Special Plantar Fasciitis edition

I’ve gotten a few questions about my efforts to overcome plantar fasciitis (PF) so figured writing it all down in one place would be worth the effort. So here’s my first special edition newsletter.

My recovery plan focused on 3 main components: stretching, strengthening, passive/recovery.

Stretching - this is important, and there are three main areas I worked on stretching.

1. Calves - Tight calves were found to be prevalent in people suffering from PF / heel pain. This paper points to a similar conclusion. I did the standard wall lean stretch, for 2 full minutes, at least once and sometimes twice a day. Muscles lengthen more effectively with longer stretch periods. I also used my slant board for simple “toe touch” stretches to hit both my calves and hamstrings at the same time.

2. Hamstrings - tight hamstrings are implicated in PF, and mine have been tight for a while and caused me plenty of other issues. So in Q4 2022 when I gave up on running I decided to make stretching a key focus. I do long (1-2 minute) stretches both seated and standing, as well as on my slant board. Focus on pushing your belly button forward, as a queue to rotate your pelvis. Don’t just use your spine to reach forward, that doesn’t really target the hamstrings.

3. Toes/feet - I addressed this mostly by simply pulling my toes back with my hand, and with a stretch called kneeling rollbacks, which I got from Dr. Scott Carlin (twitter thread linked below). I’m slowly working up to sitting back on my heels for longer periods. It’s still a strain though. I also look for opportunities to stretch my toes, anytime I’m sitting on the couch, or at my desk. I’ve made toe stretching a “nervous tick” that I go back to again & again.

4. Timing: I do most of my stretching in the evening but I critically stretch and massage my foot with the massage gun before getting out of bed in the morning. Anyone suffering with PF knows it’s usually worst on waking. You really need to prep the foot and get some blood flow for those first steps in the morning. “No ambulation without circulation” is a good rallying cry.

Strengthening - just as important as stretching. To address this I have done a number of things:

1. Slant board heel raises - I’ve read muscles strengthen more quickly when loaded at full stretch, so I do weighted heel raises on the slant board.

2. Toe Pro - their website (linked below) has a good info as do several videos on Youtube. The Toe Pro is a foam wedge shaped device that does a couple of key things: it puts the toes in extension for the strength exercises, and because it’s a soft unstable surface it really works your foot muscles. Try it and you’ll quickly see how fatigued your foot gets from just a few heel raises. I’ve gotten a lot better at doing these (free-standing, with nothing to balance or lean on) over time but they are still hard. There are other exercises besides heel raises, you can read about those on their website.

3. Backwards walking - just try it, and pay attention to how it works your foot muscles. It’s essentially an eccentric loading motion on your foot. I do these as a suitcase carry with a weight vest and a 62 lb kettlebell to also get some good core work in parallel with the footwork.

4. Plyo - look at this Kenyan drill session. Bouncing. And bouncing some more. Go brew a cup of coffee, come back, they are still bouncing. I’ve been doing a variety of hopping drills as part of my warmup to add more springiness to my feet.

Passive - Maybe the least important but I’ve also used these tools to help recover and manage discomfort.

1. Arnica - yeah it’s homeopathy, which rightly has its skeptics, but this seems to help, so I keep using it. There’s at least one study confirming that it works as well as ibuprofen gel.

2. Red light therapy - also seems wu-wu or dodgy but there’s actually good data over many years on RLT. As I understand it the main mechanism is through nitric oxide production/release, which stimulates blood flow (something I’ve written about before in other contexts). Tendons and soft tissue benefit from techniques that improve blood flow, they don’t get an abundance like muscles do. Anyways I had a red light bulb laying around, so I plugged it in under my desk and point it at my foot a few days per week. No time required, no cost, might as well try it.

3. Massage, roller balls, etc. - often recommended and worth the very small effort. Lacrosse balls are a favorite, in addition to the Hyperice.

Equipment -here are links to the devices I used and mentioned above.

1. Toe Pro - this came recommended by a former colleague and it’s been helpful. Doing heel raises with your toes on an angled, soft platform is notably harder, and I’ve gotten a lot better at it since I started.

2. Slant Board - I got this one on Amazon and love it. Great grip, wide range of angle adjustment.

3. Foot Brace for sleeping - I tried a couple of them, this one worked best.

4. Hyperice - Bought it for PF but now use it all over, especially on the legs after long hard rides. Love this thing.

A word about shoes and training.

1. I read a bit about the importance of getting your toes spread out, so I got away from any shoes (running or otherwise) that make my forefoot feel tight. No more Stan Smiths for me. Altra Rivera running shoes became my everyday shoes, with their wide toe box. I’ve been using these Merrell’s in the weight room for many years. And I spend a lot of time in my Sole sandals.

2. Foot support - I have Sole or Superfeet insoles in all my shoes. That said, I spend dedicated time either barefoot or in minimalist shoes to gradually build up the strength of the feet. But the insoles do seem to provide some relief.

3. My return to running was/is MINIMAL. Specifically, after 3 months of no running and strength/stretching focus, I started running once a week for 1.25 miles. You read that right. 1.25 miles per week, for 4 weeks. No pain, so I went to 2 runs per week. I’m currently at 3X/week for 3.75 miles of running/week. Also working in a few longer (4-6 mile) walks. After 4 weeks of 3x runs, I will get on the 10% per week ramp plan until I return to the weekly mileage I had last summer (17 miles/week). Then I’ll decide where to go.

Additional resources I found helpful:

1. Resource on foot strength - Although I did not end up using much of the guidance from this article, it seemed quite thorough, and some of you might find it useful.

2. Another video with a slightly different perspective and some good info on stretching the top of the foot as well. Squat University has quite a bit of good info.

3. This thread is good. It’s where I learned about kneeling rollbacks. I also used the Pain Monitoring Model to guide my progressions. Scott has good info on a lot of running related rehab / strength work.

One final, very important point: as with any injury, if you are not systemically healthy you will not recover. That means good sleep, good nutrition, managing stress levels, regular blood work to make sure everything is in order. Your foot pain may be isolated but it depends on the rest of your body systems to heal. So don’t take your eye off the macro issues while you focus on the foot.

I hope that was all helpful. Let me know if you enjoy single-subject emails like this, or if you prefer I stick to touching more lightly on a variety of topics. Thanks for reading, either way.