A Cure for Plantar Faciitis?

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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.

The Cure
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.

A Disclaimer
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.

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Saturday Tweets: Sump Pumps, Uniforms, Toilets and Watering the Fake Grass

Josey Baker whole / wild / wet / slow / bold

The bread nerd club I co-founded, the Los Angeles Bread Bakers, brought Josey Baker down to LA to teach a class. Now you can watch a version that very same class via Youtube for freeeeeee. I’m a huge fan of his method and his book Josey Baker Bread. If you’re interested in making your own bread skip the Netflix tonight and get whole, wild, wet, slow and bold.

Designing the World’s Most Pretentious Garden Shed

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The new garden shed, under construction.

At the very top of my “honey-do” list is a much needed garden shed to store tools, pots, fertilizer and chicken feed. After years of dragging my heels for years, the project went from napkin sketch to construction in under a week.

I set as my goal to build the world’s most pretentious garden shed and, as much as possible, to use salvaged materials. Yes, I’m crazy. I have to admit that when British hedge fund manager Crispen Odey tried to build a $250,000 neo-classical chicken coop at the height of the 2008 economic crisis I couldn’t help but admire the design.

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For ideas I thumbed through a coffee table book of 18th century French revolutionary architect Claude-Nicolas Ledoux’s oddball sketches But fabricating a waterproof sphere from used headboards and pallets is beyond my carpentry abilities. Nevertheless, I came up with a few scribbles:

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Thankfully, most of my thoughtstylings stay in the sketchbook like the idea of a 20-foot tall observation chair on top of the shed. Kelly pointed out that the neighbors might not like that idea.

After dashing off a few sketches I created a Pinterest board to gather more notions, mostly from Ian Hamilton Finlay’s garden, Little Sparta:
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The garden shed design I settled on is a kind of mashup of Ian Hamilton Finlay and the front of an “airplane” bungalow (a common type of house in our neighborhood).

Next it was time to put the idea into Sketchup. I’ve said it before and I’ll say it again, Sketchup rocks. All DIYers should know how to use it. With Sketchup I was able to come up with a framing plan that allowed me to cut all the pieces out of the hot sun in the comfort of my garage workshop. Then I just had to carry my stack of pre-cut lumber up the hill and hammer it together.

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Another goal of mine was not to hoard materials ahead of time. I’ve been aided by two great resources, Reuse People of America and the Habitat for Humanity ReStore. They both hoard materials so you don’t have to. Those two resources have kept me mostly out of the big orange store. And all of the doors I needed came from the street.

I’ll post an update and maybe even a video tour when I finish construction. Rents are so high in our neighborhood that Kelly and I might just move into the shed and rent out the house!

Saturday Linkages: Modem Sounds, HOAs, and Hand Counting