I Felt Her Pain
During the August 2016 Anchor Down 24 Hour Ultra, I slowed down to make sure a limping fellow runner was OK. It was a few hours after the 7 pm start. My headlamp shined on her face and hers on mine. She had a scrape and a bruise below her left eye. She had fallen on the trail after tripping on a tree root. But she was limping because she was suffering painful plantar fasciitis (PF).
I empathized with her. I felt her pain. I shared my story of my bout with PF. I told her about my unsuccessful attempts to heal my PF. I shared how I finally overcame my painfully annoying and somewhat disabling PF in my right heel, and healed.
According to research, approximately 4% to 7% of the population experience heel pain. Eighty percent of those with heel pain experience PF, an inflammation of the plantar fascia. The pain is usually sharp. PF sufferers experience the worse pain after bearing weight on the heel after it has been at rest. They also experience severe heel pain after getting out of bed, after being at rest, or after sitting for a long period of time. Continued walking seems to provide some relief. In my experience, as soon as I got out of bed in the morning and hit the hardwood floor, the pain and discomfort caused me to limp and shuffle my feet.
Overtaking My Active Life
My bout with PF began in spring 2015. Attempts by my podiatrist to treat PF in my right heel included a foot brace, sport orthotics, a night splint, a short air walking boot, and crutches. None of these well intentioned contraptions provided relief or successful therapy. I watched YouTube videos and came across contradictory tips. However, two tips that provided some temporary relief was rolling my foot over a golf ball or a frozen water bottle.
(clockwise) The author with a brace at the 2015 Montour 24 Hour Ultra, a night splint, an air waling boot, and crutches ©Miriam Diaz-Gilbert
My PF was distressfully overtaking my very active life. A life-long runner, I had never experienced or been sidelined by a running injury. A veteran of 10 marathons and 13 ultra endurance runs, I wasn't going to let PF completely disable me. I painfully trained and completed 62 miles (100K) at the July 2015 Montour 24 Hour Ultra. I ran gently without my foot brace the first 40 miles, and walked slowly and painfully with the brace the last 22 miles. I managed to place 10th in the women's division. The previous year I placed fourth.
And while I probably should not have, after this ultra I hiked and rock climbed in Acadia National Park. Although painful, moving was better than being sedentary. After that I rested my foot and body. No running, hiking, or rock climbing. But walking and standing while teaching in the fall semester, remained painful. Teaching and hobbling around campus with a boot and crutches did nothing for my PF. I was frustrated.
I Had Been Running Incorrectly
A ray of hope alleviated my frustration when a friend told me about a doctor who successfully treated his left shoulder. I googled the doctor and learned that Dr. Marc Legere is a recognized authority in sports and physical medicine. He treats student athletes, professional athletes, and runners. I had a few appointments with Dr. Legere. During these visits he manipulated my right heel, foot, leg and hip. I also met with a physical therapist twice a week. I diligently did my exercises at home.
I learned from Dr. Legere that PF is more about the hip and less about the foot. I learned that my gait was incorrect. I stand with my feet outward instead of inward. I had been running incorrectly all those years! To strengthen my foot and calf muscles, and to reduce pain, he prescribed walking barefoot at home.
Muscle Weakness and Improper Gait
In an email correspondence for this piece, Dr. Legere explained two things that often cause PF. Muscle weakness in the foot or calf muscles that hold up the arch of the foot can cause PF. Muscle weakness and improper gait patterns (the movement our body makes when it walks or runs) stress and fatigue the muscles that hold up the arch. The height of the arch can begin to decrease. This causes a pulling on the plantar fascia, which is close to the heel. The heel becomes painful.
He further explained that, "In many cases of plantar fasciitis, the actual problem starts in the hip area. When the external hip rotators (a group of muscles that sit beneath the gluteus maximus) contract, they open up the leg, which turns the leg/foot into an outward position. When the leg is rotated outward, ever step causes a great deal of pressure on the arch of the foot and, therefore, the plantar fascia."
Fanatic About My Gait
Dr. Legere's advice to ultrarunners is simple - "Be a fanatic about your gait...Imagine how much stress an ultrarunner is putting on their leg/foot over a long run or race! If your gait is off even a few degrees, over time all of those little differences can really add up...and [cause] pain in the plantar fascia."
I tossed the foot brace, the boot, the night splint, and the crutches into the attic. I became a fanatic about my gait. I began to train in January 2016. Between April and August 2016, I ran two 50-mile ultras. I had a personal best in one. I placed third in my age group in the other. I also placed third in my age group at the Anchor Down 24 Hour Ultra. Before each of these ultras, my healed heel visited Dr. Legere for a tune-up manipulation.
Every runner's experience and treatment is different. What worked for me was finding the right expert, whose treatment corrected my gait, healed my PF, and made me an improved runner. Don't let plantar fasciitis keep you off course and from your next marathon or ultra!