Today on the Doc on the Run podcast, we’re talking about first aid for plantar fasciitis in runners.
When plantar fasciitis first starts, doctors call that an “acute case” of plantar fasciitis.
It means it just started. It’s just means inflamed and irritated because it just began.
Acute plantar fasciitis (which just started) should be treated differently than chronic plantar fasciitis (that has been around for months).
Because when you get a inflammation of the plantar fascia, when you have true plantar fasciitis that just started, technically it’s a little bitty sprain where you have on a microscopic level some micro tearing or little disruptions in the collagen fibers within the plantar fascia itself, and that’s what causes the problem.
The reason you feel pain when you run is that you have inflammation around the plantar fascia, and all that extra fluid causes discomfort that you feel as pain. So, you have two things going on. First of all, you have some little micro tearing in the plantar fascia, very, very minor, but it’s there, and you have inflammation as a consequence of that, and that causes your pain.
There’s a couple of mistakes that people make when they’re runners and they get plantar fasciitis and it first begins. The first mistake is that most runners will just stop running and wait. This is usually because some well-intentioned running buddy or even a doctor may have said that, you know, plantar fasciitis is self-limiting.
If you just stop running, eventually it will go away. Well, that’s true, but you’re going to be waiting for all of your fitness to vanish in front of you as you’re waiting. So, that’s not really the best plan.
Now, the second mistake runners make is they often kind of half treat it, and although I have over and over and over in episodes said that I think it’s a terrible idea to put people in fracture walking boots, casts, on crutches, all that sort of thing, I think it’s actually really useful to do it for a very, very short period of time. But most runners don’t do that.
Most runners kind of decrease their activity a little bit. They run a little bit less, they’re still putting a lot of stress on the plantar fascia, and it doesn’t calm down. That sort of half treating it really is the second mistake that I see most runners make. So, you don’t want to just stop running for several weeks. That’s suicide in terms of your fitness.
You also, I think, really want to try to treat it very, very aggressively early on just for a very brief period of time. And that’ll make a big difference in terms of letting it actually heal right from the get-go. That way, it’ll do much better.
There’s really three things you have to do when you’re a runner and you have an acute case of plantar fasciitis that really did just begin a few days or a week ago or so. The first thing is you have to stop the inflammation. Remember, the inflammation in the fluid around the plantar fascia that’s causing your pain; that’s what is causing your discomfort. And if you do some stuff to really dramatically reduce the inflammation right away, you will almost instantly feel better.
Many times, runners will do a routine that I give them in the course on runner’s heel pain. Just from doing this routine on reducing the inflammation, using the contrast bath routine, you’ll get a huge improvement, sometimes 50%, sometimes 80%, almost 100% in just a couple of days doing that. And you’ve just removed all the inflammation, so it feels so much better.
That also tells you a lot of really useful things like it’s not a partial tear of the plantar fascia, it’s not something major, and you can get it to heal really quickly. So, that’s the first thing is you want to get rid of that inflammation.
And when I say that, don’t take nonsteroidal antiinflammatory drugs like ibuprofen or naproxen, because those can slow down the actual healing of the collagen and the plantar fascia, so don’t do that. But you’ve got to stop the inflammation. That’s step number one.
Step number two is to protect the plantar fascia. Remember, you have microscopic little bitty tears within the plantar fascia that need to heal. So, what you have to do is you have to decrease the tension on the bottom of the foot where the plantar fascia is. You have to do something so that when your arch comes down and pulls on the plantar fascia, it decreases the amount of pull and the amount of stress on the fascia itself.
There are several ways to do that. You can get a fracture walking boot and you can wear it around the clock, treat it like a cast literally for like one or two days, but that’s it. Not four weeks, not six weeks, not two months, nothing like that. Just one or two days to really immobilize it. Really let it start to heal, and that really kind of jumpstarts the process. That’s very effective. A lot of people don’t want to do that, and I understand.
If you’ve been running a minimalist shoes, shoes with a really low drop or zero drop and basically no heel, if you just temporarily switched to wearing shoes that have an elevated heel … A normal running shoe has 10 to 12 millimeters of an heel on it, and that’s the drop is the difference between what it is, the heel versus what it is the forefoot. And you wear a shoe that has that increased heel height over what you’re used to. Then that will also decrease the tension because it allows the distance between where the plantar fascia bridges from your heel all the way out to your toes. It sort of shortens that when you put that heel lift under there, and that decreases the tension on the plantar fascia.
Another option is if you’ve been wearing normal running shoes, you can just add a heel lift inside the shoe, underneath the insert in the shoe, and that will lift your heel up, decrease some tension on the plantar fascia, and that will really help to jumpstart the healing. But you’ve got to do these things. That’s the second thing. So first thing, stop the inflammation. Second thing, protect the plantar fascia so it’ll actually start healing with decreased stress and strain on the fascia. The third thing is you have to fuel the healing process.
Remember, the stuff that you put into your body, what you’re doing in terms of your nutrition and your hydration will make a huge difference in how fast you actually heal. If you’re doing collagen supplementation and you’re adding collagen to your diet, you’re doing bone broth, you have micronutrients, you have antitoxins, you have all these things in your diet that will make a big difference … The plantar fascia is a huge sheet of collagen.
So, if you’re doing a 15 grams of collagen with 48 milligrams of vitamin C in your in your smoothie that you have every day or mixing it in with your food, then that will actually increase the rate of synthesis in your body and can help your plantar fascia to restore that collagen because that’s what really has to happen when you have those little micro tears in the collagen. You’ve got to repair it. You need collagen to do that. Your body can make it, or you can add collagen in your diet to supplement that to hopefully speed up that process so you can get back to running sooner.
Now if you do everything right, if you’re doing these things and you really have acute plantar fasciitis, you will notice a huge improvement within just a few days. As soon as you have improvement, well, then you can start experimenting and saying like, you know, can you go for a light run? Does it make it any worse? Does it feel worse the next day? And if not, you’ll know you’re on track, and you’ll know that you can get back to running quickly. So, that’s really what you have to do, but once you start improving, once your pain subsides, then you can start doing some really short runs starting with the test run.
So, if you haven’t seen that, go look at the test run. You can get it on the show notes page where you can download it. It’s a video, shows you exactly how to do a test run so you don’t screw it up and ruin all of the repair that you’ve put into it during this very short period where you’re very aggressively treating the plantar fascia to get it to calm down. Once you do that, then you know you can get back to running and, when you get back to running, just make sure you don’t apply too much stress to the plantar fascia. That’s part of the test run.
And then, of course, in the course on runner’s heel pain where we talk all about how to do all of the different things that you can do for plantar fasciitis, it talks also about how to run on the right side of the road, use the slope of the road or the slope of the sidewalk to decrease the stress and strain on the fascia. But there are so many different things you can do to decrease the stress on the plantar fascia.
But that is the key. It’s been injured, and once it starts to heal, it doesn’t mean you have to wait months or years for it to be better, but you do have to wait until it starts to become stronger. As it starts to become stronger, you can start running, but you have to make sure that the stress that you apply to it as you return to running does not exceed the capacity of that repaired tissue to withstand the running activity.
So, you’ve got to ramp up slowly, but you can also increase your distance and still decrease some stress on the plantar fascia by supinating in your foot a little bit by tilting the foot when you run to decrease some of the stress and strain on the fascia. Doing some small things like that can get you back to running a whole lot sooner. So, make sure that you check out the test run and then just be careful to make sure that you’re not ramping up too quickly as you get back to running once your plantar fascia gets back on track.
If you think you are ready to run, you are at HIGH RISK of another injury.
DON’T JUST GO OUT FOR A RUN!
Follow a careful test run plan and transition safely back to running.
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