He’s the world’s crankiest man and one of Twitter’s most entertaining trolls. If he’s right it means most of what we’ve been taught in school is wrong. I’m talking about Nassim Nicholas Taleb, author of The Black Swan and Antifragile: Things That Gain from Disorder. You can apply his ideas to many areas of human knowledge, everything from the economy to beekeeping. In this post I want to look at how his notion of “antifragility,” systems that benefit from shocks, applies to a little understood malady that effects 2 million people in the U.S. every year: plantar faciitis (I’ll call it PF for the sake of brevity).
PF is an inflammation of the plantar facia, a band of tissue that connects the heel to the toes. It causes a sharp pain that makes walking extremely painful. Risk factors include tightness in the calves, overuse and obesity. I’ve had three cases of it in the past ten years, two brought on by running and one by fencing.
I’d cured my PF last time by going barefoot. That time, it worked quickly. When it didn’t work quickly this time around, I gave up and decided to seek the advice of medical professionals, including a sports medicine specialist. I didn’t trust my own experience. This was a mistake.
The standard medical advice for PF is rest, immobilizing the foot, constant arch support (I was never barefoot unless in the shower or pool), orthotics, needling and cortisone shots. In my my most recent bout with PF, I tried all of these things for a year and a half, following my instructions to the letter, and none of them worked. One of those strategies, immobilization in a boot with crutches made things much worse and, I believe, set my recovery back by months.
If my experience is any indication, I’m going to step out on a limb and suggest that if you have PF you shouldn’t go to a doctor.
I’m not going to let alternative medicine off the hook either. I also made the mistake of seeing a chiropractor. She pulled my hand around, using it as a kind of augur with which to indicate which worthless, expensive supplements (including rancid cod liver oil) I needed to buy. She also waved a kind of pimped-out laser pointer around my heel. That was also pointless. In the end I talked to another chiropractor I trust who is an ultra-marathoner and fellow PF sufferer. She admitted that she can’t fix PF and that’s why she’s a good chiropractor.
What seems to be working is giving my feet a heavy dose of antifragility. I’ve stopped babying my feet: no orthotics, no rest, going barefoot as much as possible.
It was painful at first but I took it slow and now I’m walking and doing light running. This is exactly the opposite of what the majority of podiatrists, sports doctors and orthopedists will tell you to do.
What sent me back on the barefoot antifragile path is the webpage of a San Diego based physical therapist named James Speck (thank you Kathy Turk for that link!). Here’s what Speck has to say,
Plantar fasciitis doesn’t develop from overuse or too much stress on plantar fascia. It happens when the wrong kind of stress replaces the good kind of stress that the foot needs to remain healthy. The aim of treatment, therefore, should not be reducing stress on the arch. Instead, treatment should focus on changing the types of stresses being applied and encouraging normal function of the foot.
If Taleb ranted about feet instead of Ben Bernanke, I suspect he’d agree.
The usual warning about correlation not implying causation could apply here and certainly applies to many supposed PF cures.
PF tends to resolve on its own eventually and perhaps we can end up thinking that whatever the last crazy thing we did is the cure. But I have a feeling that Speck is right about restrictive footwear being a primary cause of PF. If you’ve got PF check out his background on PF, why common treatments don’t work and how to treat it.
I also want to be clear that this is not an indictment of all of Western and/or alternative medicine. Let’s just say that the virtue of Socratic ignorance is lacking in both sometimes.
Tomorrow I’ll do a post on what shoes I’m wearing (when not barefoot, of course). In the meantime, my feet are now more like the happy foot side of the happy foot/sad foot sign.