Bad Idea? Plantar Fasciitis Mitigation Thoughts

[Curt Peterson]

Looking for some experienced advice.

I’ve never had plantar fasciitis before. This is my first time in my late 40s. It’s not pleasant and it’s persistent. Ice, rolling, ibuprofen, etc and it’s not really improving after 3+ months.

I have my annual “Big Trip” coming up in late August. 12+ years of a ‘Life List’ trips that cover some premium route in the West for 8-10 days. I look forward to it all year. It’s definitely the highlight of my outdoor life each year.

I’m getting a bit worried about being in very remote country and being unable to hike. Right now I’m in pretty much constant pain, but I tolerate it. Walking actually helps a bit, but I’m easily spending most of my waking hours aware of the issue.

So – am I an idiot for moving forward on a 70+ mile trip in a remote area? I’m thinking maybe a cortisone shot just prior to going? Tons of ibuprofen and hope my liver isn’t overwhelmed? Am I doing permanent damage if I do the trip anyway – regardless of pain?

Any words of wisdom are appreciated. I can manage the pain – just don’t want to do longer term damage or be incapacitated on the actual trip.

Thanks!

[Jon Fong / Flat Cat Gear]

plantar fasciitis

1. Who diagnosed it?
2. How did it originate, what was the root cause?
3. What treatment are they recommending?

[PaulW]

Several years back I was faced with a similar timing situation as yours. I opted for a cortisone shot, taping, and Orthotics. But, PF can turn into a long term, debilitating issue if you don’t address the root cause/s, so as soon as my trips were over, I headed to PT and learned some great foot and Achilles exercises that healed me and have allowed me to stay pretty healthy these past few years. From a PT perspective, I cannot say enough good things about eccentric heel drops. They’re directed at the Achilles tendon, but PF and Achilles function is closely intertwined. You’re getting short on time, but a quick visit to the Doc and maybe even PT could be worth your while. PF is a connective tissue issue and those can take some time to heal, so don’t expect miracles. BTW, the Orthotics I used were off the shelf from Birkenstock and they worked really well in certain shoes. But, my Doc showed me how to tape for PF and this is what I did on my longest trip as I wore trail runners.
Good luck on this.

[Rex Sanders]

My PF diagnosed correctly about 30 years ago, after persistent foot pain for the previous 25 years. Pretty much only option then was custom orthotics. Made a huge difference. Latest pair, about 5 years old (they last around 10 years of constant wear), are 113 grams total.

I’ve been reluctant to explore options because custom orthotics work and I don’t want to risk something new and potentially painful. Though I might try SuperFeet soon – much cheaper. It’s kind of a pain to swap orthotics between shoes, so I wear the same shoes for almost everything until they wear out.

Needed a foot doctor appointment for custom orthotic measurement. Delivery after that was several weeks. Probably cutting it too close for your trip, but you could ask. There’s definitely a semi-painful foot break-in period which you might not want to go through while backpacking.

Helps to wear shoes with removable flimsy foam “insoles.” Some shoes work better with those insoles on top of orthotics, on others bare orthotics are more comfortable. Must try and see what works for me and those particular shoes. I always try new shoes with orthotics in the store because they take up more volume in a shoe, which affects the overall fit.

Nice that there’s more options now. Good luck.

— Rex

[Garrett]

I just started getting PF after switching to a stiffer boot compared to my Altras. Anyways check out the video in the link. It’s been helping me quite a bit. It’s only been three weeks, but the pain is almost gone, which is relatively quick for a condition such as this. I could barely walk before, but now I’m hiking 4-5 miles daily. Be sure to use a band with some stretch when doing the exercises. I believe the most effective one is the standing heel drop.

https://austinfootandankle.com/conditions/plantar-fasciitis/

 

[AK Granola]

I’m a pretty serious believer in physical therapy, proper stretching, and exercises for your specific issues. And they can work quickly, depending on your case. I have have various knee, foot, achilles and other issues, and my PT is the one who has helped resolve them all. I follow her exercises still – writing the alphabet with my feet, heel drops, stretches (don’t overdo), etc. I also have been wearing a brace for my achilles at night, which has worked wonders. You are you, so no one here can tell you exactly what you need, but consulting a qualified PT who works a lot with athletes, hikers, runners, etc. may help you prevent injury on your upcoming hike.

[David Thomas]

The two things (both free) that helped me were 1) wearing more cushioned shoes and 2) keeping my toes up at night.

1) while there is an Alaskan habit/culture about removing your shoes upon entering a house (one my wife endorses), walking around in bare or stocking feet wasn’t helping.  I kept cushy shoes (running shoes) on at all times and that helped me.

2) if you don’t let those tendons contract all night long, you won’t stretch, tear and inflame them the next morning when you awake and take your first steps.  I was able to subconsciously retrain myself to meep my toes up towards my knees and to sleep further towards the footboard of the bed so my feet would be flat on the footboard (rather than pointed like a ballerina).  There are socks and splints to assist with that and given your time-frame, I’d suggest you go that route.

Those two steps dealt with my moderate plantar fasciitis over 2-3 months.  I suspect if I’d gone with the splints that are available online, I could have shortened that period a lot.  By continuing to wear cushy shoes whenever I can, it hasn’t reoccurred.

[Matthew / BPL]

My understanding is that PF is a likely when there where there is too much tension or tightness under the foot. The Achilles heel is pulling hard and disrupting the fascia under the heel.  A couple thoughts:

1) Start with a good PT. Mine has a doctorate and does private practice. She costs $120 per appointment but I’m getting 70 minutes of one on one time. I feel like I get so much more out of our appointments than when she was in a group practice that accepted insurance and cost $35 for a copay.

2) PF for me is about having the whole back of my leg being too tight. Rolling/stretching my calves, hamstrings and glutes/hips seems to help.

3) a night brace has been very effective. I can’t find the one I use but it’s a soft model like this one. I have found hard braces slide off my foot. You want the foot to heal in the extended Laotian. Having it heal overnight in a relaxed patio on shortens everything, increasing tension. https://www.amazon.com/dp/B07B6WRJBH/ref=cm_sw_r_cp_api_i_XWLhFbR6BTCQM

4) walking technique matters. I discovered that I used to push off my big toes. It’s not hard to imagine that doing so increases tension. I now push off the ball of my foot.

5) barefoot on hard floors sucks. I have some soft, squishy flip flops with an anatomical footbed. I protect my feet from our concrete floors by wearing those inside as much as possible.

[Bruce Tolley]

1. Get yourself to a good podiatrist and get a diagnosis

2. Find a good Phy therapist and follow  their exercises.

3. I would stop the ibuprofen and use Voltaren, it is a liquid NSAID applied topically. It just became available over the counter.

4. Everything everyone else said above.  You will probably need to take a night split. Get one called a dorsal splint where the stiff part is above the foot.

5. I get re-occurances  when I forget to stretch before I go to bed or go barefoot around the house.  The little hard roller balls help too.

6. The podiatrist might recommend custom orthotics. I have used Aetrex and Smartfeet

7. The cortisone shot makes the pain go away but does not cure the PF. It just addresses the inflammation where the fascia bundle attaches near your heel. Also read up on the side effects.

[Curt Peterson]

Thank you all SO MUCH for the advice! Lots of good stuff in here. Much of it I’ve run across before, but hearing it from backpackers really helps. Very much appreciated!!!

[jscott]

Yes to going to a PT and religiously doing stretches etc. In other words pray that it will go away while you’re doing the boring exercises.

You may need to take it easy for a while and not aggravate the injury. Ask the PT. Not what you want to hear but as you say, seventy miles on rough trail with a pack on your back may not be what the doctor orders. But it may! I can’tr say.

I had a mild case and rolling a cylinder under my feet while seated worked very well, along with other stretches.

Maybe the hike won’t make it worse…? (wishful thinking?) I would think resolving this should take priority over an immediately desired hike. I have a friend with a really debilitating case and her hiking life is over, and worse. You want to avoid this.

[Tom Peterson]

I’ve had PF for almost 40 years. The number one thing I do that helps is to sleep with my feet hanging off the end of the bed. When we’ve had a foot board, I keep them against it, when we haven’t I make sure the sheet and blankets are tucked in tightly at the foot. It was recommended to me by a doctor friend.

[Diane “Piper” Soini]

Get a night splint (or two). They’re fairly effective. You can even bring them on your trip, although they are bulky.

[Max L.]

I will echo what others said: stretching. I’ve also been a runner for the past 8-ish years. I had PF for a couple months before getting diagnosed adn having some solid advice to follow. In addition to the rolling pin and ice, I think the stretches helped for me a lot. It did take several months to be free from pain. And now I can tell if I skip my post-run stretches too many times when I feel the twinge of pain waking up.

While I was healing, I kept a rolling pin on the floor next to my computer. I could use it throughout the day. I only iced for 10-15 minutes just before bed.

Since I healed, I only need to keep up with several minutes of stretching after each run. It hasn’t come back, yet.

[M B]

PF…is basically tendonitis.

Like any other tendonitis

 

Microtears have occurred

 

The only solution is to let them heal.

It can take weeks months or years depending on the loads it is capable of ,  and how much you keep aggravating it as it’s trying to heal.  Different peoples, are different.

 

99% of remedies are just Band-Aids to try and let you deal with it.   That doesn’t work. Only the body can heal itself.

 

if you had a big trip coming in a few weeks you worried about it, I would cancel. Sorry, that’s the only smart thing to do.  I had it atnat one time, bad, I know you can be stuck without a being able to take a step.   Would really suck to be that way out on trail.    I developed ITB and tendonitis of muscles on my shin once and it was quite debilitating….. I managed to finish hiking 30 miles to a place I could get a shuttle…… But it wasn’t pleasant and I did it by taking a lot of ibuprofen…. Since that time I carry enough ibuprofen to get me through several days of that scenario where you have to take 2 ibuprofen every 4 hours all day…8 per day x 4-5 days…. Is the minimum I carry now….

 

 

[M B]

But back to my own PF, it started in college and would only occur wearing Sperry Topsiders that had virtually no arch support.  I would get stranded walking across campus when all of a sudden it would hit and I couldn’t take a step because of the burning under my feet.  Did not occur with athletic shoes.

 

Years later as I was lifting heavy weights…. It got so bad I could not take a step when I got out of bed in the morning.

 

Alzners orthotics 100% fixed my problems.

I had PF for years, because my arches were going flat in my feet… I went to an outfit that evaluated your feet and provided orthotics ….. To reshape your foot and put Arch back in it. Not just an arch support…. An orthotic…. Ortho means to reshape.  At first it was like walking with golf balls under my feet. 30 minutes a day is all you can take.  After a few months you don’t even feel them anymore as your foot adjusts.   They put Arch back in my feet. My problems went away completely and have never returned. 28 yrs later…. Worn in my shoes everyday, hiked in thousands of miles, haven’t had a single pane of PF in that time.

 

The alzner orthotic was bought out by the Good feet store….. They are still selling this service today in the same way.  People have criticized these orthotics by saying that everybody’s foot is different….. But they’re wrong because even an idealized arch…. is better than no arch at all

 

 

[Bruce Tolley]

@ Curt

If you have a podiatrist you trust/like, make sure you talk through the risks of the cortisone shot before agreeing. The most severe side effect is a weakening of the attachment point of the ligament to the bone if not actual detachment. So if you go the cortisone route, you do not go backpacking 70 miles the next day.

 

[Rick Reno]

I just got it for the first time (from too much barefoot sprinting) and it sucks. I found a couple good videos on YouTube that might be helpful, especially if you combine the two ideas into one set of stretches that works for you. I just started a couple days ago and so far it seems to be helping, though it’ll be a while before i start sprinting again ; – )

Good luck, and “I feel your pain!”

[Jeremy W]

You should check out the MoveU guys on YouTube. They have over 900 videos of various stretches and exercises to help just about anything that ails you. Fair warning they do tend to joke around a bit and can be a bit goofy. They also have their own program but it’s pretty expensive and theres already plenty of free info there.

[jscott]

“While I was healing, I kept a rolling pin on the floor next to my computer. I could use it throughout the day.”

Yes. I have a largeish wooden dowel made for rolling under your spine when you’re on your back (that’s gotta hurt) with two flanges in the center where your spine would sit,. I use those flanges and the edges of the dowel to roll my feet under for a gentle stretch that really helps a lot. I had a mild case of PF and this plus other stretches resolved it. Lately I’ve felt early warnings and since beginning again with the dowel things have improved.

[victor larivee]

My sister, a runner introduced me to oofos sandles I said I would never wear those they look silly.  Now I wear them all the time.  They definitely helped me with my pf

[Ray J]

Lots of great information here.

I started getting PF just a few weeks ago.  It also just so happened that I had my yearly physical so easy to discuss with my doctor.  He told me to do the following.

First thing before even getting out of bed, lay flat and full toes up towards knees for 45 seconds.

Lean forward on wall and do the PF stretches as noted above.  Do those several times a day

when sitting in a chair, slide the effected foot back so the ball of the foot us under the knee, with foot flat on floor.

 

All that helped, some.

I ordered a “Tension Night Splint”.  They are a bit goofy but I had instant relief the next morning!  I’m still wearing it for about a week now as I’m still getting some heal pain.

[Diane “Piper” Soini]

My sister, a runner introduced me to oofos sandles I said I would never wear those they look silly. Now I wear them all the time. They definitely helped me with my pf

Those look exactly like Chacos footbeds only perhaps with a softer foam.

[Garrett]

I would go to a foot specialist to comfort the injury. What I though was PF actually turned out to be a stress fracture. Recovery would have been much quicker had I received the proper treatment a month ago. Not to mention the wasted energy spent on PF exercises. Oh well, you live, you learn!

[Barry P]

There’s a lot of good advice here. Some ideas that has helped me:

1.        When I feel PF coming on, when hiking, I immediately point my toes upward and walk that way until the pain disappears. Thirty seconds is probably my longest wait.

2.        When sleeping, I’ll point my toes backwards (toward my knees). Sometimes my zpack quilt can keep my toes slightly bent back (it’s an art). This way I won’t scream in pain in the morning from a PF attack.

3.        Also it’s critical that your arch aligns with your footwear arch.

4.        And finally a very squishy sole (especially in the heel) helps minimizes a PF attack.

-Barry

-The Rockies were made for Tevas

-May everyone find their sole.

[Author]

Posts