Oh, My Aching PFoot!
Hiking with Plantar Fasciitis (PF) and almost making it
Somewhere in Virginia I woke up with pain around my heels. I thought at first it might be bruising from the rocks and rigors of the trail. But soon it morphed into pain radiating along the tendons from the heel to the toes. It was worse in the morning, lessened during the day, and returned with a vengeance in the evening.
Plantar fasciitis ( “PLAN-ter fash-ee-EYE-tus”) is an inflammation of the plantar fascia, the flat band of tissue (ligament) that connects your heel bone to your toes. It supports the arch of your foot. It might become inflamed after strenuous athletic activites, including soldiers carrying heavy packs, running and …. hiking. Carrying extra weight, natural or in a pack, increases the risk, as does putting in long miles. The old warning about hiking “too far, too fast, too heavy, too soon” seemed to have caught up with me. I built up the miles slowly in the beginning, but by Virginia was putting in 20 mile days a bit too often for someone my age (62) and not taking enough shorter days, NEROs or ZEROs, to rest and recover. In hindsight I should have followed up a 20 miler with a shorter or NERO day rather than doing them back to back to back.
What to do? I’d already invested two months and hundreds of miles, and wanted to complete the through hike. I researched on the web, reached out to friends on social media, including physical therapists, pharmacists, nurse practitioners and runners, talked with my MD and the Orthopedic surgeon who had reconstructed my ankle after breaking it in the Whites 7 years ago, as well as many hikers I met who had also experienced PF.
Here’s what I put together to keep hiking, adapting the usual prescriptions to accommodate the hike:
- That’s what is always recommended first. But how to rest when you are trying to make it another 1000+ miles before winter closes Katahdin? I did a few more ZEROs and NEROs, and lowered my miles per day from 18-21 to 12-14. That ended up adding a month to my hike. Occasionally I would do a longer day, and would usually feel more inflammation, but I would always followed it up with a shorter day.
- Medication: I took the maximum dose of Ibuprofen, and even exceeded it during more intense pain periods, taking care to eat and drink with the doses. Thankfully, I did not experience stomach problems, but ran across one hiker who did the previous year and had to get off the trail due to stomach bleeding. I got conflicting advice about steroids. I had one round of Prednisone with me, and after the Dr’s split on their advice, Pharmacists discouraged it, and a Nurse Practitioner encouraged it, I went ahead and did a two week round. I’m not sure it helped.
- Ice: This is hard to do on the trail, but you can find cool water. This should be done only at the end of the day for hikers; doing it during the day tightens up the whole foot, and then you have to stretch it out and warm up again to continue.
- Stretch: There are several stretches that help PF, and they hurt. I stretched before, after and during the hike, stretching approximately every 30 minutes, or whenever the pain increased. Look on the web for stretch techniques. Also recommended was sleeping with foot support to keep the foot from dropping, and the tendons from shortening up during the night. The foot braces for this aren’t really practical on an unsupported hike. I used them when I stayed with my wife off the trail, but did not use them when overnighting on the trail. I couldn’t think of a low weight/volume alternative.
- Massage: Most of this was self-inflicted. Use a tennis ball, press down hard on it, and roll your foot back and forth. You can also use a rolling bar, although I wouldn’t want to pack one. With your thumb press as hard as you can and rub along the tendons and around the heel, including the Achilles tendon. Wherever it hurts, massage more. I did some “scraping” which is using the handle of a bread knife or something similar, lubricating your skin, and rubbing it hard along the effected tendons. This really hurt, which probably means it was helpful. No pain, no gain.
- Arch Support: Some hikers got off trail to a Podiatrist for special prescription inserts. Being a cheap sort, I followed some friend’s advice to go to a Walmart or larger Drug Store that had a Dr. Scholl’s You stand on it, it reads your pressure points, gives some advice, and tells you which insert would help. My high pressure points were the same as the parts of my feet that were painful. Hmmm. I wore out the inserts, shifting them from hiking boot to trail shoe, but one pair sufficed. Use them on both feet, even if only one hurts. I also used KT Tape, although I was skeptical it would help. How much support can stretchy tape give? But lots of hikers and other athletes use it. You can find Youtube videos on how to apply it for PF, and each box has a “how to” insert. I used the Pro rather than Original formulation, as it lasted a day or two longer. I was surprised. The pain in the outer fifth metatarsal (connecting the little toe and heel) was significantly better within two days. I went through a lot of tape.
- Change your hiking stride. This was the hardest information to come by. It basically boiled down to this – don’t run/walk uphill landing and taking off the ball of your foot. Hit your heel first, roll the foot straight, and keep it flat as you push into the stride. Don’t push off as much. So I used my poles a bit more to propel myself down the trail. I also took slower, shorter steps, reducing speed from 2.5 or 3 mph to 2 mph on flatter sections, and even slower during elevation gain and descent. This made for longer hours and shorter mileage days, but fit in with the “rest” part of #1. When I did speed up, I could tell at the end of the day that the inflammation was worse. I also tried not to slam my foot down, and instead glide over the trail.
- Less Weight: I’d already lost body weight, but I reduced my pack some more, and did more slack packing than I had planned.
- Shoes: I tried shifting from boots to trail shoes to trail runners. I don’t think this made much of a difference. But shoes with no arch support, like flip-flops and most sandals, should be avoided.
What I did NOT do was get a cortisone shot into the tendons. That just sounded awful, although I talked with a couple guys who got them, and claimed they helped. I also didn’t try heel cups, although one hiker got trail shoes that kind of had them built in.
And I did not stop due to PF. In fact, it gradually got better over the next 1300 miles.
But with 117 miles to go, after completing all the hardest parts (except for Katahdin itself) I stepped off a rock wrong and got a stress fracture in my right, third (middle toe) metatarsal. The pain was on top of the foot for a change. I waited a few days, and tried again. On another crooked, off balance stride it exploded in pain.
So I had to stop. 2070 miles down, and I’ll return next August to finish the AT. I was totally bummed about that, but did make it through the PF.
I anticipate a longer recovery than if I’d stopped and totally rested right away. It has been a month, and the stress fracture is better, and the PF has returned a bit since I can’t stretch quite as well with the fracture. I’m hoping it’s gone by March, when I hope to tackle the 800 mile Arizona Trail in a supported hike. Hiking up the North Rim of the Grand Canyon and keeping my foot flat should be interesting.
My hope is that by doing the above steps from the beginning, the PF will not return. We’ll see how it goes.
Dave Michel, aka as Pitchit
This website contains affiliate links, which means The Trek may receive a percentage of any product or service you purchase using the links in the articles or advertisements. The buyer pays the same price as they would otherwise, and your purchase helps to support The Trek's ongoing goal to serve you quality backpacking advice and information. Thanks for your support!
To learn more, please visit the About This Site page.