I went for a trail run yesterday and logged almost two hours through the tall grass, wildflowers, and absurdly steep hills in my back yard. That I’m running at all feels like a miracle. That I woke up this morning with no pain anywhere in my body feels even more like one.
In December 2011, I was skiing down College at Sun Valley at a rather high rate of speed when I caught an edge, tomahawked, and my binding didn’t release. My right tibial plateau shattered into pieces, my fibula broke, and my MCL tore. The five-year journey of recovery since then has been a nightmare of slow progress, setbacks, crazy amounts of titanium screws, ever-present pain, and more surgery—my friends no longer ask how the leg is, ha. But through it all, I have been determined to get back to skiing at a high level and, to my surprise, to something that felt even more important: trail running.
Deep in the middle of this interregnum, 2013, I think it was, I finally got clearance from my trauma orthopedist to start running again, but only on the treadmill. Then I got the green light to ramp it up, still on the treadmill. One day, I ran with what passed for hard effort at the time. The next morning when I got out of bed, my left heel was so sore I could hardly walk. It got better as the day went on, and the next morning repeated the same pattern.
Figuring I’d bruised the bone, I took time off and just rode my bike. But the pain never went away, and when I’d walk or hike it would come roaring back. Maybe it was a stress fracture. I went back to the doc.
His diagnosis was plantar fasciitis, which afflicts about 10 percent of runners. The plantar fascia is a thick band of tissue that connects your heel bone to your toes, and as the “itis” suggests, fasciitis is an inflammation. It can cause severe pain, which typically manifests itself right on the bottom of the heel itself, rather than along the length of the fascia. An easy way to diagnosis it is through the symptoms I experienced: The fascia tightens at night while you sleep, is excruciating when you first start walking, and then loosens and mellows out once you use it.
That’s the conventional thinking, anyway. It turns out this simple explanation of plantar fasciitis is overly simple. One post-mortem study of people who’d suffered from plantar fasciitis showed they didn’t actually have inflammation. Bone spurs may play a role, fallen arches, even tight calves. If that’s the case, what’s causing such gnarly pain—and how do you recover from it?
A WINDING PATH
My journey to pain-free running took me several years, beginning with visits to well-intended medicos who clearly didn’t have the answer. The first doc—every doc, actually—gave me a squishy pad to put in my shoes under both heels. This alleviated the pain slightly, but had no impact on recovery. We tried a cortisone shot (three months of relief, but the pain came back). One doctor suggest eight weeks in a cast with the toes pulled back to stretch the fascia, followed by another eight weeks if that didn’t work. Another suggested surgically cutting the fascia to relieve the strain. Um, no.
The internet, that Horizont Alley of medical advice, had all sorts of suggestions. For months, I slept with the Strassburg sock, which pulls your toes to stretch the fascia. Or tried to sleep, anyway—my foot cramped, the sock got tangled in the sheets, and I had crazy dreams about being in a medieval traction device. I spent a couple months performing a strengthening exercise recommended by the New York Times, claimed as the only routine you need to cure the ailment, but only got chiseled calves and really strong toes out of it. I stretched, I taped, I never went barefoot. I bought a Sharper Image massager and used it twice a day. I rolled my arch over a golf ball while I at my desk. Nothing worked.
By this point, I was a year into it. There had been the delay when I thought time off would cure it, then the bouncing from doctor to doctor, the self remedies, and skeevy internet rabbit holes. A friend’s daughter, who runs track and suffered from PF, found relief from something called Transverse Friction Massage therapy, and I spent $600 over four sessions—subjecting myself to the indignity of paying for the worst noogies I’ve ever had. That only made the pain worse, and it was accompanied by the sharp tang of foolishness.
A SOLUTION AT LAST
Finally, I turned to the deepest source of collective wisdom there is: Amazon customer comments. Yeah, I know. But it was there on Amazon that I found the answer.
The reviewers—maybe bots, maybe sweatshop workers—raved about a product called Heel That Pain Plantar Fasciitis Seats. They cost $25 and look like every other of the 101 bajillion insoles, wedges, and gel pads sold on Amazon, except for one thing—they have a slightly more rigid plug of rubber that sits just in front of your heel, where the fascia connect to the bone. This had the effect—I’m assuming—of supporting, pressuring, and stretching the fascia.
User comments warned of days of pain, as if a massage therapist was working a pressure point without mercy. For me, it didn’t feel that bad—it hurt initially, but the fascia seemed to chill out within a few hours. The next day was slightly uncomfortable, but by two day I didn’t notice it any more. Within a week, 90 percent of the pain was gone. It was as if someone had spun the dial from 11 to 1. After all I'd been through, it seemed nigh on a miracle.
Over the next year, I slipped the inserts into every shoe I wore. I never went anywhere without them. And over time, slowly—very slowly—but surely, the pain went away.
Eventually, I had all the hardware taken out of my leg. It affected my gait and was excruciating inside a ski boot. When the surgical wounds had healed and I was able to walk, I felt like me again for the first time in years—a weaker, older me, but still. For most of 2016, I hiked and hiked and hiked. My knee creaked and swelled from time to time, and the left heel let me know it was there, but only occasionally and it never debilitated me. By fall, I started running—slow, short distances, as low impact as I could. At first, I experienced minor pain in the heel, perhaps from the bone spur that X-rays revealed, but then less so and now never.
So, here we are. It’s been a hella long journey. I’m six years older than when I got hurt, and I wasn’t young then. I was never a fast runner and I’m sure not now. But I don’t care about that–if I can hang on for a couple hours and do it without any pain, other than the expected and deserved muscle soreness, I’m on top of the world. Skiing has been the center of my life for so many years, but trail running feels like life itself.
Will those wedges help your plantar fasciitis? Heck if I know. My personal experience suggests to me that no one really knows whether you have plantar fasciitis or even precisely what it is. Paul Ingraham of Pain Science isn’t a doctor, but he’s right when he says, “Unfortunately, there are so many possible causes of plantar fasciitis — probably several of them happening at the same time — that it is effectively impossible (or just extremely impractical) for therapists to make any confident biomechanical diagnosis. It’s simply too complicated an equation, and the scientific literature is riddled with contradictions.”
That means you have to take responsibility for your ownrecovery, and it probably won’t happen without trial and error. So maybe you can learn from my errors—and one great success. Good luck.
Here's that link again: HTP Plantar Fasciitis Seats.
Words by Stephen Casimiro // Top photo by Brian Erickson