I experienced something similar last fall - below are some notes I wrote to myself to try and help someone else. Some of the pictures didn't come across in the cut and paste. Last week I had my first pain free (at least no left foot pain) in about four months. In addition to everything below, I've also been doing some light plyos a couple times a week - this has helped to increase ankle flexibility without pain the next day.
Good luck.
PLANTAR FASCIITIS THOUGHTS – December 2015
Anecdotal Thoughts:
Similar to the last episode in 2007, both feet experienced plantar issues. Left foot dramatically worse this time. Extreme pain after a treadmill run where pain switched from medial to lateral in the left foot. Likely related to propensity to overstride on a treadmill, creating additional load bearing on the lateral portion of the heel. Original pain started after a 2 hour run, noticed extreme tightness in lower left soleus, with extreme trigger point response. Other issues present before the onset of pain – left glute and left hamstring had been tighter/slightly sore compared to the right side for months beforehand. Could definitely feel these specific left side issues when doing Supermans. Arches also sore, but likely related to long runs and more running on pavement, as well as higher mileage on one pair of shoes. Long runs were also being performed in the early morning, likely putting more pressure on the plantar. After onset of pain, continued to run every day from 1-5 miles, with 12 trips to Physical Therapy. Shoes that tightly gripped the heel (for example, motion control shoes or hard dress shoes) created tremendous pain around the lower Achilles/back of the heel.
From a biomechanical perspective, I have to wonder whether this can be attributed to the left ankle break in 2001? Are my foot mechanics also compromised by the big toe arthritis in both feet that I’ve experienced since the mid-90’s?
Overview of Plantar Fasciitis:
Below are the links to several good overviews and treatment discussions:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC385265/
http://www.runningwritings.com/2013/02/injury-series-plantar-fasciitis-in.html
http://www.northcoastfootcare.com/pages/Heel-Pain-and-Plantar-Fasciitis.html
http://www.dubinchiro.com/plantar.pdf
http://www.mshc.net/files/download/plantar%20fasciitis.pdf
http://blogs.bmj.com/bjsm/2014/09/15/plantar-fasciitis-important-new-research-by-michael-rathleff/
http://www.stretch-works.com/differential-diagnosis-of-heel-pain/
Treatment Thoughts:
Cortisone shot – from comments made in numerous articles, although the first shot provides some relief, continued shots appear to contribute to fascial weakness. A definite no-go for me, strikes me as a bad idea.
To ice or not? - there is substantial debate in the literature about whether there is inflammation associated with PF. In the extreme short-term, in my opinion icing helps to numb the pain. Some articles have suggested alternating hot/cold to increase blood flow/reduce inflammation.
Night Splints/Strasburg Socks – there doesn’t appear to be any evidence against using these devices, except for poor sleep. As a stomach sleeper, I’ve chosen to let my feet hang off the end of the bed. Given the shortening of the fascia during sleep, it has been suggested that you perform a big toe/arch stretch before the first step in the morning to relieve/avoid the first step mayhem of the morning, when the PF reacts to being stretched in a load-bearing position while compromised and shortened.
Medications – this of course depends on whether or not you believe inflammation is associated with PF.
ASTYM/Graston/Dry Needling/Shockwave/Platelet Spinning/Massage – I’m grouping all of these items together because they seem to me to be different versions of trying to accomplish the same thing – remove scar tissue, regenerate and remodel through manipulation/blood flow. I do believe this speeds up the recovery process – but obviously there is a price/value equation that needs to be examined.
STRENGTHENING/STRETCHING THOUGHTS
Direct Targeting – Eccentric heel drops have been shown to help Achilles tendinitis by helping to reorient the collagen fibers to normal through eccentric loading (the Alfredson Protocol). There is some discussion in the literature about this being used to help PF. The only direct study I could find in this area was in the Rathleff article, which researched a slightly different exercise, as shown below and discussed in that article:
Intrinsic and Extrinsic Muscles – There are several articles that discuss the windlass mechanism of the PF, and the impact of very small muscles/tendons on the ability of the PF to function given this mechanism. Historically certain researchers have thought that overpronation was a contributor to PF, but my review of the literature would indicate that both over and under pronation can be contributors, with no bias between the two as an indicator of susceptibility to PF. Seated calf raises and ankle exercises for eversion and dorsoflexion are recommended, as well as toe scrunches. In addition, I came across an article that discusses the use of bands for strengthening the Flexor Digitorum Brevis and Flexor Hallicus Longus.
I also just isolate the big toe with the band (Flexor Hallicus Longus), which tends to produce a response in the soleus right where the original trigger point pain was at the beginning of the PF fun!
Calf Stretching – The literature suggests that calf tightness contributes to either the ankle not dorsiflexing properly, causing overpronation, or calf tightness putting too much strain on the Achilles, causing underpronation. Almost every article I read would indicate that calf stretching/calf strengthening should be part of a rehab program.
Glute/Hamstring – I’m a big believer that glute weakness starts problems down the chain, with weakness attributed to age and sitting on my butt 12 hours a day. There are several articles that discuss these issues.
Great, but how do I beat this?
1) Use night splint/Strasburg sock/hang toes while in bed. Self release the plantar by pulling the big toes before getting out of bed. Before at least two sets of big toe pulls per day.
2) Running – slowly increase run/walk components as the injury heals. I have no opinion on shoe issues, given the presence of PF in under/over pronation. I do think that a more flexible shoe promotes foot health, but PF may restrict use for awhile, especially if access to soft surfaces is limited. Given the severity of my PF, I started back going 1 minute running/1 minute walking for 15 minutes daily for one week.
3) Stretch the soleus/gastroc right after a run or other exercise.
4) Roll foot over ball/massage several times a day to generate blood flow and regenerate.
5) Roll calves over foam roller at least once day.
6) Ice as desired, I plan on icing once a day at night.
7) Perform the exercise illustrated above once a day that involves a calf raise/eccentric heel drop on one leg while barefoot for collage remodeling. Increase reps/sets/add weight as pain dictates. Perform basic seated and standing calf raises throughout the day.
8) Use a band and perform the toe exercises isolating toes 2-5 (Flexor Digitorum Brevis) and the Big Toe (Flexor Hallicus Longus). Perform multiple sets daily. Also perform toe scrunches for a minute at least once a day.
9) With and without a band, perform exercises to evert and invert the foot. Perform multiple sets daily to increase ankle flexibility and strength.
10) For overall glute/adductor/abductor/quad strength – perform band walks twice a week, alternating side to side (basketball defense slide drills) and forward Monster Walks (exaggerate leg swing out). Twice a week after running and stretching perform backward/side/forward lunges.
11) Heavy dose (800 mg) of ibuprofen in the morning.