How to Manage Plantar Fasciitis as a Runner
The diagnosis every runners knows and hopes to never hear for themselves: plantar fasciitis. While this injury plagues a large number of runners every year, many will jump to this diagnosis with any feeling of discomfort in their foot/heel. It’s important for runners to be able to correctly identify the signs and symptoms of plantar fasciitis and to work with a running medicine specialist in oder to return to running the right way!
Plantar fasciitis accounts for around 10% of running related injuries every year.
Plantar fasciitis is a common overuse injury to the fascia on the bottom of the foot where it becomes irritated or torn. The plantar fascia tissue plays an important role in absorbing shock with walking/running and provides support for the medial arch. Millions of people suffer from plantar fasciitis every year, many of them runners who have to take time off from training. With plantar fasciitis, people will typically complain about pain with walking first thing in the morning or after prolonged periods of standing. Most of the time patients will point to a very specific point on the medial heel as the main source of pain.
Plantar fasciitis is a common cause of foot and heel pain in runners but it can be easily misdiagnosed.
Head to a group long run on a Saturday morning and you might hear a large handful of runners all talking about their plantar fasciitis pain. While it may be true that they all share the same diagnosis, there’s a good chance at least one of them has maybe misdiagnosed their pain. That is why seeing a medical professional is so important. You want to make sure that you are treating the correct diagnosis! Other common causes for foot/heel pain include:
Sever’s Disease: More common in younger kids and teenagers, this injury can cause severe heel pain due to excessive pulling from the Achilles tendon on the calcaneus bone growth plate.
Achilles Tendinitis: Due to the attachment of this tendon at the heel, irritation to the Achilles tendon can sometimes present similarly to plantar fasciitis.
Posterior Tibialis Tendinopathy: Dysfunction in this muscle can create pain in the medial heel where the tendon passes the ankle joint. Runners with this injury will also commonly feel pain in the arch of the foot as the posterior tibialis is a major support muscle for this structure.
Haglund’s Deformity: A bony overgrowth occurs at the heel which will create discomfort as it rubs against the soft tissue in this area.
Bone Fracture: The calcaneus bone can be susceptible to stress fractures or acute fractures and will present with a deep aching in the heel that worsens with standing or walking.
In order to find the root cause of your heel/foot pain, you sometimes have to look beyond the foot.
Runners, especially those that train consistently for races, can find themselves at a higher risk for developing plantar fasciitis for a number of reasons. Making sure you slowly progress your mileage and intensity throughout a training block helps to prevent this kind of overuse injury. Training errors continue to be a huge risk factor for running injuries! Other common issues that might lead to plantar fasciitis include excessive calf tightness, pes planus (flat footed posture), limited mobility in ankle/toe, weakness in hip musculature, over-pronation and improper footwear. Understanding the exact factors contributing to your pain is the key to developing a solid recovery plan to get you back running.
Plantar fasciitis is a very trick diagnosis. It’s hard to give a definitive recovery timeline.
Plantar fasciitis is tough to predict in the sense of knowing when a patient will no longer have pain. I’ve seen such a range in when patients get better. Some feel improvement in their symptoms within a few weeks while others will deal with pain for up to a year. 95% of cases will resolve on its own within 12 months. Typically conservative management tends to be the standard treatment for this diagnosis as surgical intervention has not shown great evidence for better outcomes long term.
Proper footwear is an important piece in preventing worsening symptoms.
Runners are lucky. We don’t need to spend hundreds of dollars on equipment to get started but we do need to make sure that we invest in a good pair of running shoes to prevent injury. While this is not the case for 100% of runners with plantar fasciitis, a stability shoe tends to be the best option for runners with this diagnosis to help control the excessive pronation. The best thing would be to check out your local running shoe store in order to be properly assessed and fitted for a shoe that works for your foot and gait pattern.
Rehab for plantar fasciitis should be more active than passive.
Most doctors without a background in running will just tell you to “rest and let things calm down” as the best way to treat plantar fasciitis. Warning: this plan rarely works! While rest from the aggravating activity may be appropriate initially, there is still so much that you CAN be doing as you work through plantar fasciitis. Do you only have pain on roads? Stick to running on grass. Does the pain flare up only on your long runs over 10 miles? Mix in some cross training to finish out your aerobic work after you get to mile 7-8. There are so many nuances to this injury where it doesn’t need to be “all or nothing”. No matter what, one of the first things a runner with plantar fasciitis should be doing is strength training to build up the load tolerance of the following muscle groups:
Gastrocnemius/Soleus
Foot Intrinsics
Gluteus Medius
Gluteus Maximus
Posterior Tibialis
…and more!
