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.
Exactly my experience sans going to the doctor. I just worked harder in the garden and one day it just disappeared.
I’m glad you’re finally getting some relief. As an LMP, it drives me *crazy* to see the prescribed solutions for weak arches…things that make the arches weaker. I work on so many feet that have flattened out due to bad shoes and poor foot mechanics. And, of course, working on them only helps manage the pain unless someone is doing a corresponding strengthening program. I do think taping and cold laser (I use it at home, not in my practice) can help manage pain during the strengthening process but can’t be relied on without a strengthening program.
Although I have never experienced PF, my daughter has. She blamed it on jumping rope on concrete. Her podiatrist had her wear Clarks with an orthotic. She was sad to give up cute shoes.
My arches are very high, and I hate a shoe that touches my arch on the sole of my foot. I have received repeated warnings that I am going to ruin my feet if I don’t wear arch supports, that I will get pf. It’s confusing!
So, does wearing a shoe without good arch support help to cause pf? I wear good leather shoes, but nothing that touches my foot much.
This reminds me I need to go buy shoes today.
Our contention is that support causes weakness. We’ve found that wearing less structured shoes is better for the foot. We look for shoes with lots of room in the toe box and lots of flexibility of the sole and no heel elevation at all. I mean, heels are fine for an evening out, but not to live in, and that even includes the elevated heels on running shoes. Erik is going to post about his favorite shoes tomorrow.
Fitflop footwear. I’ve had PF twice now and both times I wore Fitflop footwear for some weeks until it was gone. That was that – sorted.
The best treatment for my planter fasciitis was published in the New York Times health column and it basically involves toe lifts off a short elevated platform like a 2 x 4 or a phone book – put your toes on the elevated platform and you slowly lower yourself until you are fully descended and then lift up until you’re on your tiptoes and then lower yourself again and repeat the process in sets of 20. I did that every time I stood in front of the computer for a month and my plantar fasciitis went away after years of struggle and pain. According to the Times article this is the only Method they found that had been shown to work in a controlled study.It’s certainly work for me
Hi John–Thanks for your comment–I should have noted that I’m also doing this very same exercise.
Your article is a cliffhanger…but my heel hurts now! I have a red hot spot where my Achilles inserts into the heel. Its worse when I first wake up in the morning and roll out of bed. My chiro has me working on my inactive glute…I sit too much, and when I move my foot splays out trying to increase my stability. I guess I have a lazy bum. It won’t stop me from working in the garden, but it’s incredibly aggravating. Thanks for sharing your article, I look forward to the next one!
1000 times yup! to all of this. My dh had been dealing with PF and Morton’s Neuroma for years. Was being told he needed surgery for the latter and told to lay off much exercise on it. Finally got him to ditch the orthotics and stiff shoes, use toe spreaders, invest in wide box/thin flexible-soled casual shoes and running/walking shoes, and wide width bike shoes, use thin soled mocs for house puttering shoes instead of thick old flip flops and voila – same thing as Mr. H here. DH is completely and totally sold on using those wee foot bones in all their glory instead of binding them up like sausages.
The only area where he hasn’t gone completely flat and flexy is for work. He’s still not completely comfy with that look in the required business suit attire he has to wear, but he at least donated away a pricy pair of beautiful, but narrow boxed/stiff/traditionally heeled italian oxfords in favor some wide box loafer style ones with a more flexible sole and less heel rise.
I won’t steal Mr. H’s thunder and talk about which shoes we now use – yet 😉
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Have you read Katy Bowmans books or blog? Her exercises have helped my PF tremendously.
Many years ago my mother-in-law came to visit and saw that I was wearing cheap canvas shoes. She told me I needed Birkenstocks so that I could ‘walk correctly’ and have ‘arch support’. Bless her soul, she insisted on taking me with her when she when shopping for hers and she bought me two pairs and insisted that I now get rid of all my ‘junk’ shoes. I did. I wore the ‘Birkies’ for two years. But my knees started going bad and my feet kept hurting even though I thought I was doing a good thing with the ‘exercise’ I was getting from my shoes. Finally someone pointed out that my arch was not the same on both feet. I started wearing my cheap flat canvas shoes again (like the ones they now sell for tai chi)and haven’t had any problem since. When I am not in shoes I am barefoot.
This is a great post, especially for those of us who suffer from PF. I get it from time to time, when I start running again. I give it a break when moving to a new place or when I have nowhere to run (like in the far Northern Rockies where we work in the summer months). I comes back as soon as I start running again in the fall. I just persevere and never stop running. I think this time, I will take your advice and go barefoot a lot.
Oh man, this is timely. I have been suffering from PF since I started my internship this summer. I know that my work shoes are two thirds of the problem (the other third being my weak ankle on that foot which I tend to pronate), but I am required to wear steel toe shoes at work and I have yet to find a truly minimal pair of steel toes. I don’t know if it’s even possible. I wear minimalist shoes or go barefoot whenever I’m not at work, but by Friday my feet are always aching. You don’t know of a minimalist steel toe shoe, do you?
Other than that, I’ve been doing exercises and massages for my foot and ankle. I guess it’s helping some. I was thinking of trying a night splint maybe, I don’t know.
I wonder if you could take the shoes to a skilled shoe repair/shoemaker person and have them grind down the existing soles and replace them with something more thin and flexible? The steel toe part is likely going to limit the movement of the shoe somewhat, but I’m still guessing it would help not to have the stiff, thick soles that typically go with them.
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