Keeping the plantar fasciitis research ball rolling.
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If you know someone with a plantar fasciitis story to tell, please let them know about us and our project, or share our letter on Facebook and Twitter, as someone out there may have just the information we need to make sense of this whole thing. THANKS!

"Patients with conditions such as tennis elbow and plantar fasciitis, which triggers pain under the heel, are being injected with their own blood to boost healing. Fleur Allen, 37, a restaurant manager from Blaby in Leicestershire, had the treatment and tells CAROL DAVIS her story," in the Mail Online at
this link. Fascinating!

"Extracorporeal Shockwave Therapy, or ESWT, is a treatment that was originally used for treating kidney stones however its other uses soon became apparent.  It is a non-invasive treatment that can be given in the outpatient clinic, no operation or anaesthetic is required.  ESWT uses energy generated in a hand held applicator which is administered to the painful tissues"
The Hampshire Foot and Ankle Clinic.

A friend of mine was fed up with rolling and massage, so he gave this a try and he is back running, pain free. Worth a try, but he said it is painful and expensive.

"Dear FitOldDog & Rebecca,

I'm a 66 year old male runner who took up the sport at the age of 33. I first encountered PF in the ball of my right heel in 2004 and found that trying to run through it only made it much worse. I was in so much pain after only a mile into a training session that I had to hobble home. I have no idea what brought it on. I had experienced an uncomfortable feeling in my heel and only realised what it was after it suddenly became really painful.

I saw my GP and a physiotherapist, tried ice/hot and cold treatment, rolling my foot on a golf ball and other objects recommended on relevant websites (hadn't discovered yours then), various stretches, foot lifts, etc. all to no avail. I eventually saw a podiatrist, who made me some orthotic inserts for both my running shoes and dress shoes (simply standing and walking about had been painful). He also suggested that I tried a different type of cushioned training shoes with more "give". I'd been using Asics Gel Kayano so switched to Nike Air Structure (I'd used Nike previously for years until they got the fashion bug and made those open air bubble shoes that didn't last long enough to justify their price). I still had to lay off running until the symptoms disappeared and only then could I start to train and gradually build up mileage. In total, I had to rest from running for about 7 months.

I continued to use the orthotics in my trainers, although their thick cushioning raised my heel rather high in the heel cups. For that reason, I did not use them in my road racing flats or cross-country spikes. Nevertheless, I regularly renewed the orthotics for fear that PF would return if I trained high mileage without them. I was free of PF for 7 years.

In December 2011, I felt mild symptoms of PF in my left heel and thought I could nip it in the bud this time. It might have been brought on by the fact that I'd been having difficulty tightening my laces due to having a broken right arm (the result of a slip when running down a steep fell/mountainside). Despite my broken arm, I'd jog to the gym to exercise the parts of me that weren't broken but my feet were slipping around in my shoes causing slight friction. My precaution at the first signs of PF was to no avail. I avoided any form of running/jogging full stop in the hope that the PF would quickly disappear but it did not. Indeed, it got worse on occasions when I had to stand for an hour or more.  I kept myself fit by swimming, riding my bike and using  a cross-trainer (as I had done in 2004). I used all the various treatments I'd used before, saw specialists, had a cortisone injection in August and still had PF until October 2012. 

Nearer the end of this period, after watching your video on the use of rollers, I started using a roller on my legs, as well as a small,ribbed one for the bottom of my foot. I also used a PF sleep support, which did seem to help a bit but did not provide a cure in itself. The various heel cushion inserts I tried made me conclude that heel elevation added to the problem. I therefore ditched the orthotics. After reading about barefoot running. I bought a pair of minimalist shoes but after trying them out, I felt that running anything more than 3 miles in them would aggravate the PF. I then bought a pair of Nike Lunarglide and now own several pair of them. 

Whether as a result of the cortisone kicking in late or possibly a combination of the whole spectrum of things I was using the symptoms moved away from the ball of the heel to the outside edge of the my foot (lateral PF). I used foot lifts/standing on my toes on the stairs but also standing so that only my heel was lower than the rest of my foot thus working on the lateral PF. Added to that, I took a holiday in a warmer climate and felt the heat and sunshine conducive to my first attempt at running for 8 months. This time, I was able to run the PF off.  The more I ran, the more it diminished and it was gone by the end of that week.

A happy ending? Not quite, I'm afraid. During a spell of bad winter weather, I decided to run on a treadmill in my minimalist shoes.  They felt OK on the "cushioned" surface of the treadmill so I clocked up 6 miles. Although there were no distinct symptoms of PF, I sensed my left heel to be in danger so I rested for a couple of days. I then ran outside on the compact snow/ice in my off-road shoes but came across the occasional piece of road that was clear and for which my shoes were not suitable. I gave up after a couple of miles but felt that my heel was showing very mild signs of PF. The symptoms seemed to recede but the next week I did hill circuit intervals with my running club and my heel took a pounding on the downhill sections. The next day, I felt discomfort in the lateral PF but thought I could run it off, as I had in October, starting with a cross-country race four days later. Less than half way through the 6 mile race, I had to drop out because of the intensifying PF pain.

This last encounter with PF ended after 2 months without running and once again after trying my foot out on holiday in a warm, sunny climate. 

In sum, what are the lessons from my experience:

1. It is not certain what causes PF and not certain what makes it go away. That is also the opinion of the GP who gave me the cortisone injection.

2. It is more likely that trying to run through PF will exacerbate the injury than get rid of it.

3. It might be more possible to run through lateral PF than ball of heel PF but by no means guaranteed and could make it worse. Those who have had PF and ran it off should consider themselves very lucky indeed!

4. There is no one best treatment. A combination of them all gives you the best chance of beating PF. That includes a warm sunny holiday, if you can manage it, when the symptoms have diminished enough for you to feel ready to try running again.

5. You need patience and to use other means to keep you fit rather than be frustrated runner. I found the cross-trainer the nearest thing to running I could do and enjoy by setting targets. Swimming and cycling are also recommended. Avoid standing for long periods of time if you can and wear cushioned shoes as much as possible.

I hope this helps with your research.

Best wishes

Walter Fraser

Low Fell, Gateshead, UK


Here is a small extract to entice you to buy this lovely book (and he has a great blog, too, at this link!).

"Summary: The science on pain is fascinating, counterintuitive, and somewhat mindboggling. It is easy to get blown away by all the details and strangeness of pain.
  • Pain is a conscious experience that requires a certain pattern of brain activity for its existence. The neuromatrix is the pattern of brain activity, that when activated, creates pain.
  • Without the activation of a pain neurotag, there will be no pain, even if the body is damaged. If a pain neurotag is activated, there will be pain, even if the body is not damaged at all.
  • The purpose of pain is to motivate protective behaviors, not act as a reflection of reality. Thus, pain is an action signal, not a measurement of damage."
Don't hesitate to send us your plantar fasciitis story, or to share this news letter with your friends, especially if they have, or had, plantar fasciitis. The clues are right in front of our eyes, but we have to see them to ask the right research questions that will lead to cures (yes, plural) for this horrible condition.

Happy, pain-free trails.

FitOldDog (and Rebecca).
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