Sunday, December 27, 2015

Running with the devil


I've met the devil and his name is plantar fasciitis. PF, for short.

In the past, I've run with PF until he finally left me alone. This year, PF started to remind me that it's never completely gone. PF started to sneak up on me. Towards the end of marathon training, the arch of my left foot would start to twinge. Very familiar with what that means and what's to come, I furiously rolled and stretched. I kept PF at bay for a while.

But even after taking a week off from running post marathon, PF returned with a vengeance. The ironic thing about PF is that you can run with it. Initially, when I start running, my foot hurts, but that ends after about 2-3 minutes into the run. That is because the plantar fascia, the large thick tissue that runs along the arch, stretches out with movement.

source

With the exception of that half marathon I ran in November, I've been running pretty conservatively since the Chicago marathon. But PF doesn't care. The pain has continued to worsen, particularly if I don't adhere to my massage and stretching regimen. Because, as you will see in the report card below, that is really about all you can do for PF.

Oh, if I had a dollar for everyone who has recommended that I get a steroid shot in my foot. Everyone knows someone who did this and "was cured". Remember Mr. Loud OM from my yoga class? He's also very convinced that a steroid injection in the foot is the only thing I need. Well, Debbie Downer NP has news for the steroid people:
"The risk of ..plantar fascia rupture... is greatly increased by history of treatment with a corticosteroid injection....Corticosteroid injection into the superficial fat pad can cause fat pad necrosis due to the lack of shock absorption normally provided by the superficial fat pad..." Medscape
Wah wah. Um, no thank you. I'll take a pass.

As a medical provider, I like my treatments proven and tested. I turned to the clinical evidence and found exactly what I was looking for, clinical guidelines for the treatment of plantar fasciitis. Clinical guidelines can be found for almost any entity. The guidelines are research based and interventions are graded, much like a report card, so you can make an educated decision about your treatments. The only exception is the grade F, which as opposed to the failing grade we all associate with the letter F, is the expert opinion of the team evaluating all the studies and is a recommended course of action. No matter what the grade given, keep in mind that with every treatment tested, there are always outliers, and low rated interventions will work for some folks. My advice is if you want to play it safe, stick to the tried and true, highly rated interventions.

source
Here's what I've been employing to try to control the pain of PF: (some links may be affiliate links)
-I've been massaging my arch with the Rubz ball. You can use a golf ball as well.
-Wearing my homemade Faux Strassberg Sock at night. Although I will admit to tearing the thing off halfway through the night because the stretching of the fascia can be somewhat painful at times. The longer I wear it though, the better my foot feels in the morning.
-Stretching is done via yoga--I find Downward Dog to be very effective as it not only stretches out the bottom of my feet but also my calves and Achilles tendons.
-I'm not taping my foot (but you can and they like KT tape), but I do wear my Feetures PF compression sleeve religiously.

The physical agents, which were given a D, included electrotherapy (TENS), laser therapy, phonophoresis/NSAID, ultrasound, and shockwave therapy (which was successful for me in the past). Nowhere in this article did I see anything about ice. Icing the foot, rolling on a frozen water bottle...not mentioned. I suppose it's one of those interventions that can't hurt and might help. And I have resorted to an occasional dose of ibuprofen when the pain is unbearable.

Rest as an intervention was given an F, meaning that the team evaluating the evidence likes this recommendation. Makes sense to me. I'm going to follow that advice as well, taking a week or 2 of rest after January 1.

The other intervention I am going to investigate after the first of the year is ART. Active release technique is manual therapy at its most intense. I'm ready to dig in. I've got big plans in 2016, and I'm not going to let this devil in my foot sideline me.


So you're probably wondering why I'm not taking my break now while I'm having so much pain in my foot. I'm in pursuit of my final goal for 2015. My mileage goal for this year was 1251 miles. A strange number, right? But 1251 miles=2015 kilometers. I'm SO close. With the flare of my PF, I was going to give up on the goal. That was until my friend Sue, at This Mama Runs for Cupcakes, challenged me to finish. She's chasing her 2015 goal of 1000 miles. Also very close. So we're doing this together. 

Don't judge. I'm so close. As of today, I have 12 miles to go.

And then some rest and a plan of action to exorcise this devil from my foot.

Have you ever had plantar fasciitis? What treatment modality worked for you? Would you push to get those last 12 miles done?

I'm linking up with Holly and Tricia for their Weekly Wrap! What are you up to?


83 comments :

  1. You know I feel you! Mine is flaring a little too while on vacation stupid concrete sidewalks I think. So I thought the frozen water bottle helped a bit after each run. Oddly wearing Birkenstocks around the house helps a lot. I never ever go barefoot and wouldn't dare wear my Uggs or any heels for a long time. I hope you can reach your goal!!

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    1. I'm wearing that PF compression sleeve with pretty good relief. I may end up needing to wear shoes in the house. Damn.

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  2. I would definitely get those last 12 in - it's too close! But then, runners are known for their stubbornness ;)

    Hope you find some relief soon!

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    1. I think it will be fine. Some rest and intense massage should make it go away. Or at least down to a dull roar.

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  3. My Achilles has been getting snarky, so after my 6 mile run last Tuesday I decided to give myself a little break. I think it's just what I needed as I have been sleeping, resting, and spending time with my family. I pray it feels better for you soon!!

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  4. I've had this for a while. My best advice is don't skip daily stretches. Best of luck! ��

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    1. Best advice ever! Got my yoga mat ready for some after dinner stretching.

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  5. 3 miles per day, you've got this! Does walking count? Either way, I know you will RUN it anyway. :)

    I have had PF twice but THANKFULLY it isn't something that has hounded me. When I feel it come on, I IMMEDIATELY rest. The second time I got it, I went to ART as well. He says the ART made it go away a lot faster, but I don't know if it's true because of COURSE he is going to say that, he is the one I pay for ART! But I would say both times I got PF I didn't run for 5-7 days and it went completely away.

    The thing that HOUNDS me is the IT band. It goes away and crops up, goes away and crops up... It is something I just live with and deal with. I tried the whole resting thing. I rested for about 2 months once. I don't know what else to do. Just deal with it.

    Cortisone shots I am SKEPTICAL of, not for any reason except that it seems VERY invasive. Thank you for reminding us that we need to do research on whatever it is we choose to try. I almost paid about $600 or a knee treatment an Orhtopedic surgeon recommended (he said I had arthritis) and then I went to a different orthopedic doctor who said he WISHED he had my knees, I do NOT have arthritis, and I have "the knees of a 20 yr old". Seriously wish I would have gotten different opinions 3 yrs ago...

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    1. I rested after the marathon and the PF came back worse than before. So I think I need to do something more intensive. We'll see how the ART goes...

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  6. I'd absolutely do those 12 miles. PF is one thing I've never had. But I know how painful it is for my husband, so I sympathize with you. I'm having a series of alcohol shots (not steroid) for my neuroma. They are supposed to kill those extra nerves. I've only had one so it's too early to know whether it works. I hope with two weeks rest and your ART treatment, you'll be good as new. Do you ever feel like it's just always something? I do!! Thanks for linking, Wendy!

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    1. I do feel like it's always something! I'm glad it's "only" PF. I can get through this. I've had stress fractures. This is nothing compared to that (altho it's really painful!).

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  7. Hopefully you're getting your last 12 miles with a few shorter runs! I have had PF - I had a bout of it 2 years ago after realizing that my new Asics (post-stress fracture) were killing my arches. I went to PT and just did a lot of stretching. Thankfully I haven't had any serious flare-ups since then. I hope your strategies work!

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    1. I'm going to try to kill those 12 with shorter runs for sure! I did 10 today, which put my foot into a whole new world of hurt. Heading to the yoga mat as we speak.

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  8. Very interesting stuff Wendy and I appreciate you sharing! I am glad to hear you can run through this. I have very minimal symptoms now in comparison to what was going on a month ago and I have every intention on pushing through. My tenderness seems to get better actually with the just the right amount of running. I may have had different issues initially, the pain in the ball of my foot was a very intense pain when I first felt it. My big issue was once my foot hurt, the tightness started a hard tugging in my calf and I was afraid of injury. After a lot of rest, I just feel the tenderness around the heel area at random times. I live in compression socks these days :) I hope you get some relief soon!

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    1. After writing this yesterday, I took my own advice and hit the yoga mat, stretching my legs really well. I was able to sleep all night with the foot splint, and my foot feels pretty good today.

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  9. If I were as close as you I'd like to think I'd push for that extra 12 but that's about how short I will be of my 100 this year so I have no right to speak! I have had PF once. It was terrible. It only went away when I broke my foot and had to boot it up for a few weeks. The heel bone spur it what really hurt. I am still amazed that I never ever (knock knock) feel it anymore. I have heard of that ART before but know nothing about it. Good luck getting the rest of that mileage and as pain-free as possible!!!

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    1. I'm going to push for it. Today my foot feels pretty good. We'll see...

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  10. As a podiatrist and who has seen this so many times before, please be so careful

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  11. Wendy, I feel your pain. I wish I had any decent recommendation. I'm suffering from mild PF plus I have lost some fat padding in my right foot. Both issues are causing me quite some pain during my runs right now. Knowing you, I'm pretty sure you're crushing those 12 "easy peasy" miles:)

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    1. 4 miles a day x 3. I'm behaving myself. Sort of.

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  12. This sounds painful! I've never had PF.

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    1. Lucky you!!! Seems like everyone I know (runners and non-runners) have had it.

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  13. uuugh....damn devil!!!

    I have had many friends with planter fasciitis...iced. rolled, stretched. No one got cortisone.

    I would totally push through to complete those 12 miles! You got this. Sending no-pain fairy dust your way!!

    Happy running!

    -Tamieka@fitballingrunningmom

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    1. I'm taking the fairy dust and rubbing it all over my foot!!! Damn!

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  14. Sorry to hear about your PF. I'm sure you'll get those 12 miles, you got this! Have a great week and Happy New Year!

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  15. I didn't think I had PF in the past, but when i look at your picture, I had pain there for months and didn't know what it was. I also had achilles tendon issues in the same foot. Both eventually went away, not sure how. I do downward dog religiously and stretch my calves and soleus muscle religiously. I always make sure to warm up my feet & ankles too, and I never start off just running. My warm up is 15 to 20 minutes of walk / run (at least). Starting off slowly helps me tremendously.

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    1. I stretched last night like crazy and I feel pretty good this morning! Time to do as I say, right?

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  16. PF is the devil. I had graston therapy, which is similar to ART, I think. I hurt like a mother but worked. I think the ice is more for temporary relief. I had it so bad I could barely walk, so the ice helped with that.

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    1. Yes, graston therapy is pretty much the same thing. I'm prepared to cry.

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  17. Oh no PF is the devil! I had a bout with it once and it was awful. I think I rested for two weeks, (from running) and did foot exercises, I do all my HIIT cross training bare foot now so that my feet get exercise too and stay strong, so far it has worked and I haven't had to deal with it again. I hope yours goes away soon!

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    1. I did some major stretching last night and slept with that foot splint. I feel pretty good this morning. I think the week off will help it calm down. And I need to do some major maintenance to keep it calm.

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  18. I probably wouldn't push it, but hey, I'm not the one with that particular problem. I know people who swear by ART, although I hadn't heard of it in conjunction with PF nor have I personally done it. Yet.

    As an aside, have you ever been to Big Sur or will the marathon be your first time there? Just curious.

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    1. We went to that area of California for our honeymoon. Now 27 years later, we get to go back. I can't wait!

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  19. You know that I would say not to push it. But you know yourself the best. I've not had chronic PF like you, but I did find yoga and massaging my foot and parts of my leg to help.
    Whatever you choose, good luck!

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    1. You know you would...with only 12 miles to go? I'm going to do 4 miles x 3 days this week. Then I'm off it for a week.

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  20. I'm getting a little achy in my feet. Probably need to get to the bottom of it!
    I'd probably push through... but I'm not sure that's actually the right thing to do :-))

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    1. I'm going to finish this thing. But with lots of stretching and no worry about pace...

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  21. Sorry to hear you have PF--my mother does as well and it sounds painful. I have my own injuries holding me back right now. Let's hope 2016 is pain-free at some point. :)

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    1. I thought 2015 was going to be my pain-free year! Guess not!

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  22. No judgement here. You are SO close!!
    I had PF once years ago. Luckily a cortisone shot (after trying 1,000 other things) did the trick and I've been PF free every since. Good luck!!

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    1. I'm finding that stretching is really helping me the most. We'll see how the massage works!

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  23. Thankfully I've never had PF, so I can't speak directly to that. But I have to say that I swear by ART. My chiropractor has gotten me from not able to run at all to running pain free after just a few treatments. (He also gives me suggestions on how to prevent reoccurrence, but ummm, yeah, I suck at following directions.)

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    1. Oh, I'm the worst at following instructions. Not only am I runner, but a medical provider as well. We are the worst patients!

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  24. Ah! I feel for you! I'd do as you're doing, though, and get in those last 12 miles. You're so close! I had PF two summers ago and am grateful it hasn't come back. It really is the devil! The ole' stretching and foam rolling is what helped me.

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    1. This is my second go round with it, and it really is painful. Yep, pushing forward to catch that goal.

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  25. I have not had any PF issues so far, I didn't really know what it was until recently. I see your going to look into the ART, will you do this or will you find a provider who can do this? It sounds very interesting and I would looking into if I was having those issues, it also looks like it helps a lot of other things too. Hummm wonder about IT Band? I see it does help with runners knee. On the year end goal, I would so go for it! You are too close not too right!!

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    1. I found a provider via Marcia, and I'll be calling him after the new year. I need to catch my goal first!

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    2. I can't wait to hear about this! Good luck in your goal!

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  26. You're sooo close that either way you've had such an accomplished year of running! 'm sorry you have PF - I hope it heals up soon! My feet get so tight and a lacrosse ball helps a lot.

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    1. I love my lacrosse ball. Helps all over.

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  27. Yay for evidence based guidelines. :) Love it! And absolutely agree with you about the steroids - a) doesn't actually fix the mechanical problem so it would just happen again and b) yikes for the risk of rupture! I confess I'd probably drag myself through 12 more miles too. Just take it easy!

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    1. Yep, I'm taking it easy but I'm going to meet my goal! 8 miles to go.

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  28. My husband has the worst time with it... he stretches his foot like CRAZY so it doesnt come back. Praying I never have to deal with it.

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    1. This is my second go round with the beast and it is not fun.

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  29. I had PF so bad years ago that I was on crutches for a month. I found a Certified Athletic Trainer who understands orthopedic injuries and together we worked to eliminate the CAUSE of my PF. For me it was a combo of things: limited range of motion in my ankles due to improperly rehabbed ankle injuries, weak arches, and glutes that didn't fire properly when running. I did two months of therapy and had custom orthotics made. I've been doing the rehab exercises ever since and haven't had a problem with my feet. I also have an Athletic Therapy background (certified but no longer practicing) and I strongly believe that you need to find the cause, and treat the cause, not just the symptoms. Most of the advice on the internet just addresses treating the symptoms. Good luck!

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    1. My coach is a corrective exercise specialist who continues to work with me on all my "issues". She has helped me a ton.

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  30. You will get those last few miles in if you have to run/skip them for sure! I haven't experience the PF devil (thank goodness!) sounds like you have a solid plan, who cares what Mr. OM has to say.........everyone is an expert!

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    1. Isn't that the truth? Thank you Dr Google!

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  31. 12 miles to go? Yes, I'd push. But I've never had PF, knock wood. Dr. Miracle has TENS too. It's fab. I think he needs to pay me a kickback for recommending him so much.

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  32. I truly and absolutely HATE PF with a passion.

    This year was my second flare up and I had success going to the chiropractor. Myofascial release and adjustments with the occasional ultrasound used as well. I'm down to once a month (when I first started going it was 2-3 a week) and I'm so grateful for the relief. I hope that you're feeling better soon because the devil truly is PF.

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    1. I can't wait to see this guy. As long as he doesn't make me stop running (which Marcia assures me he won't) I'm game for whatever he throws at me.

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  33. Bah so sorry about the PF. Hit that goal and then take it easy!

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  34. I feel your pain, quite literally. On the one hand, I'm glad that PF is the extent of my running injuries, but at the same time, oh it can hurt. Stretching is fantastic, and the more I do yoga, the better it is, but I don't always make the time. I have had great success alternating heat and ice on the affected area, but I have no idea if there is any science behind it.

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    1. Funny you should mention heat. I've found nothing about the benefits of heat, but I warm my feet up on a heating pad in the morning while I sip my coffee. Helps a ton to loosen them up.

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  35. Uggh, why are these monkey wrenches being thrown in our plans. I'm sure you saw that I re-tallied and am over 1,000 but I wanted to keep going until I ended up in urgent care today with horrible bronchitis. Now on prednisone burst and an inhaler, whomp whomp. But I am cheering you on! I know you can do it!!!

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    1. If it weren't for you, I wouldn't be doing this! LOL! But I'm glad you gave me that push. Now, I hope you feel better! Steroids. UGH!

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  36. I'm sorry it is so tough to reach the goal but you will get there. Take it easy on yourself though!

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    1. It will be fine. I'm so close now. I just need to do a better job of stretching after I run.

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  37. When I've had PF in the past my husband (who is a chiro) has adjusted my foot and it has helped tremendously!

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    1. Oooh! I wish you lived by me. I'd go see him!

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  38. That stinks! Sounds like you've got a great recovery plan in place though. I hope it feels better soon! That's an awesome goal for 2015! If you can stand the pain, I would most definitely continue to go for it with just 12 miles to go. My goal has been 1200 miles the past two years. Last year, I fell short 41 miles. I was sick a good bit this spring only hitting 40-50 miles some months, so I'm 200 miles short this year. I'm 10 miles away from 1,000, so I'm definitely going to try to reach that at least. 1,200 will continue to be my goal for next year.

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    1. Oh yes, I'm going for it! I'm stretching like crazy this week!

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  39. I relate to the pain of PF. I had a small bout with it a few years ago and it is a stubborn bugger! What worked well for me was rolling a frozen golf ball on my foot. I've heard good things about wearing that overnight sock, though I never tried it myself. Many folks have mentioned keeping their calves well stretched out, too. I wish you a speedy recovery!

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    1. It's pretty painful...I know I can run with it, but after this week, I'm going to give this poor foot a break!

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  40. I experienced a mild case of PF a few years ago. Rolling my foot and wearing orthotics helped me tremendously. Sorry to hear you are going through it now. Sounds like you will reach your goal before the year ends - did I read 8 more miles to go? You can do it!

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  41. PF was my first ever running injury back in 2007. At the time I went to a podiatrist and he made me orthotics and told me to take ibuprofen. It got better (gradually) but less than a year later I got achilles tendonitis on the same side. I always wondered if it was related, and that stuck with me for awhile. Since I have switched to lighter/minimal running shoes and ditched the orthotics neither has bothered me (knock on wood). There are some injuries that I feel like rest does not help with. I hope that you find something that works for you!

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    1. Yeah, I don't think the orthotics I got in the past did much. In fact, I was told by an ortho to take them out of my shoe. They were causing a problem with my toe...

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