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PF Recovery, Day 4

4 days pain free! Even on first step out of bed…

I never thought I’d be saying that so soon, but it’s true. Hopefully it’s not just the cortisone, but that there is some healing going on as a result of wearing the inserts and avoiding running. It’s been two weeks tomorrow since I’ve run on the foot, and I’m getting antsy, but am just glad I can continue to stay fit by going to the gym and swimming. I’m very thankful for that.

I’ve also been thinking a lot about this, and I’m definitely modifying my goal for this fall. I’m certainly not doing the marathon, and I think I’ll defer Richmond until next year because I really want to run Richmond. I will pick a 13.1-miler or 10K, and use the training to establish a base that will help me reach my goals of a 6 minute mile and a 75 minute 10-miler.

Revising my goal will allow me to be flexible about really listening to my body and my foot, rebuilding some of the lower body coordination and strength I may have lost due to not lifting heavy squats/deadlifts and not doing hill sprints, and changing the way I work in faster intervals.

PF is a really remarkable thing. As I said, there were a couple very interesting posts here and here on PF I found informative on runresearchjunkie.com. These posts (aside from a YouTube video I have to find the link for you for) are hands-down the most informative and credible pieces on PF written for the general audience. Virtually everything else I’ve read is either solely anecdotal accounts or polemical position-focused writing. 

Both articles deal with the science of PF’s etiology, natural history, and effectiveness of treatment strategies. You should read runresearchjunkie’s write-ups, for sure, but the rundown is as follows. First, there seem to be relatively few effective treatments when compared with the natural history (i.e., course of PF without any intervention or treatment). These effective treatments are basically limited to *rest*(!!, which I guess to some folks is the same as natural history), low-dye taping, orthotics, and cortisone shots. Almost everything else you see advocated as effective courses of treatment have not been demonstrated in randomized, controlled clinical trials (RCTs).

Now, if you read the running blogs or do a quick Google search of “plantar fasciitis treatment running” or some combination of plantar fasciitis and athletics, you will believe that the treatments I’ve described are wholly ineffective. First off, many writers seem to believe that cortisone therapies are actually harmful, when in fact, they are demonstrated in RCTs to be effective. I believe much of the controversy centers on the risk of PF rupture. As I wrote previously, PF rupture seems to be associated with cortisone shots when the drug is administered wrongly, or the athlete decides to return to normal activities too soon. Orthotics are another controversial treatment, if you were to believe the anecdotes on running blogs, etc. Some people swear they are worthless. However, one must be careful to define what is meant by “orthotic.” First off, if orthotic includes custom and generic, then it is clear that orthotics are effective. The question seems to be, “Should I sink $100s into custom orthotics or buy a good off-the-shelf orthotic?” The answer to this question is, in fact, more equivocal, with some podiatrists instructing their patients to purchase OTC orthotics before they try prescription orthotics. Nonetheless, orthotics are clearly effective, and demonstrated so in  RCTs.

I think that the problem seems to be in the tension between the expectations of the athletes and the reality of PF. First off, just because a treatment is demonstrated effective, doesn’t mean that it is foolproof. For example, suppose the natural history (course without treatment) of PF is that 50% of patients are returned to normal activity after 4 weeks of rest (I’m just throwing these numbers out there as examples). Well, if cortisone returns 55% of patients to normal activity after 4 weeks of rest in an RCT, then cortisone would be demonstrated an effective treatment. But, what this says is that there is a relatively small effect size (true for almost all PF treatments, regardless of the actual numbers) meaning that there is relatively small improvement in treatment efficacy over the natural history. When athlete sees a doctor or a physical therapist, what they want is fool-proof, not something slightly better than their current inability to perform. Yet, that’s what you get with most PF treatments, and hence why there’s so much controversy and passionate debate about this topic based in anecdotes and personal experiences. PF takes time, rest, and seems to resolve itself over time. The control of this recovery, unlike the recovery from many other types of injuries an athlete can suffer, is simply out of their–or their care provider’s–control.

If you have PF, you know that it tests your ability to trust the process and be patient. Have you had PF? Are you able to let go and listen to your body while letting the process work?

Peace and blessings.

Published in athletes injury rehab personal development plantar fasciitis running