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Plantar Fasciitis – going, going…gone?

My last blog focused on marathon training advice for the large numbers of you who are preparing for spring marathons. I hope it’s going well. I had deliberately omitted from that blog any mention of my own injuries, particularly my plantar fasciitis (PF). This was because something was happening. Or more accurately, that something wasn’t happening. And that something was the pain in my foot was starting to be less severe and less frequent.

I have tried to establish when the pain started to subside but, perhaps surprisingly, it’s not been easy. Although I use Strava, I still keep a handwritten running diary. I record my thoughts on how each run feels and include specific notes on injuries I’m currently suffering with (as a Perpetually Injured Runner, there is always plenty to say on that front). After the London Marathon in October, I was keen not to lose the fitness I’d gained during my training and wanted to keep doing some fairly long runs. But I found anything more than a slow parkrun a week was just too uncomfortable and so I almost stopped running completely. I felt deflated and miserable, at least in the running part of my life.

My sports doctor had arranged for me to have an MRI and x-ray on my foot after the marathon and I met him to discuss the results in mid-November. The results confirmed classic plantar fasciitis. The x-ray also showed up a very menacing looking heel spur that had almost certainly developed because of the PF. He said not to worry about the heel spur (it was of ‘questionable clinical significance’ apparently, even though it looked far from it) but suggested a Platelet Rich Plasma (PRP) injection which I had on 14th December. I’ve described the experience and what a PRP injection does in a previous blog which is here if you want to read it.

After two weeks of no running and avoiding walking too much, I started running again with a New Year’s Day parkrun. Nothing had changed. There was still quite a lot of pain in my foot. If you ask the experts how long a PRP injection can take to have a positive effect, they literally say anything between one week and one year! I concluded that I just needed to sit this one out. PF rarely lasts longer than a year, and often vanishes just as inexplicably as it arrived. My symptoms had started in April 2022 and this was January 2023, so maybe I just needed to be patient.

After that, I only ran very little and when it wasn’t too painful. I had started swimming a little in the mornings in the surprisingly pleasant outdoor pool underneath the building where I work. I also decided to use the opportunity to get back to proper strength work in the gym. But I kept doing plenty of specific PF related rehab. I stepped up my calf strengthening exercises, particularly the exercise with the toes under a towel which directly works the plantar itself as well as plenty of foam rolling and spikey ball action on my plantar and calf.

By mid-January, my running diary states that I had a couple of runs where the foot pain ‘wasn’t too bad, about four-to-five out of ten’. A week later the diary says only ‘two out of ten’. I also mentioned that I even forgot about the foot pain on one run. By this point I’ve now increased my number of runs from one or two a fortnight to a couple of runs a week. I was starting to feel quietly confident that change was afoot (excuse the pun) but I wasn’t telling anyone. I was barely admitting it even to myself.

In early February I went on a skiing holiday and took a week off running. Whilst the restrictive nature of a ski boot impedes ankle flexibility, skiing naturally pushes the body weight forward, off the heel and onto the forefoot. I felt the odd twinge during the week but very little at all. Maybe it’s not hurting much because I’m not running, I thought, but I was now walking almost entirely pain-free too which was a good sign.

I returned from holiday with a tickly cough and a lateral flow test confirmed I was positive with Covid, although happily I didn’t feel unwell. A week working from home and with no social activities meant I was well rested and with plenty of time to fit in some runs. By now I was completing entire runs without any foot pain at all. One evening, I laughed out loud when after a long time sitting, I stood up and started to limp, only realising that my reason for limping had gone – I was so used to hobbling around that my muscle memory had kicked in. It's taken a few more weeks since then for me to fully accept that I am now cured. The pain in my heel hasn’t gone completely, there is the odd murmur from time to time, usually after I’ve been running, but there is no doubt it does not impact my ability to run. Or walk or do anything at all in fact.

I finally believed it when a few weeks ago, I ran Cambridge Half Marathon. The longest distance I’d run in the last few months prior to this was an uncomfortable 10K and I wasn’t keen to pick up another injury by hammering out 21K without much training in my legs. And (because I’m a Perpetually Injured Runner) I was also worried about a twinge in my right hamstring that I’d noticed recently. I decided that I would follow a run-walk strategy to give my legs regular breaks rather than drag myself round a distance I wasn’t ready for. Hopefully this would mean my running form wouldn’t fall apart and my hamstring and foot would stand a much better chance of holding up.

I set my watch to ‘run nine minutes, walk one minute’ and decided that, at least for the first half few miles, I would take it very slow and steady. I would probably finish in a personal worse time but simply finishing the race was the goal. In fact, it went much better than I anticipated. I skipped the fourth walking break, then the sixth, eight and ninth. As I was coming up to the ten-mile marker I felt good. My hamstring was aching but no more than it was on the start line and my foot didn’t hurt at all. On top of that, I felt physically fresh and strong. I decided to take one last walk break when my watch beeped and then I gave myself permission to move up a gear. I flew through the last two miles, over-taking everyone easily (and probably annoyingly smugly) and finished fast, strong and smiling. You can see how happy I am in the finish funnel photos.

It was wonderful to enjoy a running race again and for it to feel so much easier than I expected. Obviously, it helps if you considerably under-estimate your ability but it was an amazing confidence booster. I am still pinching myself that I was able to complete an entire half marathon without the eye-watering pain in my foot that I endured during the London Marathon less than six months ago. I must admit, I’m feeling pretty positive about my running at the moment. I just need to keep an eye on that hamstring…

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