Yep....another PF thread. I've had this debilitating injury in one foot since Feb '19 and the other since March of this year. Came on in about a week while ramping up running volume for an IM. I've read through all of the other threads on here and all over the internet looking for an answer and feel like I've tried everything and the pain is still there with every step of every day.
The list is pretty exhaustive at this point:
Physical therapy (4 different practitioners, dozens of sessions, being extremely dedicated with ~1hr per day every day for months on end)
I've tried not running at all for I think around 6 months with no relief. I've tried no exercise at all and drastically limiting my steps for 3 weeks, with not even a hint of improvement. I've tried simply running through it, dealing with the pain, and doing 1-4 miles every day or every other day, while wearing orthotics...and that's when the PF in my other foot started (fun times). Besides that three week stint of doing nothing, I've been able to bike through this because it's not painful to ride and every PT/podiatrist I've talked to says it's fine to keep doing so. Occasionally there's a dull ache, but nothing like walking around.
Waiting on the results and recommendations from a gait specialist now. Currently on a routine of weighted eccentric heel drops, focusing on foot strengthening exercises and some limited barefoot running in the grass. I've felt like the orthotics among other things have made my feet weaker, so ditching those for now.
My few options left are an injection of stem cells that would theoretically promote healing, while emptying my wallet. PRP injection, which I've read doesn't have a whole lot of conclusive, unbiased studies that say it works. Surgery, which I 100% will not do. Or ceasing exercise all together for as long as it takes to get better and maybe putting my foot in a boot, which probably aren't happening without a deep dive into depression.
With all that said, cycling is certainly the common denominator through the last year and a half+. I have 6k miles and 500k vert so far this year, so it's not an inconsequential amount of time turning the pedals around. Are there any anecdotes of cycling preventing recovery or even being the root cause of the injury, and how did you go about fixing it? My close riding buddy is a professional bike fitter, who's fit me on the bike.....though I have 6 bikes and most of those fits are by feel and the heel on pedal with an almost-straight-leg technique. He'd tell me pretty quickly if something looked off though. I certainly don't have much "ankling" during the pedal stroke that I've seen others have that may overwork the calves/achilles....though I certainly get a tight posterior chain from cycling as I think all of us do. I've always run my cleats pretty far back, but definitely have them slammed as far as they go out all my shoes now to try to take the achilles/calf out of play as much as possible.
Searching for answers, trying to leave no stone un-turned. Would be lovely to walk again without pain.
The list is pretty exhaustive at this point:
Physical therapy (4 different practitioners, dozens of sessions, being extremely dedicated with ~1hr per day every day for months on end)
- calf stretching
- ankle stretching/mobility/strengthening
- glute strengthening (bridges, fire hydrant, leg raises, and extensive gym work with squats/deadlifts/weighted bridges while that was an option)
- eccentric heel drops (toes raised on towel, progressing to one leg and weighted backpack)
- hip mobility
- hamstring stretching (flossing, every hamstring stretch imaginable)
- posterior chain foam rolling & lacrosse ball pinpoint rolling
- core strengthening
- golf ball/lacrosse ball/frozen water bottle rolling on foot
- extended standing on angled board to stretch calves/achilles
- toe/arch/foot strengthening (toe scrunches, foot shortening exercise...etc)
- yoga
- NSAIDS
- Topical NSAIDS
- Cortisone shots x4 (one did the trick for ~2 months, the rest were duds)
- Extracorporeal shockwave therapy (3 sessions over 3 weeks, 0 difference)
- 4+ pairs of custom orthotics worn in every shoe, all day every day for months. Including in cycling shoes.
- Low-Dye taping method
- Strassberg sock
- Plastic night splint
- Heel cups
- Arch sleeves
- Correct toes
- Collagen supplements
- More supportive, squishy shoes with substantial heel to toe drops (Asics)
- Less supportive, less squishy shoes with no heel to toe drop (Altras), both with orthotics and without
- Graston technique - self administered
- Oofos sandals
- Foot in bucket of ice every night
- Percussion massage on posterior chain & feet
- Extensive self massage before standing or putting any weight on foot in the morning
- Changing bike cleat position to be all the way to the back
- Crying myself to sleep
I've tried not running at all for I think around 6 months with no relief. I've tried no exercise at all and drastically limiting my steps for 3 weeks, with not even a hint of improvement. I've tried simply running through it, dealing with the pain, and doing 1-4 miles every day or every other day, while wearing orthotics...and that's when the PF in my other foot started (fun times). Besides that three week stint of doing nothing, I've been able to bike through this because it's not painful to ride and every PT/podiatrist I've talked to says it's fine to keep doing so. Occasionally there's a dull ache, but nothing like walking around.
Waiting on the results and recommendations from a gait specialist now. Currently on a routine of weighted eccentric heel drops, focusing on foot strengthening exercises and some limited barefoot running in the grass. I've felt like the orthotics among other things have made my feet weaker, so ditching those for now.
My few options left are an injection of stem cells that would theoretically promote healing, while emptying my wallet. PRP injection, which I've read doesn't have a whole lot of conclusive, unbiased studies that say it works. Surgery, which I 100% will not do. Or ceasing exercise all together for as long as it takes to get better and maybe putting my foot in a boot, which probably aren't happening without a deep dive into depression.
With all that said, cycling is certainly the common denominator through the last year and a half+. I have 6k miles and 500k vert so far this year, so it's not an inconsequential amount of time turning the pedals around. Are there any anecdotes of cycling preventing recovery or even being the root cause of the injury, and how did you go about fixing it? My close riding buddy is a professional bike fitter, who's fit me on the bike.....though I have 6 bikes and most of those fits are by feel and the heel on pedal with an almost-straight-leg technique. He'd tell me pretty quickly if something looked off though. I certainly don't have much "ankling" during the pedal stroke that I've seen others have that may overwork the calves/achilles....though I certainly get a tight posterior chain from cycling as I think all of us do. I've always run my cleats pretty far back, but definitely have them slammed as far as they go out all my shoes now to try to take the achilles/calf out of play as much as possible.
Searching for answers, trying to leave no stone un-turned. Would be lovely to walk again without pain.