Plantar fasciitis is by far the most common cause of arch pain in runners. Not surprisingly, most runners who get heel pain or arch pain think they have plantar fasciitis.
But sometimes runners have a more serious injury where there is actually a rip, a tear or what doctors refer to as a partial rupture of the plantar fascia ligament.
The problem with this more serious injury is that it doesn’t get better with the same treatments that will help plantar fasciitis.
So if you are a runner and you have foot pain that you think is caused by plantar fasciitis, but you’re not getting better the listen closely.
If you were to peel all of the skin off the bottom of the foot and look inside, the first thing you would see would be the plantar fascia. The plantar fascia covers all of those muscles tendons and ligaments and nerves inside your foot.
But the plantar fascia is more than just recovering.
The plantar fascia stretches from the heel bone all the way out to the bones in your toes. So technically the plantar fascia is a ligament. In fact, the plantar fascia is the largest ligament in your foot.
Since the suffix “-itis” means inflammation, “plantar fascia-itis” is just a case of inflammation of the plantar fascia ligament. It is a very mild sprain.
Most runners who ice, stretch and do something to support the plantar fascia ligament will heal relatively quickly. But I often talk to runners to think they have a case of plantar fasciitis that just won’t go away.
Whenever a runner calls me and says they have had plantar fasciitis but they’re not getting better, I basically ask them to tell me their story. Then I listened for three specific clues to suggest they actually have something much more serious than a standard case of plantar fasciitis.
1. Sudden serious arch pain
When it comes to foot problems in runners, plantar fasciitis is about as mild as for problems get.
Plantar fasciitis begins gradually. In the initial stages it’s barely noticeable. Over time the discomfort becomes more and more frequent. You start to have pain more frequently when you step out of bed first thing in the morning. Eventually you notice sharp pain in your arch or heel anytime you get up and start walking again. But this is a very gradual onset of discomfort in the arch and heel.
A partial rupture of the plantar fascia is a rip that happens in one specific instant.
Runners who suffer a torn plantar fascia remember exactly when it happened.
These are the key phrases that tell me somebody probably ruptured the plantar fascia:
“I felt a sudden excruciating pain in my arch.”
“I had to stop running and I could barely walk on it.”
“I had to limp all the way home”
“If I hadn’t been on a trail when the pain started I would’ve called for a car to pick me up.”
“I was 3 miles into my run and I turned off the sidewalk, and I felt this sudden searing pain stopped me in my tracks.”
All of these descriptions are things different patients and told me over the years. All them relate a very sudden onset of excruciating pain that brought a sudden end to the run that day.
That never happens with plantar fasciitis.
So if you have a clear recollection of the moment when the arch pain or heel pain started, it’s much more likely to be a partial tear in the plantar fascia, than it is to be a true case of plantar fasciitis.
2. Bruising and swelling
If you rip or tear the largest ligament in your foot, it is going to bleed. That bleeding under the skin is what you see when you get a bruise.
Plantar fasciitis is just a very minor sprain of the plantar fascia ligament. Plantar fasciitis is never associated with bruising. In fact, plantar fasciitis is really never associated with swelling either.
If you have bruising or swelling in your arch or on the bottom of the foot, plantar fasciitis is not the problem.
If you saw a bruise on the bottom of your foot the day after you noticed some sharp pain in your arch or your heel, it is much more likely you have a partial rupture or a torn section of the plantar fascia.
3. Doesn’t respond to plantar fasciitis treatment
The treatments for plantar fasciitis are pretty simple. You decrease the inflammation, decrease the stress on the plantar fascia ligament and stretch the Achilles tendon.
When I wrote the book on runners heel pain, I wanted to explain all the simple things runners can do to cure plantar fasciitis, without seeing a doctor.
The overwhelming majority of runners who have plantar fasciitis can read that book and cure their plantar fasciitis without any difficulty. Those treatments work very consistently for runners and non-runners alike.
If you know what the problem is, and you do all of the right treatments for that problem, you will get better.
There are really only two reasons runners don’t get better when they have an injury.
1. You have the right treatment, but the wrong problem. Your diagnosis is incorrect.
2. You have the correct diagnosis but you aren’t following the treatment plan.
One thing I know about working with runners is that runners are really good about following a plan. We have training plans, and we stick to them. We hire coaches, and we listen to them.
When a runner tells me they have tried all of the appropriate treatments for plantar fasciitis but they’re not getting better, I have to assume they’re treating the wrong problem.
Runners almost never call me when they first get foot pain. Almost all the runners who call me for phone consultation or a WebCam visit have already seen another doctor, but they just aren’t getting better.
When it comes to runners with plantar fasciitis, there’s almost never a time when the runner who isn’t getting better actually has plantar fasciitis. Most of the time, it’s actually a partial rupture of the plantar fascia.
But there are other conditions that can cause heal and arch pain that can masquerade as plantar fasciitis.
So if you’re running when you think your plantar fasciitis, but you’re not getting better, make sure you understand the different causes of foot pain they can resemble plantar fasciitis.
Remember, even if you’re doing all the right treatments, but you have the wrong diagnosis, you shouldn’t expect to get back to running as quickly as possible.
I believe most runners can fix plantar fasciitis without ever seeing a doctor.
Click on the link below to get the free lesson, check it out, and then get started today so you can get back to running without any heel pain.
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!