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Don Nordin 08-15-2011 11:52 AM

Plantar Fasciitis and injuries
 
I'm dealing with Plantar Fasciitis and a minor tendon tear in my achilles tendon. The achillees is not as painful as the plantar. Lately it is adversely effecting my ability to get on the tatami. Generally I am OK on the tatami after the foot loosens up, but it can be quite a bit painful afterwards. and it is throwing off my posture, so that's not good either. I am not convinced that staying away from practice is the best thing, as I get alot of personal well being from practice.

My question for other Aikido players is have you had this problem before and how did you get rid of it. I am presently using a sports medicine Chiropratic technique called active release, coupled with EPAT (Shockwave thereapy).
In particular it would seem that the type of shoes one wears can make things worse. My doctor pointed out to me this morning that he deals with Martial Artists as barefoot atheltes and that normally a minimal shoe does better than a heavily padded shoe. No I do not wear shoes in the Dojo or on the tatami it is for the other times of the day that ask about the shoes.

Pauliina Lievonen 08-15-2011 01:09 PM

Re: Plantar Fasciitis and injuries
 
So what kind of shoes do you wear off the mat?

Personally I prefer shoes with as thin a sole as I can get away with (as in - in the winter they have to be thicker...) but I'm not sure that making dramatic changes right now when you're already dealing with pain is the best thing to do?

BTW, what shape are your hips in? My experience as an Alexander technique teacher is that foot problems often are caused or made worse by the whole leg not working in a well coordinated way, starting with hips/pelvis/lower back areas that are too tense.

Pauliina

Janet Rosen 08-15-2011 01:10 PM

Re: Plantar Fasciitis and injuries
 
Don, I feel your pain! I had bilateral plantar fasciitis for the first time back in the early 1980s and was taped for a couple of months.

At that time the feeling was an absolutely rigid custom orthotic was the best way to go. Now maybe that works for some, but what I have found via trial and error over the years is quite different (and perhaps things have changed if this doc of your's recommends minimal shoe).

I find that too rigid an orthotic or too much of a "good shoe" in the old fashioned sense is something my foot fights against after one day. I do best with casual, soft, thin soled shoes, some of them as is, and some with a minimal, flexible insole from the pharmacy foot care shelf. I also do best if I don't wear the same model of shoe more than two days in a row . Canvas sneakers, with a light flexible insole, and Okabashi slides are my standbys but if you need something nicer for work it may be a bit harder!

If I start to get a flare up, I do an exercise, seated, feet on floor, about a foot apart. Keep heels down, raise front of feet, flex toes down (so arch is flexed, not stretched), pivot so big toes meet in the air, reverse to bring feet back to original position - repeat a dozen times. And also the thing about making ice in a round shape (like small paper drinking cups) is very good - you can roll bottom of your foot over that.

If there is a predisposition because of tight or short Achilles tendon, which in some of us is anatomical and can't be fixed by stretching, only mildly abated, then it is important to NOT make it worse by using a shoe with a recessed heel (Birkenstock or the ones that claim to be like walking on sand).

lbb 08-15-2011 01:15 PM

Re: Plantar Fasciitis and injuries
 
Two cortisone shots was the cure for my plantar fasciitis, but a doctor will want to try other things first. I have been using ice massage for other inflammation problems and found it to be much, much more effective than old-school icing.

Keith Larman 08-15-2011 01:29 PM

Re: Plantar Fasciitis and injuries
 
GIGANTIC WARNING. Anecdote to follow...

Had trouble with it on and off for years. Tried lots of things including cortisone shots (which helped a bit). For me it turned out that it was more related to my calf muscles. So it was stretching and ironically enough wearing my "vibram five finger" "shoes" that made a difference for me. It changed how I walked, how my feet were used, and over time it simply went away.

Could be coincidence. The physical therapist thought it was possible, however, that it was related to the change in my gate, running style, etc. with the "minimalist" shoes.

So today I tend to wear Nike minimalist walking/running shoes if I need a full pair. Vibrams in my workshop. Nothing when possible.

Again, gigantic fwiw and completely a study with a sample size of one...

Pauliina Lievonen 08-15-2011 01:50 PM

Re: Plantar Fasciitis and injuries
 
Keith, I would agree with your physical therapist that it's well possible. And that's exactly the kind of thing I meant with the whole leg working in a better coordinated way.

Pauliina

jester 08-15-2011 02:43 PM

Re: Plantar Fasciitis and injuries
 
I used to run pretty hard and had this once. There's a few things to know that can help it heal faster. I also have a high arch and arch supports help out!

First, your toes point when you sleep and this makes the plantar fascia (arch tendon) on the bottom of your foot contract. When you stand up in the morning you risk tearing it where it attaches to your heel and further irritating the pain you already have.

To help with this, you can wear a foot brace that holds your foot at a 90 degree angle at night so that plantar fascia doesn't contract.

Stretching the calf is also great thing to do. The Achilles tendon needs to be stretched because that attaches the calf to the heel.

Having good arch support also helps out. It will take a few months for this to heal. Anti-inflamatory medicine and applying cold will also help.

Good Luck.

lbb 08-15-2011 03:37 PM

Re: Plantar Fasciitis and injuries
 
Re minimalist footwear, I've been alternating between Invisible Shoe huaraches and Tevas this summer...thinking of getting a pair of Soft Star Ramblers for the cooler weather. Link to review here.

More and more, I do not not not like a bulky stiff sole.

Pauliina Lievonen 08-15-2011 04:01 PM

Re: Plantar Fasciitis and injuries
 
What I'd really like to see is a minimalist shoe that looks like a very normal conventional shoe...
Pauliina

Lyle Laizure 08-15-2011 04:28 PM

Re: Plantar Fasciitis and injuries
 
Identifying the cause of your plantar fasciitis is the first step. For myself it was a matter of stretching my calves more and I began wearing inserts in my shoes. In addition to that for a while I also wore mat shoes with the same inserts. I continue to wear the inserts in my regular shoes but now can get on the mat without any foot support and minimal pain during extending training sessions. Good luck.

lbb 08-15-2011 04:40 PM

Re: Plantar Fasciitis and injuries
 
Quote:

Pauliina Lievonen wrote: (Post 290339)
What I'd really like to see is a minimalist shoe that looks like a very normal conventional shoe...
Pauliina

Google minimalist dress shoes for work.

Tom H. 08-15-2011 05:55 PM

Re: Plantar Fasciitis and injuries
 
Quote:

Don Nordin wrote: (Post 290323)
I'm dealing with Plantar Fasciitis and a minor tendon tear in my achilles tendon. The achillees is not as painful as the plantar.

Don,

Over-use injuries like plantar fasciitis, shin splits (to which I used to be very prone), and IT band tendinitis are often caused by dysfunctional movement habits used repeatedly over long periods of time. Movement dysfunction propagates through your body, as the muscles in one area are affected by the function of muscles in adjoining regions. Over time, this cause micro-trauma to accumulate until it crosses an injury or pain threshold.

Unfortunately, the cause of the pain may be remote from the region that hurts, and there may be multiple inter-related issues, so alleviating the symptom (i.e. pain) may not remove the cause. Tight muscles can play a role in this problem, too. For example, consider a scenario where someone's plantar fascia is painful because it is continually over-stressed because their feet severely over-pronate, because their calves are habitually tight, so they have lost dorsiflexion in their ankles. Massaging your feet and stretching your calves may alleviate pain in this case, but you may not have addressed the problem. You calves may be tight because your hips are dysfunctional, and so you and your body have learned to compensate by off-loading the proper roles of the hips to nearby muscle groups that become chronically over-stressed or under-stressed (e.g. lower back or legs). The real solution in this case is to address pain, tightness, and inflamation as it occurs, but also remove the cause of those issues by retraining the hips to provide proper function during your movement. Even that solution may have multiple factors, as there may be a combination of joint mobility, motor control stability, and muscular strength issues all mixed together.

Restoring joint mobility, motor control, and strength with rehab may then allow to to attack an even deeper cause--dysfunctional movement patterns, because your movement can be dysfunctional and injurious even when all of the component muscles and joints have the proper range of motion, muscle length, and strength when tested individually. (This is like identifying a software problem, after all the hardware checks out).

I strongly recommend having your movement assessed by a Physical Therapist (MPT or DPT) who is qualified to perform a Selective Functional Movement Assessment (SFMA). (See functionalmovement.com). The PT should quickly be able to drill down to the most dysfunctional components of your movement, and give you guidance on how to prioritize and tackle the issues he finds, as well as explain how that dysfunction may relate to the pain you experience, even though the underlying problem areas may be pain-free.

(I used to believe that my arches were falling, I had bad knees and a weak ankle, and that eventually I would have to give up long-distance hiking and start wearing custom orthotics, but in the last two years those issues have been almost entirely resolved to a degree I would not have imagined possible, because I started looking for the causes of my injuries in my movement, as opposed to continually chasing symptoms of pain and tightness.)

Good luck!
Tom

thisisnotreal 08-15-2011 06:39 PM

Re: Plantar Fasciitis and injuries
 
Tom, that was a fantastic post. Extremely well articulated.
The mechanism you outlined, by the way, was exactly the same for me. From the foot to the ankle to the shins to the tight hips. Systemic body wide issue...But how come only my foot hurt? Going down stairs was agony in the mornings. For me; trigger point therapy and foam rolling really helped knock things loose..and allowed for the beginning of the restrengthening and rebalancing work.
Good Luck Don.

Janet Rosen 08-15-2011 10:43 PM

Re: Plantar Fasciitis and injuries
 
Quote:

Josh Philipson wrote: (Post 290348)
Tom, that was a fantastic post. Extremely well articulated.
The mechanism you outlined, by the way, was exactly the same for me. From the foot to the ankle to the shins to the tight hips. Systemic body wide issue...But how come only my foot hurt? Going down stairs was agony in the mornings. For me; trigger point therapy and foam rolling really helped knock things loose..and allowed for the beginning of the restrengthening and rebalancing work.
Good Luck Don.

Agreed re Tom's post! And I will second Josh on trigger points and foam rollers (I use the latter routinely for t.p.s in my quads and rarely in my itbs)

Don Nordin 08-16-2011 07:28 AM

Re: Plantar Fasciitis and injuries
 
Thanks Everyone for the replies. To address some of Toms points I am working with a Physical Therapist and working on a number of core/hip strengthening and flexibility issues, as well as stretching the calves, hips, and hamstrings. No doubt that this is part of the underlying cause, however it all flared up when I wore a new pair of running shoes on a long plane flight. I just bought trail running shoes and they apparently had too much padding for me. For the past several years I wore a couple of pairs of good dress shoes and a pair of casual boat shoes almost everywhere I went. The shoes basically have a thick leather sole minimal heel and almost no padding on the insole. I could walk for miles in these shoes, but me feet would be sore. Not debilitating but sore. So after a trip from Rio then on to Seattle I thought I would give my feet a break and wear my hew running shoes for the trip from Houston to Seattle. I felt pain as soon as I got off of the plane. That was early June, I missed about 4 weeks of practice after that trip, last week I started experiementing with shoes again and it got worse, that brought me to the minimalist shoe discussion with my doctor. I also think there is a diet component to the plantar fasciitis. Its all related, get one spoke to tight and the whole wheel goes out of true.

Diana Frese 08-16-2011 09:26 AM

Re: Plantar Fasciitis and injuries
 
A lot of information in less than twenty-four hours! I'm so glad to have y'all on Aiki Web for present and future reference. Not much to add myself, since my plantar fascitis problem was way back in 1986 as a result of jumping back into stretching exercises when my hubby and I came back to my mom's lawn for some long postponed practice. I didn't know what plantar fascitis was until later, after I got it. We were doing the normal lean forward over the leg and grasp the foot as usual, but after almost a year of no stretches. Of course that was stupid, to begin with. Then walking around our horseshoe shaped road in my late brother in law's minimalist soled wrestling shoes that laced up the ankles lightly. Well, bad for the heels...

Imagine me limping around with that condition as a construction gofer carrying tool boxes out of the car .... needless to say I had to tone back on that and stick to the errands part, not the schlepping tools in and out....

So.... in line with something some other posters have mentioned, eventually my knee went out too, but when I went to the doctor, he said there was a normal range of motion and I decided not to gamble on surgery. In 1988 I had a chance to teach class for a few months to others who had injuries and couldn't attend the regular dojo in town, and though I missed doing ukemi it was still great to be practicing at all, and surprisingly the class did well until we had to rent out that part of the woodworking shop to another artist.

Well, that's my story from way back when. In my case I seem to remember that Japanese zories (what we call flip flops but with a more substantial sole than the old style beach variety) helped when I could finally locate a pair. But for me, that was what I had been used to during my training years, I had just worn out my old ones and not found new until I hunted in stores.

Perhaps it was the elapsed time, taking it easy on carrying stuff, or maybe it was the zories. I had noticed, however that my arches seemed to have fallen since Aikido days, and felt the zories might guide my feet back into balance. For those who can do suwari waza, curling your toes under seems to have been great for arches, from what I remember from when I was doing suwari waza (and loving it)

Well, that' s me reminiscing again, but I can agree with two main points I found from the above posters, that an injury can throw off other parts of the body's functioning, and conversely, an injury can often be corrected by looking to hip function, etc. Now I am gratified to note that there is a special branch of medicine devoted to sports, where there are doctors knowledgeable about the various functions and needs in various sports and activities. Didn't quite say that right, but y'all know what I mean. Thanks again for the wealth of useful information.

Robert Cowham 08-25-2011 03:51 PM

Re: Plantar Fasciitis and injuries
 
Having had fasciitis for a number of months, the minimalist shoe (heel) approach worked for me. I combined with reading up about barefoot running and the like, and trying it out - a pair of light weight and non-sculpted sandals helped a lot, as did examing my walking/running style.

Robert
(I have naturally high arches)


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