Chronic Plantar Fasciitis Treatment For Those Who’ve Tried Everything

Research-Based Approach to

Chronic Plantar Fasciitis Treatment

It worked for Elise

chronic plantar fasciitis

Heel pain was ruining Elise’s runs, and she really is a runner.

The boot didn’t help. Orthotics made it worse.

Tom’s had Elise running 16 miles, pain-free, within a week.

It’s a cure based on eight years of research.

chronic plantar fasciitis

Individual online survey data, converted to 1, 0, -1, or absent, and clustered using Cluster/Treeview Software. Note lower right group (more red), who generally don’t respond to the treatments selected for the study.

Why is Tom still fighting the dangerous craziness of heel injections:

Here’s why:

chronic plantar fasciitis treatment

Getting this idea across is like swimming through treacle. Fun but tough. You could call it chronic plantar fasciitis treatment chronic marketing.

During his online research,

Tom found two groups of plantar fasciitis (NFP) heel pain sufferers.

It’s all explained in this ebook.

chronic plantar fasciitisThey’d tried multiple guaranteed cures.

They still had horrible morning or runner’s heel pain.

The doctor diagnosed plantar fasciitis. A better name is Nociceptive Foot Pain, by the way.

They were looking for a solution in all the wrong places.

Such places can include their painful heel or their calves.

They needed to think again!

–ooOoo–

A relevant story from the book:

Pain Puzzles

chronic plantar fasciitis

 

Puzzle, transitive verb

To offer or represent to (someone) a problem difficult to solve or a situation difficult to resolve : challenge mentally; also : to exert (oneself, one’s mind, etc.) over such a problem or situation they puzzled their wits to find a solution.

– Miriam-Webster Online Dictionary

It’s the summer of 2001, and Tom, in his late 50s, is watching the Lake Placid Ironman race. Lake Placid is a quiet little town in up-state New York, not far from the Canadian border. Well, it’s quiet unless the Ironman race is on, which happens every July. A full Ironman race includes a 2.4-mile swim, 112-mile bike ride, and a 26.2-mile marathon, all in one day. Are these people crazy?

Three thousand athletes of all ages have stationed themselves in the beautiful, crystal clear water of Mirror Lake. The water reflects a cloudless blue sky and the breathtaking Adirondack mountains. It’s a perfect backdrop to a perfect day. Cool, a light breeze, low humidity. What could be better?

The crazy people in the lake are awaiting the starter’s gun. It goes off  at 7:00 am, on the dot. Sitting in a cold lake is not Tom’s idea of fun. The thought makes him shiver. Tom looks down on the water from a grassy bank. One of the white, pink and blue swim caps is on the head of his youngest son, Nigel, a good-looking, tall, muscular young man. A remarkable athlete.

Tom is a proud father and spectator. The energy of the competitors and the excitement of the crowd sucks him in, as he watches the swim start. Three thousand bobbing heads turn into a churning mass of arms and legs. Each swimmer must force his or her way through the maelstrom. To Tom, a swimmer and water-polo player in his youth, this looks pretty dicey for the weaker swimmers, at least.

At the swim-finish-to-bike-transition, Tom watches Nigel head out on his triathlon bike, giving his dad a friendly wave as he goes by. Nigel looks completely relaxed, unfazed by the 2.4-mile swim, which he completed in less than an hour. He’d told his dad that the swim was the easy part. By the early afternoon, Tom is stationed in an ideal spot to watch Nigel return on his bike from the Adirondacks, and to start the run.

The last leg of an Ironman is a grueling marathon.  In less than 10 hours from the swim start, Nigel makes the final turn to the finish line, at the high school stadium. Tom leans on a retaining fence, a hundred yards from the finish. It’s a noisy, energetic place, full of family and friends, everyone jockeying for a better view as the athletes enter the stadium to deafening applause.

Then, from the loudspeakers comes the announcement: “NIGEL MORGAN, YOU ARE AN IRONMAN.”

I’d like to do that, Tom thinks. And he does. Takes him ten years.

On that July day, in 2001, leaning over that fence, little did Tom know what he was letting himself in for. If there were any weak links in Tom’s physical or mental chains, the Ironman would reveal them. He was pretty fit for an older guy, but he was no Ironman: five foot six, built more like a wrestler than a cyclist or runner, with skinny legs and a big head. A nerd, not an athlete.

Tom’s decision, made in the heat of the moment, was to take him on a painful journey. He was about to learn a great deal about physical pain, including heel pain.

Swimming

As an enthusiastic water polo player, in his youth, Tom knew how to sprint in the pool. But long-haul, open-water swimming? Not so much. Then he discovered the Total Immersion Swimming Technique, created by real long-distance swimmers, who swim of tens of miles in the open ocean. It’s about balance and endurance, not speed, as is the Ironman, when you undertake it in your sixties, seventies and beyond.

The effect of Total Immersion on Tom’s swimming efficiency was remarkable. It also led to him to understand the critical role of balance in body movement, whether swimming, biking or running. After he’d conditioned his body in the pool, Tom’s long-distance swims were up to snuff. This lesson would prove important to his later studies of “plantar fasciitis,” which Tom would come to call nociceptive foot pain (NFP). But that’s getting ahead of the story.

Poor balance, in the water or on dry land, leads to constant, generally imperceptible corrections.

OK! First part worked out. Only took a year or so.

Cycling

Tom cycled a lot as a youngster. One hundred and twelve miles through the Adirondack Mountains would be tough, but doable. For the next few years, Tom biked thousands of miles, with a cycling partner, Rory, an experienced cyclist. It took several years for Rory to knock Tom’s cycling into any kind of shape.

Tom’s success on the bike was revealed by a comment from Rory, about sixty miles into a long ride. “Say, Tom, let’s do this extra twenty-mile loop. It’s one I like, and it’ll bring our distance up to about a hundred miles for the day. What do you think?”

Tom agreed, and Rory pulled away. All Tom could do was hang close to Rory’s rear wheel. The twenty miles were a grueling battle to not be dropped, as cyclists say. As Rory and Tom reached the end of the extra loop, Rory spit out, “You fu**er!” Rory then admitted he’d been trying to drop Tom the whole time. Tom felt both dog-tired and triumphant on the ride home.

Competitive cycling is very much about mastering pain. You soon learn the difference between good and bad pain. Good pain leads to conditioning and better performance. Bad pain indicates risk of injury. It takes a while, and a few injuries, to recognize the difference. Furthermore, balance is critical for safe bike handling and performance. For cyclists, rule number one is, keep the rubber side down!

Running

Tom was starting to develop a level of Ironman fitness and skill. This was becoming a way of life. Now to add the running piece. Shouldn’t be too bad, Tom told himself. Little did he know!

Tom hadn’t enjoyed running in his youth. His legs lacked the stamina for it. Mild rickets as a toddler, due to poor nutrition, led to weak bones and joints, one of the effects of World War II. Tom was born in England in 1943, eighteen months before the end of the war. Even though his Mum did a great job, food, especially good food, was scarce for the first ten years of his life. War is hard on kids.

War and rickets aside, you can’t complete an Ironman without learning how to run a marathon on tired legs. He took lessons from his triathlete son. “You run like a loaf of bread,” Nigel said, without explanation. It meant that Tom had no idea how to engage his whole body, while running. So he hired a coach and took running lessons, gradually increasing the distance.

Then trouble started. Every time he made it to five miles, his right knee expressed extreme distress. Pain! The deep, throbbing, “you-have-to-stop-running” kind. His coach recommended the gold standard of rest, ice and stretching, plus pain relief gel and a heating pad. Nothing helped.

Tom knew he had to fix this knee pain if he ever hoped to complete the 26.2-mile run segment of his Ironman dream. Over the next year, he tried everything he could think of to pass the five-mile running barrier. Finally, unable to solve the knee pain on his own, he sought professional medical help. As he had a well-paid job and health insurance, money wasn’t a major issue. But where to seek advice?

His coach suggested a sports physician. Nigel recommended his friend Dave, a talented triathlete and sports physician, with considerable experience of running problems. Dave applied ultrasound to Tom’s knee. This he combined with running analysis videos and X-rays. They worked on relaxing Tom’s leg muscles, along with strength training. But after weeks of work still no improvement!

In despair, Tom moved on. Several fellow athletes suggested a chiropractor, so he gave it a go. Two well-known chiropractors later, Tom still could not pass the five-mile run barrier. Knee pain stopped him around five miles, every time.

“How about a sports massage therapist,” one friend suggested. He went to a masseuse, Carolyn, who works with the UNC-Chapel Hill track team. In the process, Tom learned a great deal about tight muscles. He also experienced how painful and effective sports massage can be. In spite of Carolyn’s remarkable massage skills, nothing changed.

Was Tom’s Ironman dream becoming an expensive nightmare?

To keep a long story short, there was no improvement. Not with Yoga, kinesiology, or acupuncture. Nor with several podiatrists and their expensive orthotics, and two physical therapists. Each of these experienced professionals scratched their heads, then presented their bills for payment.

A second sports medicine physician diagnosed an inflamed bursa in Tom’s knee, and injected the anti-inflammatory drug cortisone into the bursa. It hurt a bunch, but made no difference in Tom’s running.

A year gone by, over three thousand dollars spent, and nothing to show for it.

There was a bright side, however. Tom gained insights into the nature of a wide range of physical therapy disciplines. Later, he would benefit from this experience. But what about the Ironman?

Moshe to the rescue

One sunny day, Tom was wandering around his favorite coffee shop and health-food market, when he ran into Karen, an attractive and soft-spoken woman. “Hi, Tom, what’s up?” she said. “Haven’t seen you since I left science, several years ago.”

Karen informed Tom that she’d abandoned molecular biology to teach the Feldenkrais Method, a method invented by Moshe Feldenkrais, after he suffered a serious knee injury while playing soccer. Moshe used his approach to return to his beloved soccer. “The Feldenkrais Method is now employed all over the world,” Karen explained. “It’s used to help people recover from injuries. Both athletes and musicians use Feldenkrais to improve their performance.”

Tom said, That’s interesting. Do you think you can you fix my running-induced knee pain?” Tom told Karen about his litany of attempted cures, and she said that she would be happy to give it a go. The following week, Tom arrived at Karen’s house, expecting another failure for his $70.

First, Karen asked him to walk around her home office, while she watched. Then she said, “Stand in front of me, relax, and sway from side to side.”

Tom did as instructed.

Tom’s understanding of the pains of body movement were about to change forever. Karen spoke these magic words:

“Tom, did you know that when you sway to the left your body remains straight? When you sway to the right, your shoulders rotate a little. Your right shoulder moves forward a few millimeters.”

He looked down, and there it was! But what did it mean?

“Have you had any serious accidents in the past?”

“Well, I did have a motorcycle wreck about forty years ago, which broke my right ankle.” He couldn’t imagine what that would have to do with anything.

“I suspect that you’re guarding, or locking, that damaged right ankle. This forces your body to turn around your hips, as you sway to the right. Do you have more trouble balancing on your right leg?”

The jig was up!

He’d been locking that right ankle ever since a motorbike wreck in his teens. Guarding, or psychosomatic tension, protects damaged tissues in the short-term. If it becomes a habit, however, guarding or locking can lead to problems. Tom had effectively immobilized that painful ankle to protect it after the motorcycle wreck. He was still doing it more than forty years later. This impaired the movement efficiency of his right leg. It also made it hard for him to balance on that leg.

Balancing on one leg requires constant fine adjustments of the ankle to stay upright. It would appear that balance is also critical for effective running. Karen concluded that this strain was causing the pain in his knee, after several miles of running.

It had no effect on Tom’s walking or cycling, but running is less forgiving, as is balancing on one leg. His knee pain was due to an issue with his ankle, believe it or not! And Karen had diagnosed it by simply observing the way he moved! Critically, she hadn’t assumed that pain in his knee was due to a primary problem in his knee.

Two millimeters rotation of his shoulders, less than the thickness of a couple of dimes. This tiny movement revealed the cause of Tom’s running pain. It directed Tom to pay attention to his ankle, his accident history, and the study of body movement. It also raised Tom’s awareness of the critical nature of balance when running.

Fixing his ankle stiffness fixed Tom’s running-induced knee pain. The pain was an action signal, all right. The action needed wasn’t in his knee, but in his ankle.

Pain as an action signal

If pain is an action signal, not a damage meter, what action did Tom need to take? It was simple! Tom had to stop locking that ankle, and return it to its normal flexibility. This involved breaking down scar tissue from the wreck, and improving joint mobility. Tom followed the advice of Bruce Buley, an excellent physical therapist.

The work involved using a hand towel wrapped around his foot, to twist it to the outside. This stretched his ankle away from the area of scarring and tightness on the inside.  Tom’s ankle had been caught between an incoming car and the metal kickstart lever of his heavy motorbike (OUCH!) all those years ago.

Bruce also gave Tom a copy of a remarkable book Running With the Whole Body, by Jack Heggie. It’s based on the Feldenkrais Method. Along with Chi Running, by Danny Dreyer, this method created Tom’s eventual low-impact running style. Otherwise, Tom would never have qualified for the Boston Marathon, at age 66, in 2008. All part of his Ironman training.

Within weeks of his meeting with Karen, Tom was running pain-free for ten miles or more. He went on to complete the Lake Placid Ironman five times, in his late sixties and early seventies. The fourth to last time Tom completed this race, it saved him from an early death, as it led to his detection of a massive abdominal aortic aneurysm, about to burst. But that’s another story.

Fixing heel pain

Tom’s knee pain story played a critical role in his understanding of the nature of pain. Tom had learned that the interpretation of pain is not always a simple matter. He suspected that it’s always trying to tell us something, but the message is can hard to puzzle out.

 

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.