Finished (?) my Plantar Fasciitis Prevention Challenge

[CBDB]

Well, it took me 12 days to finish the Plantar Fasciitis Prevention Challenge (healthunlocked.com/strength... but my tiny PF niggles are disappearing, almost gone!

I never had a severe pain, just at times a slight ache in the mornings at the telling locations on my foot. So I suspected if I didn’t do anything to strengthen my arches, it might grow to something more severe.

So I started to look into the science of PF, read a few of the newest scientific papers, listened to podcasts and committed to starting some particular strengthening exercises.

And when a couple of forum friends came down with PF, I put together this PF Prevention challenge.

What I’ve learned from this journey and from comments of posters is that although one solution doesn’t fit all, there are many little things we can embed into our regular patterns of our running lives that are likely to help ease the PF pain.

What worked best for me are - I think - the following, in order of my perception of positive impact.

But there needs to be this caveat: These worked for me, someone with tight calves, a relative good exercise load of 60min average per day, but carrying some weight, doing only low impact and being a very slow runner and not getting enough walking in. So what worked for me, as set out below, not necessarily will work for anyone, and that’s of course is where trying out different stretches as set out in the PF prevention challenge, or getting the help from a specialist to figure out best exercises, can really help.

Having said all this, these things helped me were:

1. FOOT HEEL MASSAGE : I had started with massaging my feet after each shower, doing what they call deep, little windshield wipers. But I think what was a game changer is to massage my heel as well as the balls of my feet in a way that would break up any fascia tensions beneath the hard skin. Video below. This is in my mind the key change I made when noticing a distinct lessening of aches. Before, I had avoided massaging heel or balls of the feet.

2. ROLLING LOWER CALVES : I regularly roll my calves after rowing, which is ca 5 times a week. But 2 things about the roller session made the difference in my mind. a) I focus particularly on the lower part of the calves rolling all around the sides as well. From the painfully tight spots whilst rolling I realised at that time that I may not have rolled low enough to relief some fascia tensions in the lower part of my calves, possibly not giving me sufficient release and keeping my calves too tight. b) I also started using a longer roller to roll my upper back. I’m not sure this is related to PF, but I certainly get more tension release in my back now, and knowing the posterior chain is all connected, it all may help. These two rolling movements are in my case easily integratable into every post-row stretch routine.

3. CALF RAISES WITH TOES UP: I've done calf raises before, but the trick to do them with toes bent upwards (using a rolled up towel) was new. The towel now lives in front of my wardrobe, and before getting dressed daily, I’ll put in a few calf raises with toes on the towel. Very easy to integrate daily.

4. POST-RUN CALF STRETCH WITH CROSSED LEGS: During my looking into effective stretches, I found the advice of tweaking the classic standing calf stretch to include crossing front leg in front of the other. I’m not exactly sure what it does, but the stretch in the back leg goes deeper into the calves and may also include a different group of deeper set of calf muscles. Not quite sure how it contributes, but it feels good and is easily added to the standing calf stretch I already do after each run.

5. ALL SORTS: and then there are the multitude of all sorts of adapting positions and opportune movement snacks; a) I love sitting cross legged on floors, beds and couches and I often now make sure that some of the time I keep my toes flexed against my other leg; b) in the morning I do some ankle circles to wake up my calves; c) whilst brushing teeth, I do some calf raises; d) when moving about the house, I often now go on tiptoes.

Videos with demos:

1. FOOT HEEL MASSAGE (Video by Rebel Massage)

youtu.be/PDa_bXscXWE?si=Rz7...(Not working as expected?)

2. ROLLING LOWER CALVES (Video by Caroline Jordan)

youtu.be/21aObP8kHvk?si=8i1...(Not working as expected?)

3. CALF RAISES WITH TOES UP (Video by Spectrum Performance)

youtu.be/rxz8pddpdqE?si=Zmt...(Not working as expected?)

4. POST-RUN CALF STETCH WITH CROSSED LEGS Video by Athlean-X)

youtu.be/NE0GqcRb9f8?si=NKd...(Not working as expected?)

[skysue16]

very interesting and useful videos, thanks for posting 😊👍

[MrNiceGuy]

Although pre-existing PF niggles remained slight and few before creating the challenge, after settling upon a few 'favourites', it was nice to see calf raises with toes in dorsiflexion 'feeturing' alongside rolling, stretching and massage.

Due to a combination of ongoing inconsistencies, over-prescription of orthotics (which are not supported by literature) and a lack of firm consensus over its development, a gold-standard protocol for treatment of PF still remains some way off.

However, literature that recognises structural similarity between the PF and tendinopathic tissue, and changes that occur as a result of overload/through AGEs (advanced glycation end products), also recommending that the PF ought to be rehabilitated in the same manner as tendinopathic tissue, does indeed provide promise in establishing a gold-standard treatment protocol that has remained absent for so long.

The missing link? Whilst massage, rolling and stretching may feel enjoyable, easy and provide symptomatic relief, none of the above actively LOAD the PF, do they?

With toes dorsiflexed throughout and plantar fascia remaining engaged as heels both elevate and lower, perhaps your slight PF niggles remain fewer due to continued and regular active LOADING of the 'tie-rod' that prevents a full and 'toetal' collapse of the foot.

Since passive still seems the way (massage, rolling, stretching), I'm simply throwing active LOAD into the overall equation/jigsaw 🤷‍♂️.

[CBDB Administrator Graduate Gold in reply to MrNiceGuy]

I think you are saying (and correct me if I misunderstood), calf raises (single and double) are good here?

As many of us, I’ve been adding them wherever I can and came across these two fascinating videos:

James Dunne Runner Test:

youtu.be/1GmFvyH9Hd8?si=-oI...(Not working as expected?)

And

Chase Mountain’s At home leg day

youtu.be/3Hj8YMJvdmA?si=zsg...(Not working as expected?)

Both don’t have the raised toes, but do emphasise the load?

[MrNiceGuy]

Whilst regular inclusion of such is recommended to improve PF engagement throughout when performing calf raises on a flat/level surface, not every bilateral or unilateral calf raise exercise/ functional strength test (as demonstrated by James Dunne) requires toes to begin in a position of dorsiflexion.

Although 'go-to' treatments for many do indeed remain passive in nature (rest, icing, rolling, taping, orthotics, splints, etc), I wasn't at all suggesting that they may not provide symptomatic relief, nor was I suggesting that a calf raise with toes in a position of dorsiflexion remained the panacea.

Since passive is easy, and since PF symptoms commonly arise through running loads exceeding capacity, is actively loading the PF, thus, improving its tensile strength, not the missing piece over-looked by many?

As such, following onset of PHP (plantar heel pain), depending upon severity of discomfort, does it not make sense to simply reduce (but not necessarily eliminate) weekly running miles and increase focus upon improving tensile strength?

All too often, a completely passive approach is taken following onset of pain, as many think "I must rest this until discomfort has subsided." "Ok...ok...so you've rested your PF and you've rolled and you've iced it (which do feel really good). In the month since last you ran, however, what have you done to actively strengthen your PF?" 🤔

Sadly, the above remains a familiar conversation I have with in-clinic patients who routinely view their feet as 'second-class'. Due to the increasing level of disconnect that many have with their feet (they're unsightly, they stink, they shouldn't be seen, etc), it's not until they're asked how they'd remedy glute-med or hamstring weakness that the penny eventually drops.

For example, 95% of recreational/semi pro athletes I see don't know that 25% of the body's bones and muscles exist within their feet...something that continues to startle me (and not in a good way 😔)

Anyhow...I digress.

Despite inclusion of standard straight/bent leg negative heel raises (Chase Mountain, whom I greatly admire for single-handedly taking on Steve Sachen of Xeroshoes, needs to focus upon improving medial gastroc/arch strength to prevent excessive foot supination/transfer of weight towards lesser toes (only a biomenchanist would spot that that weight transfer wasn't taking place through the hallux/1st MTP)), for those whom negative heel raises cause discomfort due to ongoing Achilles' tendinopathy issues, for example, toes in a position of dorsiflexion on a towel on a flat surface remain a viable method for improving PF strength without aggravating the AT.

Of course, recognising how conventional footwear results in displacement of the talus from its anatomically correct position, as a biomechanist who understands mechanisms of PF injury perhaps more than most, talocrural (ankle) kinematics would be improved too, as would ankle evertor strength, thus, improving overall ADF RoM (another common cause of PHP).