Plantar Fasciitis and cleat position

I develped pf this past spring, but dealth with it until my IM lou training peaked in Aug. at which point the moring/night pain had improved but develped constant pain throughout the day and begninning and end of runs. did im lou, got custom orthotics, stretches, strengthening ankles, stretching, ice, heat, nsaids, ankle brace, etc, etc etc. go somewhat better did IM AZ still not bad, but pain still present. so got steriod injx. and have now taken almost two weeks off from running. Going to start biking again on my trainer. Was wondering if anyone knew if any particular bike cleat positioning was good for preventing this from reoccuring. rroof if you read this would love to hear your opinion. My pods guy (here in lou, myrick), he said he knew you. Any further advice? thanks.

Not aware of any studies/journals that directly speak to your question, but …

Since pedaling a bike is a VERY repetitive motion, you want to minimize stress through the plantar fascia while “healing”. Most stiff soled (esp carbon) cycling shoes have zero flex, so this shouldn’t be an issue at all. In theory, a cleat position as far back as possible would minimize stress through the fascia as too far distal would activate the Windlass mechanism (Assuming you could dorsiflex your toes in the shoe). So, I’d start there if not already.

I suffered from incredibly bad Plantar facitis this past year. Cycling only hurt it when I made the mistake of riding hills and getting out of the saddle a lot on the climbs. You should be fine on your trainer though I would throw some orthotics in the shoes. Basically inserts in all my shoes.

I currently have PF now. Tried everything. Currently in a CAM Walker with orthotics. Seems to be helping. I work for an Orthopod foot/ankle specialist. His preferred treatment is a cast for 2-4 weeks. That would put a damper on all training. I chose the boot with orthotics. Reason cast is better is it supports the arch. Since I have orthotics thought this would do the same.
Anyway sorry for the rumbling. I wear the boot all the time except to bike, on trainer and swim. I do notice some pain about an hour after my ride.
So I think my foot must be flexing some. I have the Shimano TR51 if that matters.

I am coming to the conclusion that the only thing to get rid of PF is Rest 24/7

I have been dealing with this for about 3 months.

steve

That was one of the worst injuries I have had to deal with - way worse than knee sugery (on the short term). I still am babying it a bit but back to running. I can feel it slightly and have felt it for 7 months. Complete immobilization might be a good idea for a month or so in the winter. It messed up my entire summer up and I only did one tri. Best wishes, hopefully you can get it cleared up by spring.

Yeah thats the reason I am doing it now. Our pool is closed for 2 weeks. And I am eating a lot and not training as much.

steve

I’m inclined to think that my cleat position ended up contributing to my PF, now at about month 14. I bought a new pair of cycling shoes last fall and didn’t really pay attention to where I put cleats which was most of the way forward. I started to have problems with both my rt and left calf and still really didn’t put 2 and 2 together. At the same time I started to develop achilles problems and finally PF.

It did take me a while to draw the connection but I believe the constant calf issues from the cleat position ended up being the root cause for my PF. I still have PF although my leg issues have subsided after changing cleat position. This is my winter run period so I’m hoping to run through it while treating it.

Since I battled PF for 10 years off and on (1996-2005) , what worked for me is cleat slammed back all the way.

Since I battled PF for 10 years off and on (1996-2005) , what worked for me is cleat slammed back all the way.

x2, this is the only position that I found relief in as well.

That aside, have you talked with your doc (hopefully a podiatrist) about surgical options? I know that it seems like a death sentence to you but it probably needs to be discussed.

I had PF for about 16 months, never did cortisone injections b/c my doc felt it would only mask the pain not treat the injury. At any rate, I ended up having a full release (the PF is cut all the way across) and the nerve bundle in my heal removed. During the surgery my doc said he found a lot of scar tissue that was likely never going to allow the PF to fully heal in the first place and that surgery was about my only option. Surgery though was the easy part, the hard part was the not running for six months. After six months of not running it took another six months to get back to 100%, but I was also 36 at the time and attribute a lot of my slower recovery to age.

Since the original diagnosis (Sept. 04), and definately post surgery, I have worn custom orthotics religously to include never being bare foot. They are a pain in the ass but I’m convinced that this is the only way to prevent further injury.

Why am I telling you this? Figured first hand knowledge would serve you better in this case and knowledge is power, especially for planning long term. Or, this can scare the hell out of you (jk) to stay off it (period) for the next six to eight weeks - I didn’t.

Let the howling begin…

I just created a new page on my website regarding plantar fasciitis: http://www.permanente.net/homepage/kaiser/pages/c4189-62878.html
I didn’t add anything about cleat position, but my advice would be all of the way back - makes solid mechanical sense in the context of plantar fasciitis. Also, use your orthotics in the your cycling shoes. Do calf stretching before your ride (you may get conflicting opinions on this, but I recommend it). Also, consider taping, even though you are/should be using orthotics in your cycling shoes. Continue all of the things that you mentioned (shotgun approach). You didn’t mention a night splint - can be effective - certainly helped me back in my marathon running days.

Thanks to everyone that posted. Been using the night splint too and the custom orthotics in the bike shoes. After almost two weeks of no running now, I currently have no to very little pain. I would really like to run again…thinking about staring with some low mileage and no speed work…but really my goal races for the year are not until august…At the same time just really like to run but don’t want to impede my recovery any thoughts?

Thanks

Obviously, everyone is different and PF comes in a lot of flavors. However, since you’re soliciting advice (I know your question was specific to cleat position but these threads always degenerate into general pf stuff), I’ll relate what happened to me.

My PF started 9 months ago, left foot only. Pain was severe in the first week (in the arch) and then shifted to low level heel pain for approximately 6 months. I would rate it a 1 or 2. It never got any worse than that but was present for every step I took for 6 months. Was doing all the stuff everyone does (stretch, strengthen (particularly recommend the towel exercises in Aaron Mattes books), night splint, new orthotics, blah, blah). By the end of the 6 month period I had completely quit running to see if total rest would cure the pain–it didn’t. I assumed that if I started running again it was going to exacerbate it.

Finally, I just said to hell with this, I want to run again. Started very slowly, increased mileage very cautiously. Surprisingly, as I resumed running the residual low level pain did not increase–it dramatically improved. Suddenly I could walk on the pool deck barefooted, take a shower without crocs on, etc. Now, 3 months post-resumption of running, the pain is sporadic and very, very manageable.

Why did this improvement occur?–beats me. I assume that all the treatment modalities finally started working. However, the real jump from constant low level pain to almost no pain came as soon as I resumed running. I’m appreciative every time I put the shoes on to run.

Phil

Thanks to everyone that posted. Been using the night splint too and the custom orthotics in the bike shoes. After almost two weeks of no running now, I currently have no to very little pain. I would really like to run again…thinking about staring with some low mileage and no speed work…but really my goal races for the year are not until august…At the same time just really like to run but don’t want to impede my recovery any thoughts?

Thanks

I responded to a similar question in another thread. Look near the end of the thread here: http://forum.slowtwitch.com/gforum.cgi?post=2638685;search_string=stevep;#2638685
I hope it helps.

Ever consider that the same expensive routine of custom orthotics and braces that doesn’t work for anyone isn’t actually the right solution. Plantar is inflamed from improper loading of stress and constrained movement that doesn’t allow for the natural stretching and rejuvenation of the ligament. Stiff bike shoes and stiff orthotics cause this unnatural loading.

Find a nice park and run barefoot on the grass or sneak onto a golf course. Worked for me and is the technique that every serious NCAA cross country coach teaches their runners.

I haven’t read this thread to see how it got from a discussion of PF and cleat position to a discussion of PF and running but as long as you are talking about running, here is my experience: My PF lasted about a year and a half. It didn’t go away until I identified the root cause – inflexibility in the calf and lower leg – and treated THAT. When the muscles and tight the exert extra pull on the tendons and ligaments. Over the course of tens of thousands of strides, this can do a number on the PF. Once I really got religion about stretching and massaging my lower legs (really digging into the muscles during massage) and allowed myself to stop early on runs to loose them up, the PF went away almost immediately.

Running in LESS shoe – racing flats, actually – helped too, in a way. Since it’s pretty much impossible to run properly in them when my calves and achilles are tight, they forced me to stretch properly beforehand as well.

I tried the night splint and the sock but they didn’t work for me. Usually I would wake up in the morning to find the thing removed and thrown across the room with no memory of doing so.

Since I battled PF for 10 years off and on (1996-2005) , what worked for me is cleat slammed back all the way.

2x way back
now only mental problems (-:.