#425 Should I get a plantar fascia injection so I can run? - DOC

#425 Should I get a plantar fascia injection so I can run?

Should I get a plantar fascia injection so I can run? Well, that all depends. And that’s what we’re talking about today on the Doc On The Run Podcast.


Listen, if you’ve signed up for the Runner’s Heel Pain Course, or you’ve listened to a lot of the podcasts on Runner’s Heel Pain about plantar fasciitis in runners and you’ve heard me talk about this, you’ve probably heard me say that I don’t inject most runners with cortisone when they have plantar fasciitis.

So somebody asked me this question specifically about when a runner should get an injection for plantar fasciitis so they can run. And the way I break it down is that it depends on one of three different scenarios. There are times when I would do it, and there were times when I would definitely not do it because it’s not worth the risk. So I thought it might be worth talking about this just so you can understand and put it in a proper perspective. It all depends on what you want to run, how you want to run and why you want to run.

Now, the first scenario is somebody who says, look, I know that my friend had a plantar fascia injection, her heel pain went away, I want one too, so I can resume full training. I’m training for a marathon. I want to be able to run hard. I want to be able to do my speed work. I want to do my hill repeats, all that without pain. Well, not right off the bat is a bad idea.

So if you’re ramping up for an event and you know that your intensity and the duration of your workouts is actually predictably going to increase in the coming weeks, and you inject the plantar fascia with cortisone, we know that your pain is probably going to go away, but we also know that you could get some weakening in the collagen and that makes up the plantar fascia, and then it could partially rupture. It could tear.

You could get an interstitial tear. You could get a complete rupture, but regardless of what those things really are, a rip or a tear in the fascia is not going to help you run faster. It’s a problem and it’s a really inconvenient problem when you’re training for a marathon.

If you want to train for the marathon, the goal is to train as much as possible and not get sidelined at the last minute with a catastrophic injury. So for those people in group one who say I want an injection to resume full training, the answer is no. That’s a horrible idea.

Now, the second group of people is somebody who’s been training for like 5k or something, and they have a local event and they say, look, I just want an injection because I have a race coming up this weekend. I think it will be better and I think it’ll be easier to run the event fast if I don’t have as much pain. Well, totally makes sense. If you get a corticosteroid injection on a Monday and you have a race on Saturday or Sunday, the chances are really good that your foot is going to feel a lot better. You’re going to have a whole lot less heel pain and you’re going to perform much better.

The problem is that if that is your only event, then you put yourself at risk a couple of different ways. One is that in that short period of time, you could actually weaken the collagen and it could put you more at risk of actually getting a serious sprain or tear within the plantar fascia during that race.

The second thing, which worries me even more is that when that event is over and you’re done with your 5k, you may take a short period of time to rest, but then you start training for a 10k or a half-marathon or marathon or something else right after that and now you’re ramping up. You’re doing more intense work. You’re doing it when you’re a little bit fatigued from that first 5k event where you really ran hard. And so your form is a little off, your load things a little asymmetrically or a little bit, maybe with not great form because you’re still not fully recovered from that, and then that could even further predispose you to something like a partial rupture in the plantar fascia ligament.

For group number two, if you want to do it just to run a race that’s local, that’s not really that important to you and you’re going to continue to train afterward, I would say no way, definitely not worth the risk.

The last situation is different. This is for somebody who has trained for what I call a lifetime event. This is somebody that has been training for years and years and years, because they’ve had a lifetime goal of doing the Boston Marathon or Ironman Hawaii, The World Championships, something like that, where you really have worked for a long time for that event.

For me personally, the Ironman World Championships was that goal for me. I wanted to do Kona and I wanted to do it bad. I wanted to do it since I was a kid. And then when I started doing Ironman Triathlons, I actually trained 20 or 30 hours a week for the better part of 10 years, like nine years to be exact. I trained and I raced, I did 15 Ironman Triathlons. I trained a lot and I worked hard to get my Kona slot.

Turns out, because of a whole bunch of stuff, I got pneumonia and found out I had pneumonia the day I was leaving for Hawaii. Having pneumonia and doing the Ironman World Championships with pneumonia is not a good idea, but I did it. And my doctor knew I was going to do it because I didn’t want to spend another 10 years trying to qualify for Ironman Hawaii again.

So if this is a situation where you get plantar fasciitis, it’s causing pain and you have just qualified for Ironman Hawaii, and this is a lifetime goal of yours, well, I would probably inject it, but explain to you very carefully that there’s a real risk you could rupture the plantar fascia, but truth be told, I would take that risk myself. I would put it in those terms.

So, yes, you could get some damage to the plantar fascia. Yes, it could injure you. Most doctors would not be willing to accept that risk. So most doctors would tell you, no way, you shouldn’t do it. It’s not worth it, but if they’re not runners and they haven’t been training 30 hours a week for nine years, they don’t really understand the other side of that. That’s why you have to talk to somebody who is an expert on running injuries.

You really have to put the risk into the proper perspective. If it’s the thing that’s going to be a little bit of potential short-term game for some long-term risks, it’s not worth it. But if you’ve been training for years and years and years, and you have an event and a corticosteroid injection is going to help you survive that event and make that event enjoyable for you and make it more of a memorable experience, in many cases, I think it actually is worth it, but that’s a discussion you’ve got to have with your doctor. So put it in the proper perspective just to understand the risk, and then you can make the right decision about whether or not you should have that corticosteroid injection before your events.