Active Release Technique for Plantar Fasciitis

Please note – this is a description of my own experiences and is not intended to be medical advice! Please talk to your doctor so you can get the best medical advice and treatment plan for you.

I have good news and bad news about my plantar fasciitis.

Bad news: it’s the primary reason that I’ve decided to drop out of Tri For A Cure this year. My family lost one of my grandfathers to cancer in November, making it extra hard to drop out of the fundraiser. But I found myself unable to adequately prepare for the event. I’m disappointed not to participate after spending so many hours training, especially the time and effort I dedicated to swimming.

However, I am focusing on the additional time with my family, and am enjoying the flexibility in my schedule. This is the first summer since 2012 that I am not training for a half marathon or triathlon.

Good news: I ran into an acquaintance who is an accomplished triathlete and she asked me how my training was going. I told her about my plantar fasciitis, how much I disliked wearing shoes around the house all day, and that I was about to make an appointment with a podiatrist to look into orthotics since the pain wasn’t getting better.

She told me I had to go see Dr. William Caddoo at Patient First Chiropractic in Waltham, MA.

I did.

Here’s how it went.

Go Barefoot – He recommended not wearing shoes all the time, which was music to my ears. According to Patient First’s website description of how they treat Plantar Fasciitis, wearing supportive footwear can prevent us from walking and running with a normal gait that includes our toes gripping the ground. When we wear supportive shoes constantly we risk muscle atrophy in certain muscles in our feet which can lead to additional strain on the plantar fasciia. That strain leads to little tears, which result in a build up of scar tissue over time, which shortens the plantar fascia and compounds the problem.

I loved getting a green light to go barefoot regularly, especially with beach season on the horizon. The thought of wearing sneakers on sand all the time was making me shudder, but the pain I was experiencing was enough to make me do it.

Now to deal with that scar tissue…

Graston and A.R.T – Dr. Caddoo is treating me using both Graston and Active Release, two soft tissue mobilization techniques that break up the scar tissues along the fascia and calf muscles. Active Release looks a little like deep-tissue massage, but it’s much more than that. Boston Magazine does a better job of explaining it, so I’ll direct interested readers to their article, Ask the Expert: What is Active Release Technique?. Graston Technique incorporates a small metal instrument to assist with the break-up of scar tissue. (All externally.)

I’ve had two sessions so far (out of an estimated 3 or 4 based on my initial consultation and how the scar tissue feels) and while it’s unpleasant, the pain is very temporary and I’ve already felt less aching in the arch of my feet throughout the day.

Prevention is key.

Foot Strengthening Exercises – Once the scar tissue has been broken up, it’s important to prevent it from reforming. Going barefoot will help a little, but to really strengthen the foot muscles and prevent the plantar fascia from having to overcompensate specific exercises are a good idea. Dr. Caddoo printed out these additional resources for me:

Strengthening Exercises for the Foot from Sportsinjuryclinic

Stabilizing Your Foot Core from Runner’s World

Sidenote on running shoes – Dr. Caddoo is a fan of more minimalist running shoes, but also of running on softer surfaces like trails. He told me the ideal shoe to allow for mobility and natural running gait is a shoe flexible enough to bend in half. At the same time, running in less cushioned shoes on hard surfaces isn’t great either. He emphasized the importance of working into a less cushioned or supportive shoe gradually to allow your muscles to strengthen as they meet the new demands of utilizing more of your foot muscles to a greater degree. Anyone who has read Born to Run, the book that spurred the minimalist running shoe movement, may be familiar with these potential benefits of barefoot running.

Orthotics – It looks like I’ve avoided these for now! Orthotics (or even wearing supportive shoes with gel inserts as my primary care recommended) can make a huge difference in reducing pain levels for people suffering from plantar fasciitis. But I was a good candidate for getting scar tissue removed and then working to strengthen the muscles in my feet to prevent future stress and tearing of the plantar fasciia. Orthotics manage the symptoms, whereas the hope is that removing the scar tissue and rebuilding the muscles will treat the underlying cause instead.

As an interesting sidenote, my feet didn’t really have the stereotypical inflamation asociated with plantar fasciitis. (The “itis” stands for inflammation.) But the scar tissue present indicated plantar fasciosis, a deterioration of the plantar fascia from repetitive stress.

I’ll need to be diligent about strengthening the muscles in my feet, but I’m thrilled to be barefoot around the house again and already experiencing less pain.

Dr. Caddoo thinks I may be running normally again by mid to late July. Not in time to train for Tri for a Cure, but after several months of foot pain, late July doesn’t seem so far away!