Today on the Doc On The Run podcast were talking about how a runner with a plantar fascia rupture talks himself into surgery.
A partial rupture of the plantar fascia can be a truly debilitating injury for a runner.
A tear, even a partial tear of the plantar fascia much worse than plantar fasciitis. You take time off. It starts feel better. Then you run and it starts to feel worse again.
Because a partial tear can be so frustrating it becomes very easy to convince yourself that you need surgery on the plantar fascia.
In fact, I was just having a conversation with an athlete who started to talk himself into surgery, even though he has absolutely no desire to have surgery on the plantar fascia.
His story highlights how easy it is to become frustrated, and how any recovering runner can overthink a mild setback in your recovery.
The plantar fascia is the largest ligament on the bottom of the foot. Plantar fasciitis is a condition where you have inflammation and irritation of the plantar fascia. Plantar fasciitis is by far the most common condition affecting patients who go to see a foot and ankle specialist. It makes up about 40% of all visits to the podiatrists in the United States.
The problem with plantar fasciitis is that it is so common, most doctors will simply assume that you actually have plantar fasciitis. That seems to be especially true if you are a runner.
But you can get an exaggerated version of plantar fasciitis where you actually have a small rip, tear or partial rupture of the plantar fascia ligament. You don’t have to be a doctor to understand that if you stand on it, run on it and keep stretching and stressing and straining the plantar fascia ligament that has a small tear, it’s not going to heal.
Most of the time when a runner calls me for a consultation or WebCam telemedicine visit it’s because they have gone through a cycle of trying to treat it, they have been seeing doctors, the pain has been getting a little better, then a little worse and they finally just get frustrated to the point that they’re willing to consider anything.
A very commonly perform surgery is a plantar fascia release. This is where the surgeon actually cuts a small portion of the plantar fascia to release the tension on the plantar fascia ligament. Whether or not you should have that surgery depends upon your opinion and the opinion of your doctor.
The simple fact is that I have not performed a plantar fascia release surgery on a runner in more than 15 years. So that simple fact should make clear my opinion about performing the surgery on runners. I don’t think it’s a good idea, so I just don’t do it.
I believe the overwhelming majority of runners can heal a partial rupture of the plantar fascia ligament without surgery and get back to running. But to do so you have to take a lot of specific actions, have a lot of patience and be capable of following directions very carefully.
I have actually been lecturing about runners heel pain and teaching other physicians at medical conferences about this condition for many years. From the information I compiled in those lectures to physicians I created the Runner’s Heel Pain Course.
The Runner’s Heel Pain Course teaches you everything I what explain to you if I met you in person and had to help you understand whether or not you actually have plantar fasciitis, or a stress fracture in the heel bone or a partial rupture of the plantar fascia, or some other condition that just seems like plantar fasciitis.
If you follow all those directions in that course you can understand everything that I would explain to you during a $500 in person meeting. But you have to understand what is in those video lessons and then apply it to your condition if you really want to expect to improve.
And that brings us back to this conversation I was having with an athlete who got frustrated when he had a small bump in his road to recovery and return to running. He had been taking time off of activity. He been doing everything correctly. But then he had an episode where he was kickstarting his dirt bike and in doing so, irritated the plantar fascia. He started to have heel pain. He had a cycle of the several days where the pain was coming and going and that had him a little bit freaked out.
Months ago, when he first got to see a doctor the doctor told him he could just “snip” the plantar fascia and that might solve this problem. And he really did not like that idea.
But now, some months later even though he had a a dramatic improvement and was clearly on the road to recovery this little small setback had him concerned that he had undone all of the healing that had already taken place during the past several weeks and months.
So during this discussion two interesting things came to mind.
1. It’s really easy to believe you’ve done a lot more damage than you actually have done.
Most of the time when you have a partial rupture of the plantar fascia, what actually happens is not what you see in illustrations. In fact, it’s not even truly what you see in the anatomic illustrations I made to support and illustrate the idea in the Runner’s Heel Pain Course video lessons on partial ruptures of the plantar fascia.
When you first have a partial rupture the plantar fascia there’s a small gap wherever you have a tear in the ligament. Collagen starts to form. That collagen somewhat resembles a wad of tangled fishing line. It’s disorganized. The strands run in all different directions. But all of that wad of collagen it is helping to stabilize fascia and hold it together.
Over time, you get more and more remodeling of the collagen scar tissue so the fibers are better aligned with the stresses applied to the plantar fascia ligament. It becomes less like a wad of tangled fishing line and more like strands of cable side-by-side forming the sheet of collagen we call the plantar fascia.
If that process goes on for months you can be assured that the strength of the tissue on the day you’re kickstarting your motorcycle is significantly higher than it was the day after you tore the plantar fascia. So just based on that you can take comfort in the fact that it is unlikely that you could cause the same level of damage you had on day one of your injury when you initially tore the fascia.
But then our mind begins play tricks on us. And that’s where the trouble comes in.
2. It’s really easy to talk yourself into surgery.
You have pain and you start to go through a cycle of discomfort. Unless you been keeping a pain journal you don’t actually remember that the pain you have today is significantly less than the pain you had when the injury first started. That was actually the exact case here.
During the conversation with this guy he acknowledged that the pain he was having now was much less than the pain he had before. But that fact had not occurred to him. Instead he had this nagging voice in the back of his mind hearing the surgeon say, “We can just go in and snip it and that will take care of everything.”
I went on to point out that he had been healing….all along. He was doing better. His pain was significantly less. And really and truly had just hit a small bump on his road to recovery. He just needed to be patient.
Our discussion also pointed out that if he head surgery, he was going to have to be in a cast or in a fracture walking boot and likely on crutches for weeks or months. That was going to further decimate his fitness and bring about more atrophy in his calf muscle. And the last thing he needed at this point was to have more damage done to his running body just from a period of immobilization or a period of using crutches.
He also needed to make sure that he was immediately tracking his pain with a pain journal. That way if he could just see the small improvements that were happening over time he could take solace in those small improvements and know that he was at least headed in the right direction.
So basically I gave him some other small things to do to reduce the inflammation, to decrease the stress to the plantar fascia, and assist with the collagen repair process. All of those are lessons in the Runner’s Heel Pain Course.
But I also pointed out that it was crucially important to figure out what his pain was today and start tracking it daily. It was also clearly important for him to take a look at what he was doing with his recovery today that was missing opportunities. What I mean by that is that when we are training, when we are getting ready for an event it’s very easy to stay on track with everything that can help promote healing, recovery and building strength in the tissues.
When I do consultation calls with runners almost every time I can find very specific strategies runners use when they’re in training that they are not using or applying to their recovery from the overtraining injury. That’s a crucial step to take in your recovery if you want to get back to running as quickly as possible.
One easy way to do that is to let take a look at everything you know about training figure out how to apply it to healing and recovering as quickly as possible. I wrote the Runner’s Rapid Recovery Journal to help walk you through some exercises to figure out exactly what you are ready know that you can do that you’re not doing right now to accelerate the recovery process and get back to full training. This is really the same process I use when I work with runners in person through a phone consultation or a WebCam virtual doctor visit.
Any over training injury is really nothing more than an exaggerated version of the same thing you do to your tissues during your normal workouts. You just want little too far. So what you need to do now is really and truly look at all of the things that made you recover faster when you were training and apply them to your recovery and your healing.
Right now the Runner’s Rapid Recovery Journal is on sale and you can get it at discount. You can get an instant download version today. You can find a link in the show notes at the bottom of this episode at docontherun.com under the podcast tab.
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