All I’m thinking about right now is how I must make it to the London Marathon start line and almost certainly (well, you never really know!) also make it to the finish line - despite having a painful injury. The last few weeks I’ve walking a tightrope between training and not training and making some pretty big running-related decisions.
I have severe plantar fasciitis (PF) on the sole of my right foot. In previous blogs I’ve gone into a bit more detail on what causes PF (it’s not entirely clear, could be a few things) and how to treat it (same answer!) and so even with expert help to manage the condition, marathon training has been tricky. With the marathon now only days away, I thought I’d share what I’ve been doing to reduce the pain and still keep my training enough to get me through the race.
After six sessions of shock wave therapy and no improvement to my symptoms, at least in the short term, the next steps were not the standard ‘wait and see’ for a six-week period, but ‘how can we reduce the symptoms so that I can still run the marathon?’ I was recommended a visit to a podiatrist who has experience with this condition in runners. When I arrived at my appointment, and before I’d even entered the treatment room, he asked me “how long until the marathon?” My answer was “just five weeks”. Probably followed by me pulling a face not dissimilar to the ‘eek’ emoji.
His approach was pleasingly practical and focused on reducing inflammation of the plantar fascia whilst completely acknowledging that I wasn’t going to stop running and I wasn’t going to pull out of the marathon. After some discussion we agreed the following:
1) Ice, ice and ice
I’d already been doing a bit of icing of my foot and found it did give me some pain relief, but I wasn’t doing it religiously. He recommended a minimum of four times a day, at least an hour apart for around ten minutes at a time. “Ice is your new best friend” and he was right. I have been icing like it’s going out of fashion and I think it has helped. Crucially, it’s about icing the heel. A lot of my pain is actually more into the arch of my foot, but as Mr. Podiatrist pointed out, it’s the heel that takes all the hammering so even if the pain can be elsewhere, it’s really the heel that is inflamed.
Icing at home isn’t too difficult, even when working at my desk, but icing at the office isn’t quite so easy. I bought some of those single-use instant ice packs (whilst also feeling guilty about the environment – I reconciled it illogically by reminding myself that I reduce my carbon footprint by run commuting home once a week!) But they just didn’t get cold enough. I settled on rolling my foot back and forth over aluminum cans of water, meant for visitors, from a very cold fridge. Yes, it resulted in some funny looks from my colleagues, but it did the job.
2) Squidgy addition to my orthotics insoles
Replacing my old, but made to measure, orthotics might be a good thing to do in the medium term but it’s too big a change to make so close to the marathon. The surface of the orthotics is quite hard though and so the podiatrist stuck on a small and soft bit of composite material on top of the heel section (see pic). On both feet, to keep me even. As above, it’s all about reducing the hammering the heel is getting by creating a softer landing.
3) Take anti-inflammatories
I don’t have any issues taking ibuprofen, or using the gel, but taking it a few times a day for weeks on end doesn’t feel like a particularly healthy thing to do. The podiatrist recommended turmeric as an alternative. Curcumin is contained in turmeric and there have been various scientific studies that demonstrate curcumin has anti-inflammatory properties. I’ve been taking a turmeric tablet every morning and night since. In the few days leading up to the marathon he suggested that I also take ibuprofen. It has a cumulative effect, so it’s important to take it regularly over short period of time to get the most benefit. Of course, it’s also a pain reliefer so I may take one after the marathon too!
4) Remove interval training (especially hills)
I’d already noticed how much worse my foot pain was after my interval sessions, when I was running fast repeats. I’d started making the individual intervals I was doing longer to reduce the speed I was running at. For example, doing 2-3km reps rather than Yasso 800s or even 1km reps, but this only made a slight difference to the heel pain. Prior to my podiatrist appointment I’d decided to ditch intervals on the flat altogether and stick to long hill repeats. But the podiatrist said hills were terrible for PF because of the angle which the foot meets the ground, so I realised I had to ditch the hill training too.
After a little bit of persuasion I agreed to look at replacing this session entirely with a cycling workout. The purpose of intervals in marathon training is not to improve speed but increase the heart rate, training the heart for the way it is likely to be towards the end of the marathon when you’re very, very tired. The other sessions on a marathon training plan, especially the long run simply don't do that as the heart rate remains much lower. However, the heart rate can easily be raised doing other activities, as long as you really do get the heart rate up. Over the next few weeks I spent my Thursday evenings in the gym on a WattBike bashing out sessions such a 4 mins hard, 2 mins easy x 6 and even short sharp intervals such as 30 secs hard, 15 secs rest. The key is to make sure the resistance is up high to make it tough enough to get the heart rate up as high as it would be from an running interval session. It did feel a bit like cheating by doing a bike workout, but I felt my quads and hamstrings working a bit too.
5) Remove strength work on the calves and foot
Like a lot of people with PF, I diligently worked on strengthening my calf muscles because weak calves are cited as a possible cause of the condition. I often suffer from some achy calves when I step up my mileage, but this hasn’t happened recently which is a welcome benefit of this exertion. I had also been doing calf raises with my toes raised, usually under a towel. These exercises also work the plantar. As the podiatrist pointed out however, continuing to put the plantar, and even the calves which are all connected, under strain isn’t what we want to do right now. Strength work on any muscle is about working them hard to create micro-tears that when they repair themselves they become bigger and stronger. He said that whilst these kinds of exercises normally form part of a rehab plan for PF I should stop right now and for the next five weeks focus on our anti-inflammatory plan.
6) No intense massage or rolling the sole of the foot
Similar to the above, the advice was to stop heavy massaging of the plantar. Whilst I’ve never been a fan of the spikey ball as I think it’s too superficial, I have been intensively massaging my plantar with the massage gun and my hands. Also similar to the above, intensive massage can create a bit too much stimulation and stress on the area we are trying to calm down. A little bit of light massage and rubbing can stimulate blood flow which does promote healing, but that’s it!
Since the appointment I have done everything I agreed to do, and my heel certainly hasn’t got worse. I think it’s even possible to say that it’s improved ever so slightly. I did have a bit of a scare halfway through one of my run commutes home when I developed a sharp pain in the arch of my bad foot. I tried a jog, but it wasn’t feeling great so I hopped on the bus for the rest of the way home. I had just started my three-week taper and this particular run was definitely not going to make a difference to race day. Ice, ibuprofen and two rest days followed by parkrun and it was back to the normal level of achy pain. Phew.
In the final two weeks I skipped my mid-week run commutes altogether and only did parkrun (because missing parkrun is just too much) and the all-important long runs. Although I had now dropped two of my four training runs per week, I was pretty happy that I knocked out those long runs as they truly are the most important part of anyone’s marathon training plan. My longest run was 22 miles. This gave me the confidence that I can conquer all of those 26.2 miles.
It was especially exciting that I was able to make my last long run the Ealing Half Marathon on its 10th anniversary. I haven’t run my local race since the 2nd year as I’ve been involved behind the scenes as a volunteer. Of course, it was crucial that I ran it slowly just one week away from the marathon but that made it even more an amazing and enjoyable experience. It’s a very well supported race by the local community, and when so many of your friends and neighbours are dotted along the route waving and cheering, it’s very special indeed. My foot didn’t even hurt that much. Quite a day.
I’m writing this now just a few days before the London Marathon and so the next blog will cover the race itself. If you’re interested to hear how I got on it will be all over my social media accounts (Facebook, Twitter and Insta!) In the meantime, I’m resting, icing my foot and getting ready to carb-load. Wish me luck!