself, by all means find a quality podiatrist and consider other options as well.

I'll be honest; my foot still hurts--sometimes a lot.  The difference between now and prior to the Foot Log is that I can manage the pain and still hike and run with my family and clients.  If I don't run two days in a row or drive excessively, I'm really not that bad--at times my foot is almost completely normal which is a lot more than I could say prior to using the Foot Log.  I'm also encouraged by the new technique Gray Cook uses with The Stick massage tool I referenced above to release the calf trigger points.

Good luck.  I hope this article and information will help you to walk better and with less foot pain!

In Foot Fitness!

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(Updated 9.8.08)

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