Anyone who's had plantar fasciitis knows that this injury sucks, big time. While there are dozens of recommended treatments, there are also numerous triggers for this injury. What works wonders for one person may do absolutely nothing for someone else, which explains why there's no single magic bullet that works for everyone. You can can bring it on through a sudden increase in playing/training regimens. Maybe you're carrying too much weight around. Perhaps there are underlying bio-mechanical issues like tight joints/muscles or improperly supported arches.
Whatever caused it, plantar fasciitis is a sever inflammation of the ligament (plantar fascia) running from your toes to your heel. Micro tears near the heel bone cause inflammation along with intense pain. At its peak, walking is very painful. The good news is that most people who get this can recover fully. But the recovery process is long and frustrating. It simply takes a lot of time for the ligament to heal itself. There are things you can do to help speed along the healing process, but the number 1 goal during treatment is to allow the body to heal without any setbacks. In the hope that others find it helpful, here is my experience.
Acute pain came during a light hitting session. Suddenly, both heels felt raw and were burning but the right one was far worse. Walking home afterwards was excruciating; I was tiptoeing all the way. Right then I knew that tennis was going to be on hold. This wasn't pain I could have played through (and I once finished a set with a fractured rib). A couple of days of icing and massage brought relief from acute pain but the heels were still very tender.
For me recovery was a slow and gradual progression from pain (shortest time frame) to discomfort to soreness (longest time frame) to mild tightness. After visiting a podiatrist who confirmed PF plus a heel spur, here are the treatments I tried in no particular order.
1. Rest: no tennis, running or jumping; around the house I stayed off my feet whenever possible
Rest is KEY. The injury will only start to heal once you cut out the aggravating activity. Playing through this injury can lead to a recovery time measured in months or years instead of weeks.
2. Insoles: I found PowerStep Pinnacles worked best, along with SuperFeet (green) in shoes with more built-in arch support. I've got medium arches and the moment I slipped into the PowerSteps I felt immediate comfort. The difference was night and day. Everybody has their own brand preferences but make sure to look at insoles with rigid arch support. Even though the pain is in the heel, an insole that prevents the arch from flattening out under load will take a lot of pressure off the inflamed heel area. It prevents over-stretching of the fascia, which is exactly what caused the injury and brings on the pain. Soft pillow-like insoles feel good while standing still but do nothing to take pressure off the injured ligament.
3. HTP heel seat <http://www.heel-that-pain.com>
These are supposed to aid rehab by supporting and stretching the fascia while you walk. These never felt comfortable and after a week they actually became painful. Haven't used them since.
4. Stretches for achilles and calves
I did these daily, as a tight achilles and/or calf can create extra strain on the fascia. I've never been overly tight in either area, but figured they can't hurt and only take a couple of minutes.
5. Strengthening
I found quite a few strength exercises online. Curling a towel with your toes, picking up marbles with your toes, etc. These are geared solely towards prevention of re-injury and do not relieve pain. I made sure to do these daily at the beginning, though I'll admit I slacked off as the heels felt better.
6. Massage
Massaging the feet with my thumbs and knuckles before taking the first step out of bed (or after sitting for a long time) did wonders. This stretched out the ligament before I put any weight on it and kept my first steps of the day from hurting. You know you've licked PF 100% when you can get straight out of bed with no discomfort or tightness in the heel. I also rolled a tennis ball under each foot multiple times throughout the day, which has a similar effect but is more gentle.
7. Icing
I rolled my feet over a frozen water bottle for 5-10 minutes after any type of exercise, prolonged standing, long walks, or instances of pain or discomfort. This helps prevent inflammation and offers immediate pain relief.
8. Taping
I payed one last match (doubles) the day after my PF diagnosis and taped both feet with athletic tape. Great support, and my feet were relatively comfortable during the match. Not a long term solution though and you have to remove the tape afterwards because it impedes circulation.
Later on, I also used Kinesio Tape (Tex Gold) <http://www.kinesiotaping.com>. This stuff is pretty cool because it allows full range of motion and promotes blood flow to the area, in theory aiding the healing process. It's waterproof, holds up through showers and sweat, and can be worn for a few days at a time. The application of the tape is tricky because its effectiveness is related to the amount of stretch you apply. Some say no stretch, others say the opposite. I had to experiment a few times with the amount of stretch until I found adequate support AND comfort. Here's the taping method I used <http://www.optp.com/userfiles/file/PDF%20Storage/Kinesio%20Taping%20Method%20-%20June%202007.pdf>
9. Night Splint
My podiatrist sold me one to keep my foot at a 90 degree angle while sleeping. This prevents the fascia from overtightening which causes the painful first steps in the morning. I wore it for 2 weeks straight, which led to some of the worst sleep I've ever had. It did help the first steps out of bed, but I found that a foot massage gave the same effect.
10. Shoes
I over-pronate and for running have worn Saucony Stabils for years. I upgraded to this year's model and went a 1/2 size bigger. This just felt more comfortable than my "old" Stabil, which sadly I had just bought on closeout a couple of months before. Foot pain, however, will make you spend money without a second thought.
I put Insoles in all my tennis shoes (KSwiss), walking shoes and even in a pair of Croc Rx Reliefs I bought for around the house.
11. Chiropractor
I went to a sports chiro hoping for some form of deep tissue massage. Instead, the chiro evaluated me and said my pelvis was misaligned. He said that the foot would heal in due time based on the self-treatments I was already doing but that by addressing bio-mechanical imbalances I would ensure the foot was not being asked to compensate and thus risk re-injury. This was the first time I've done chiro but I'm happy with the results. I've got a lot more flexibility, posture feels much better and in general everything feels much looser and freer than before. I've got much better upper body rotation and the flexibility of my right hip and leg which were always more stiff, matches that of my left side. I did 11 sessions.
If all of the above makes it sound like treating PF is a pain, It is! There were certainly times it got depressing because I was thinking about my feet every hour of the day and not always seeing improvements. But you've got to develop a plan and be committed to stick with it for weeks. PF can be beat but it requires a ton of patience. For me the hardest thing besides no tennis, was simply replacing the physical activity. Two weeks into treatment I started hitting serves for about an hour. But that started to feel like a setback so I gave that a rest too. A substantial part of my gym routine was explosive movements and those were a non-no. Getting back into cycling was good (it helped that the Tour De France was on) and was a way to continue to do some interval training. I've ended up with about 4-5 extra pounds to shed, but did do more strength work than I normally would have at this time of year.
In hindsight the only treatment I would have skipped was the heel seats. Just didn't seem to work for me. The insoles I'll wear from now on in all my shoes. I'll continue the stretches and strength exercises through the Fall and then do them as needed. As a precaution, I'm still icing my feet after tennis or exercise.
I'm slowly easing back in to my routine. I'm playing for only an hour at a time and not yet on consecutive days. I'm playing on Har-Tru courts whenever possible. This first week back, I'm feeling overall foot fatigue more than anything else, and that has been lessening with each outing, as my feet get used to running around again. One thing I won't try again till next Summer is playing twice a day, as that's what triggered the injury in the first place.
Whatever caused it, plantar fasciitis is a sever inflammation of the ligament (plantar fascia) running from your toes to your heel. Micro tears near the heel bone cause inflammation along with intense pain. At its peak, walking is very painful. The good news is that most people who get this can recover fully. But the recovery process is long and frustrating. It simply takes a lot of time for the ligament to heal itself. There are things you can do to help speed along the healing process, but the number 1 goal during treatment is to allow the body to heal without any setbacks. In the hope that others find it helpful, here is my experience.
Acute pain came during a light hitting session. Suddenly, both heels felt raw and were burning but the right one was far worse. Walking home afterwards was excruciating; I was tiptoeing all the way. Right then I knew that tennis was going to be on hold. This wasn't pain I could have played through (and I once finished a set with a fractured rib). A couple of days of icing and massage brought relief from acute pain but the heels were still very tender.
For me recovery was a slow and gradual progression from pain (shortest time frame) to discomfort to soreness (longest time frame) to mild tightness. After visiting a podiatrist who confirmed PF plus a heel spur, here are the treatments I tried in no particular order.
1. Rest: no tennis, running or jumping; around the house I stayed off my feet whenever possible
Rest is KEY. The injury will only start to heal once you cut out the aggravating activity. Playing through this injury can lead to a recovery time measured in months or years instead of weeks.
2. Insoles: I found PowerStep Pinnacles worked best, along with SuperFeet (green) in shoes with more built-in arch support. I've got medium arches and the moment I slipped into the PowerSteps I felt immediate comfort. The difference was night and day. Everybody has their own brand preferences but make sure to look at insoles with rigid arch support. Even though the pain is in the heel, an insole that prevents the arch from flattening out under load will take a lot of pressure off the inflamed heel area. It prevents over-stretching of the fascia, which is exactly what caused the injury and brings on the pain. Soft pillow-like insoles feel good while standing still but do nothing to take pressure off the injured ligament.
3. HTP heel seat <http://www.heel-that-pain.com>
These are supposed to aid rehab by supporting and stretching the fascia while you walk. These never felt comfortable and after a week they actually became painful. Haven't used them since.
4. Stretches for achilles and calves
I did these daily, as a tight achilles and/or calf can create extra strain on the fascia. I've never been overly tight in either area, but figured they can't hurt and only take a couple of minutes.
5. Strengthening
I found quite a few strength exercises online. Curling a towel with your toes, picking up marbles with your toes, etc. These are geared solely towards prevention of re-injury and do not relieve pain. I made sure to do these daily at the beginning, though I'll admit I slacked off as the heels felt better.
6. Massage
Massaging the feet with my thumbs and knuckles before taking the first step out of bed (or after sitting for a long time) did wonders. This stretched out the ligament before I put any weight on it and kept my first steps of the day from hurting. You know you've licked PF 100% when you can get straight out of bed with no discomfort or tightness in the heel. I also rolled a tennis ball under each foot multiple times throughout the day, which has a similar effect but is more gentle.
7. Icing
I rolled my feet over a frozen water bottle for 5-10 minutes after any type of exercise, prolonged standing, long walks, or instances of pain or discomfort. This helps prevent inflammation and offers immediate pain relief.
8. Taping
I payed one last match (doubles) the day after my PF diagnosis and taped both feet with athletic tape. Great support, and my feet were relatively comfortable during the match. Not a long term solution though and you have to remove the tape afterwards because it impedes circulation.
Later on, I also used Kinesio Tape (Tex Gold) <http://www.kinesiotaping.com>. This stuff is pretty cool because it allows full range of motion and promotes blood flow to the area, in theory aiding the healing process. It's waterproof, holds up through showers and sweat, and can be worn for a few days at a time. The application of the tape is tricky because its effectiveness is related to the amount of stretch you apply. Some say no stretch, others say the opposite. I had to experiment a few times with the amount of stretch until I found adequate support AND comfort. Here's the taping method I used <http://www.optp.com/userfiles/file/PDF%20Storage/Kinesio%20Taping%20Method%20-%20June%202007.pdf>
9. Night Splint
My podiatrist sold me one to keep my foot at a 90 degree angle while sleeping. This prevents the fascia from overtightening which causes the painful first steps in the morning. I wore it for 2 weeks straight, which led to some of the worst sleep I've ever had. It did help the first steps out of bed, but I found that a foot massage gave the same effect.
10. Shoes
I over-pronate and for running have worn Saucony Stabils for years. I upgraded to this year's model and went a 1/2 size bigger. This just felt more comfortable than my "old" Stabil, which sadly I had just bought on closeout a couple of months before. Foot pain, however, will make you spend money without a second thought.
I put Insoles in all my tennis shoes (KSwiss), walking shoes and even in a pair of Croc Rx Reliefs I bought for around the house.
11. Chiropractor
I went to a sports chiro hoping for some form of deep tissue massage. Instead, the chiro evaluated me and said my pelvis was misaligned. He said that the foot would heal in due time based on the self-treatments I was already doing but that by addressing bio-mechanical imbalances I would ensure the foot was not being asked to compensate and thus risk re-injury. This was the first time I've done chiro but I'm happy with the results. I've got a lot more flexibility, posture feels much better and in general everything feels much looser and freer than before. I've got much better upper body rotation and the flexibility of my right hip and leg which were always more stiff, matches that of my left side. I did 11 sessions.
If all of the above makes it sound like treating PF is a pain, It is! There were certainly times it got depressing because I was thinking about my feet every hour of the day and not always seeing improvements. But you've got to develop a plan and be committed to stick with it for weeks. PF can be beat but it requires a ton of patience. For me the hardest thing besides no tennis, was simply replacing the physical activity. Two weeks into treatment I started hitting serves for about an hour. But that started to feel like a setback so I gave that a rest too. A substantial part of my gym routine was explosive movements and those were a non-no. Getting back into cycling was good (it helped that the Tour De France was on) and was a way to continue to do some interval training. I've ended up with about 4-5 extra pounds to shed, but did do more strength work than I normally would have at this time of year.
In hindsight the only treatment I would have skipped was the heel seats. Just didn't seem to work for me. The insoles I'll wear from now on in all my shoes. I'll continue the stretches and strength exercises through the Fall and then do them as needed. As a precaution, I'm still icing my feet after tennis or exercise.
I'm slowly easing back in to my routine. I'm playing for only an hour at a time and not yet on consecutive days. I'm playing on Har-Tru courts whenever possible. This first week back, I'm feeling overall foot fatigue more than anything else, and that has been lessening with each outing, as my feet get used to running around again. One thing I won't try again till next Summer is playing twice a day, as that's what triggered the injury in the first place.
