As a runner, you're no stranger to aches and pains. But when your heel feels like it's trapped in a medieval torture device with each pounding stride, that's an entirely different beast. While there are multiple injuries that cause heel pain with running, by far the most common is plantar fasciitis (PF) - a condition that can make you question whether running is really worth all the suffering after all. But fear not, fleet-footed friends! With the right knowledge and treatment plan, you can get those tootsies back on track and leave that excruciating heel pain in the dust.
In this blog post, we’ll explain what plantar fasciitis is, why it happens to runners, and what we do to fix it.
What is plantar fasciitis?
The plantar fascia is a thick band of connective tissue that connects the base of the toes to the heel. Its primary function is to help create tension and stiffness in the arch of the foot, which helps us propel off of our foot with more force.
Plantar fasciitis is a repetitive stress injury to the plantar fascia which often produces the following symptoms:
Pain where the arch of the foot meets the heel (medial calcaneal tubercle)
Pain that is worse with the first few steps that you take getting out of bed in the morning
Pain that may feel like it “warms up” throughout a run, but then feels worse the next day
Pain on the bottom of the heel can be caused by a few different things. It’s important to see a professional to get the right diagnosis from the beginning to get the right treatment.
Why does plantar fasciitis happen to runners?
Plantar fasciitis occurs relatively often in runners, but the reason isn’t always clear. Running puts lots of strain on the lower leg (below the knee). Runners often produce multiple body weights of force per step in the lower leg muscles, and lower limb injuries are common. For plantar fasciitis, we can often point to a specific training detail like increased running speed or more uphill running in a more minimalist shoe without enough of a ramp up. Sometimes we can point to some specific running gait mechanics that may be putting extra stress on the plantar fascia but sometimes, it can come on rather randomly without a clear reason.
People with flat feet may be slightly more predisposed to developing plantar fasciitis, but this foot posture doesn’t seem to be particularly predictive of who will suffer from PF and who will not. Ultimately, preventing plantar fasciitis comes down to three things that can ultimately be applied to helping to prevent a bunch of injuries:
Having strong feet
Gradual progression of mileage and speed
Implementing changes in footwear slowly
Treating plantar fasciitis
Below is a general guideline for how we approach treating plantar fasciitis, however we recommend seeking help from a physical therapist to individualize this treatment.
Calm things down
In the highly irritable state of this injury with pain levels 6-7/10 with most walking and weight bearing activities, it’s important to work on some symptom modification. Treating plantar fasciitis and keeping it from coming back ultimately requires a progressive loading program, but you have to be able to tolerate phase 1. Things like dry needling and soft tissue mobilization of the calf can be helpful, and using a supportive orthotic TEMPORARILY along with a rocker soled shoe can help calm things down. These things are temporary symptom modification strategies! They are not meant to be a long term solution.
Build up tissue capacity
Once you can find a foothold (😏) in some exercises, you can gradually progress towards loads that are high enough to mimic the loads that you experience during running. Below is a video of exercises going from easy to hard that we commonly prescribe for plantar fasciitis.
Optimize the running environment
Once we’ve got a progressive exercise program rolling, we can start looking at your running environment to see if there are any small adjustments that we should make to help manage the load on the plantar fascia. Sometimes this just involves rotating in some different footwear, and sometimes we work on some adjustments to your running gait mechanics. Most people dealing with plantar fasciitis will benefit from INITIALLY avoiding running uphill and avoiding running in a minimalist shoe.
Final notes on treating plantar fasciitis
Heel pain with running can be nasty, and plantar fasciitis is an injury that can linger, but it doesn’t have to be your forever!
At Alterra, we specialize in helping runners resolve any and all of their injuries that limit their running ability or performance. If you're local to Boston's Back Bay area and are dealing with plantar fasciitis, we'd love to help! Book a free discovery call to chat with a therapist today.
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Disclaimer: The information in our blog posts is not a substitute for professional medical advice. Consult a healthcare provider before making decisions related to your health. Use our content at your own risk.
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