Need help finding fitness routine-Plantar Faciitis and uncooperative knees

[MarieRMc]

Hi all!

I need some help.  I'm a smidge frustrated at the moment and I thought I would see if anyone out there had any suggestions.

I have terrible plantar faciitis which can be pretty painful at times when working out.  Additionally, I guess I reached a weight where working out in basically any capacity makes my knees and lower back KILL.  (220, 5 foot 2; age-26)

The first workout I did on December 18th was Hip Hop Abs for an hour and that night my knees hurt so bad and were so swollen that I had to ice them.  

Since then I've done it successfully again for 30 minutes (a week ago-with next to no pain afterward)  and 60 minutes (2 days ago).  Well I tried to do it today even though yesterday I had some upper thigh pain...I had to stop after 20 minutes do to severe lower back pain/thigh cramping.  I told myself I was going to do an hour though, so I popped in a beginners yoga dvd that I've done a ton before.  Well as soon as I tried the triangle pose for the second time, my knees started popping LOUDLY and hurt.  I said...screw it...and turned it all off and went upstairs.  The whole time I was going up the stairs sounded like I was walking on rice crispie treats.

I bought the PiYo dvd set on ebay and it should be here within the next couple days, so I'm hoping that that will be low enough impact.

I just need some advice on excercises or dvd's that might be better for me.  I can't swim (I'm too afraid of drowing....since I'm so short).  I will have access to a gym with excercise classes in the new year as well.  I know that doing cycling will be good, but I can't start that for another week.  

Any advice would be great!  

Oh and my gym offers personal training sessions...worth it?  

[Onmiwei]

That's too bad. I hope you find something that doesn't cause so much pain. The bike like you mentioned is the only other thing I can think of that doesn't cause me pain when I work out. Good luck 😄

[Bergie0045]

Sorry to hear about that! I know how bad injuries like that can be, last year I injured by foot, a teeny tiny bone called the sesamoid bone, and it cost me 3 weeks on crutches and about 2 months in a weird boot thing. AND IM STILL NOT HEALED! I can't run a lot because it hurts too bad. I would suggest starting with swimming or like workouts in water, because that takes some of the pressure off of the body or just getting out and walking more every day. Also stretch often. 

[Corney]

Plantar facitis is an inflammation of the fascia that runs from calcaneal tuberosity to the front of your foot, it has 3 main causes, if you have it in one leg only, then that leg is longer that the other leg and the body wants to be symetrical, so the foot goes into hyper pronation, which ineffect shortens that leg, hyperpronation also causes the patella to move lateraaly out of the of the groove fromed by the Femoral Condyles which could be the cause of your knee pain.  The second cause is decreased range of motion of the Big toe in flexion, which puts the plantar fascia on stretch when ever your foot hit the ground.  The third cause is decreased range of motion in ankle drosiflexion.  First try to determine which cause pertains to you.  If one leg is longer try to determine the length difference and add a lift in the opposite shoe slightly less than the leg length difference. Check the amount of flexion you have in your big toes, if the range of motion is less than 60 degrees, try to stretch the joint capsule to increase the range of flexion.  Next try to stretch you heel cord.  I ran for 25 years and finally had to give it up because of the severe pain in the morning upon rising, didn't go away during my runs, plus it was causing knee pain.  Wearing over the counter orthotics and running against traffic, since it was my left leg that was the long leg and since the roads are crowned running against traffic placed my left leg on a lower surface than my right leg.  I don't advice cortisone injections at origin of the fascia, it hurts and it demineralizes the fascia and makes it weaker.  Never train through pain, it just makes the problem worse.  If none of my suggestions seem to work, I hate to say this because I loved running, but as a Physical Therapist I knew what to expect if I kept up running, you may have to give up running, not so much due to the PF but due to the knee pain.  If your knee sound like rice crispies you have roughness underneath the patella, that will eventually cause degenerative changes on the Femoral Condyles, which will than cause these changes to occur on the Tibial Condyles.  Degeneratives changes in component of the knee joint will eventually spread to all three.  Since I stopped running, I now workout on and elliptical, a rower and a stationary bike on alternate days, my plantar fasciitis is gone, my knee pain is gone.  Also I do not recommend cortisone injections in knees, it just hides symptoms and does not solve the problem.

I hope this answered some of you question. Believe me, there is life after running.  You are too young to be having that much knee pain along with sounds you are hearing when negotiating stairs. Stick with any low impact exercise that you can manage.  Good luck,Charlie

[MarieRMc]

Oh I don't run except for the bus haha.

I'm glad you were able t get rid of your knee pain and plantar faciitis!  I long for the day that happens!

I do have custom orthotics, and I agree with what you said about the cortisone shots.  The first two times I did them it was AMAZING.  I mean my lord the next day I could walk with NO PAIN.  I felt like a new person and realized just how much pain I was in on a day to day basis.  It's unreal how much your pain tolerance goes up.  The second time I got them though, I sprained my ankle so bad a week later that I tore the tendon nearly completely.  Took months to heal, and I've never had success with the cortisone shot since.  It really only treats the symptoms of the inflammation, not the source, so it's only ever temporary and like you said can cause long term problems.  It sure did feel good in the beginning though.  

I agree with the being too young to have the knee pain I do.  I definitely wont bother with cortisone shots there, since I know more about them now.

I ended up doing an hour on a recumbant bike on Monday, going 15 miles.  Felt good...until I reached about 8000 steps later that day (I had a really long day).  By the end of the day I'd done over 11,000 steps and my knees were making all sorts of horrible sounds when getting up and I had to ice them.  Today I was in constant pain with my knees...so I didn't work out today.  I've just been icing and taking the max dosage of ibuprofen.  It's incredibly frustrating.

I will start next week with a personal trainer though, and I asked for one that is also trained in sports medicine (since they have quite a few that are).  Seems like I'm not good at knowing my limits at the moment and I'll end up hurting myself.  

[Loon3y]

Hi 

Have you ever tried reflexology? I have plantar facilitis and mine got to the point I am crippled in pain so I started reflexology and they can help relief the pain, its expensive but its worthwhile, Mine isnt as bad as what it used to be, still hurts but not as bad.

[Corney]

Unfortunately Plantar fasciitis is caused by a mechanical problem in the foot, until that problem is fixed PF will still be a problem.  PF is caused when the body tries to correct the mechanical problem by Hyperpronating the foot at midstance, hyperpronating the foot at midstance also cuases the tibia to externally rotate causing the patella to move lateraly out of the patellar groove between the Femoral Condyles, leading to degenerative changes on the under side of the patella, which eventually is transferred to the Femoral Condyles and the Tibial Plateau surfaces.

[tamado]

I had PF so bad a few years ago that I would sometimes fall when I would try to get out of bed and was walking with a cane sometimes.  My job is highly physical and I was in agony.  I finally went to a podiatrist for orthodics and within a few months I could function normally as long as I was wearing them.  For the first while, I wore my shoes in the house - basically, if I was on my feet, I was wearing orthodics.  One of them has a slight lift to correct for asymetrical height as well.  If yours are not working for you, I think another trip to a podiatrist is in order and wear them ALL THE TIME.  Now that I am losing weight and wear them religiously, I can actually get away with wearing flip flops for a half day at the beach and I even went hiking in my winter boots without them last week.

As it pertains to your tight calves, please continue yoga/pilates.  My wife has been doing it for nine years and me for a few months and I am already noticing the difference.  Take the words seriously - it is your practice.  If a triangle pops your knees, do it gentler or do an alternative or sit in child's pose during that section of the video.  As your strength and flexibility increase, you will be able to do more poses.  I am looking forward to that day myself.  My wife is constantly reminding me not to push too hard - focus on the breathing and the form, not pushing it too far.  Everyone I know who has done yoga for years is fit and strong so I think I want to stick with it.  A strong breeze used to knock my wife over (clumsy, no balance) and a day working in the yard would leave her sore for three.  Now she lifts a leg in the air and puts her socks on.  She is stronger and not sore as easily.  I look to her for inspiration and I hope you find some too.

You get one body and one life.  Treat it well, love it, love yourself.  Enjoy your journey.

[Heybales]

Mine was due to overdoing a race.

My short leg was actually the foot that got it.

And wasn't until years later that was discovered, but it sure explained all the other side symptoms I'd gotten through the years, but being a younger body it just dealt with it better.

That is a great reminder to get that checked out though - because for normal level of average daily activity, a short leg of certain amount may not matter.

But start adding 2 x the steps to the day, and/or more intense exercise - now that difference is enough to cause imbalance problems and bad side effects.

Great checks to do - sure which my original podiatrist had looked at all those. Wasn't until years later reading up on short leg effects did I see that podiatrists totally should be looking at that potential.

Those other checks are great too, I've got some stretching to do.

[Corney]

For anyone that is not a runner a leg length difference of less than 1/2 inch usually causes no problems, but runners land with 3 times body weight which magnifies any leg length difference.  I'm surprised it was the shorter leg that got the PF,  how is the flexibility of your big toe, and the range of motion in ankle dorsiflexion.  PF is usually caused by one of these 3 mechanical problems.

[Heybales]

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@Corney wrote:

For anyone that is not a runner a leg length difference of less than 1/2 inch usually causes no problems, but runners land with 3 times body weight which magnifies any leg length difference.  I'm surprised it was the shorter leg that got the PF,  how is the flexibility of your big toe, and the range of motion in ankle dorsiflexion.  PF is usually caused by one of these 3 mechanical problems.

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Big toes are both about equal now - no idea back when I got injured and kept it messed up for years.

Same with ankles at time of injury.

Ankles were twisted and sprained so many times as youth, they are limited, really a hard limit, because even with squats and extra 220 lbs even, once it flexes that max amount something else is moving to compensate. In fact injured Achilles couple years ago by that fact of slight roll of weight to toes more at bottom. Other ankle is artificially limited by having trimalleour break and it just doesn't have range it once did because of way bones healed.

Have to use 1/4" board under heals on squats now to compensate.

But plantar fasciitis  went away after a concerted year to allow healing. Then I progress on to barefoot running until that short-leg aspect really had an impact and was discovered. Plantar really strong now, no orthotics used in flexible shoes, only like stiff dress or biking shoes (and should be hiking shoes when I remember) where natural foot movement can't take place. Still land with barefoot technique in minimalist running shoes that I can get a full-length lift in. Which is bummer, my 5-Fingers and Merrill trail-glove are only for trail running now, and only done that 2 times now.

[HelenaFitbit]

Thank you for the information provided everyone! I'll make sure to get some orthopedic shoes since the PF pain is returning and it's pretty bad in the mornings. Main advice from my doctor is to lose weight, because of the pressure on the ankles and knees. 

Wow @Heybales! Barefoot running? That's heavy. 

[Corney]

Your Dr is wrong!  You weight has nothing to do with Plantar fasciitis.  During stance phase your foot is going into Hyperpronation which put increased stress on the Plantar fascia which help maintain you arch. Usually 3 things cause the bio-mechanical problem, 1 leg is longer than the other and hyperpronation tends to functionally make that leg shorter, you have lost flexibility in your great toe, this lack of flexion puts undue stress on the plantar fascia, thirdly your Achilles tendon has lost flexibility.  Solution: check your leg length, if one is longer place a lift in the other shoe slightly less in height than the discrepancy, try to improve the the flexion in your great toe, stretch you heel cords.  Buy running shoes with a very firm heel counter and one with a straight last.  I think you can purchase over the counter orthotics over the internet, I use Spenco supports, don't go to a podiatrist, they will charge you over $500.00, and don't allow anyone to inject your foot with cortisone

[MarieRMc]

I respectfully disagree with Corney.  Her Dr is not wrong.  Weight definitely does worsen plantar fasciitis, due to the increased stress you put on your arch.

 I recommend going to the podiatrist and getting custom orthotics.  I tried out over the counter ones and they were either too hard (causing pain in the heel) or too soft (allowing extra flexion in the ankle which just worsens the problem-they may feel better but you are just causing further damage).  You may have better luck than me, but my custom ones only cost $60 bucks with my insurance.  Over the counter ones will cost you less but you have to replace them...and these ones get replaced for free by my podiatrist when I wear them out.  He will measure your leg and the angles it makes and make a cast of your foot.  It will take a couple tries to get it perfect (over the course of a couple of weeks), but it was definitely the best thing I could do for my feet.  Good shoes to put them in are also essential.  You want to have shoes which don't bend in half, or are completely stiff.....they just have a bit of give. 

I agree that cortisone is a waste though.  It's only temporary and just delays your symptoms...plus it can make them worse in the long run.

I have to say that over the past month with losing 7 pounds so far and doing a lot of yoga (downward dog is my friend now) that my plantar fasciitis is a lot more controlled.  I can get up at the end of the night without much help AND I can make it to 10,000 steps without being in significant pain. In addition, I've found poses and exercises with the help of a personal trainer that don't hurt my knees.  

[Corney]

I agree weight does put more stress on the feet, but Plantar Fasciitis is not caused by weight alone.  It's caused by a bio-mechanical fault which causes Hyperpronation at mid stance.  If it was weight alone  there would be thousands and thousands of Americans suffering from PF.  It's mainly found in runners, because they land with 3 times body weight during stance phase, and are over pronators.  I have never weighed over 130 pounds, so why did I get PF?  I got PF because my left leg is longer than my right leg, I lost flexibility in my Great toe(in flexion).  I got my pair of orthotics over the counter over 10 years ago and never replaced them. There was an article in Runners World years ago that covered the problem of PF very throughly, never once did they mention weight as a contributing factor.  The Merck Manual mentions the cause of PF to excessive stretching of the calcaneal periosteum by the Plantar Fasci.  It recommends orthotic devices to control abnormal elongation of the foot.  No where did it mention losing weight.  Telling someone that PF is caused by increased weight is a too simplistic solution.  I would bet the Dr. is not a runner.  If you can find the book, "The Runner's Repair Manual" it will back me up 100%

[Corney]

"The Runners Repair Manual" by Dr. Murry F. Weidenfeld can be purchased on Amazon and will once again back me up 100%.

[MarieRMc]

Yeah, but that book is over 30 years old.  I'm sure there's some good stuff in it that can still translate to today, but there's been a lot of research done in the last 30 years on how to effectively help people with plantar fasciitis.  

There are also a lot of new theories as to what causes the plantar fasciitis....especially depending on how long you have had the platar fasciitis.  For instance, in people like me who have had it for years, it is now believed that it's more of a plantar fasciosis where the fascia is actually dying rather than being inflammed (-itis).  That's why it's so important for someone to treat it very aggressively with streches, custom orthotics, night splints, physical therapy, and weight loss with the help of a podiatrist.  I've never been a runner, but I've always been overweight and I think that along with my low arch really caused my plantar fasciitis.  

Additionally, more recent studies have found that a majority of americans do suffer from foot pain of some sort (http://www.apma.org/Media/PRdetail.cfm?ItemNumber=13075) and even runners world discusses weight gain as being an issue (http://www.runnersworld.com/injury-prevention-recovery/plantar-fasciitis).

I think this article is good too because it discusses the gait changes that happen when a person is overweight/obese which make plantar faciitis more common (http://www.podiatrytoday.com/blogged/crucial-questions-about-treating-plantar-fasciitis-obese-patien...

Overall I think people with plantar fasciitis do need to talk to a podiatrist and get a specialized approach to managing their pain, and I think losing weight (if your overweight or obese) will help manage your plantar faciitis.  

[Corney]

MarieRMc, yes being over weight can be a contributing factor, but if you didn't have a low arch, your weight wouldn't be that much of an issue.  I agree the book is over 30 years old but he anatomy of the foot hasn't change in that time.

[SteppingBooks]

I can certainly relate to the plantar faciitis.  Mine really started become a problem when I was trying to go from 6-8k steps per day to 10-13k.  It was awful.  The walk-in first thought I had a stress fracture in my foot.  I ended up seeing a good podiatrist who gave me just one exercise for it that worked miracles.  Took about 10 minutes to do each morning, haven't had a problem since (and I've been bad about not doing it).  Plus I wear my Asics all day which helps. Now I can average anywhere from 14k/day to 19k/day and not have my feet killing me. 

Pilates is a good one.  I did pilates after a car accident to strengthen my lower back muscles, and I would do a lot of modifying for it.  There were many times I couldn't finish the DVD because my back was starting to hurt.  Until I had built up the muscles enough my lower back, I would get radiating pain down my sciatica, thighs, and into my knees some days.  I'm trying to do yoga, though I have to modify quite a bit since I don't have much flexibility.  

It might be good to meet with a personal trainer if nothing else to help build a plan and get started.  

[Corney]

MarieRMc:  I respectfully disagree with MarieRMc.  A persons weight has nothing to do with Plantar fasciitis, it is caused by hyper-pronation at midstance that is caused by a flexible foot.  I had Plantar fasciitis and I only weigh 125 pounds.  Weight can cause the symptoms to become worse but if weight was the main cause there would be millions of Americans flocking to Dr.s for 500-600 dollar orthotics.  I bought over the counter orthotics for under $40 bought a good running shoe with a straight last and firm heel counter for rear foot stability and ran for years after.  Shame on that Dr for blaming a persons weight for a problem that he knows nothing about because he is not a runner.

[J-flex]

 Carrying extra weight affects and puts extra strain on knees, back, ankles, etc etc..