Today on the Doc On The Run Podcast, we’re talking about the top five reasons runners heel pain doesn’t get better.
We all know that plantar fasciitis is one of the most common conditions that affects feet, ankles, in runners. In fact, in all people, plantar fasciitis and foot pain that’s consistent with plantar fasciitis is about 40% of all visits to the podiatrists in the United States each year.
So, it’s very, very common, but just because you think that you have plantar fasciitis and you start doing some simple things to treat it, it doesn’t necessarily mean that it’s going to get better. I think it’s really important that if you have plantar fasciitis and you realize that you have to do a lot of things to get it better, but there are some mistakes you can make.
The first mistake is that I see runners who think that a pill will fix it. They think if I have plantar fasciitis and “it is” means inflammation, I should take something like a non-steroidal anti-inflammatory. So, number one they think the pill will fix it and they think that if they take Advil, ibuprofen, any of those kinds of medications that that alone will actually stop the inflammation and make it go away. That is very rarely the case and I very rarely if ever tell runners that the primary treatment for plantar fasciitis is a pill. It’s not so I would not think that that is going to fix it and if that’s the one strategy you’re using, you may well not get better.
The second thing is riding on the running side of the street and what I mean by this is that if you’re running in the road, and the slope of the road or the slope of the sidewalk is actually protonating your foot and increasing the stress and strain on the plantar fascia, it is going to take you a lot longer to get better. Many times, if that’s part of what’s blocking you from getting better, if you literally switch sides of the street or start running on the sidewalk right next to where you’ve been running in the street, you will get the opposite slope of the surface under you which will actually stop pronating your foot and start supinating your foot a teeny bit, to decrease some of the stress and strain to the plantar fascia.
The third thing is doing the wrong stretches. The last time I searched for this, I don’t remember the exact number, but it was about half a million different sites came up when I actually searched on plantar fascia stretches. I just put in those search terms in search engine, and I got over a half a million different videos and articles talking about the right stretches to do.
But there are a lot of stretches out there and some of them are wrong. If you do stretches that will really stretch out the Achilles tendon, we know that that will help. But if you do stretches that aggressively stretch the Achilles tendon but actually put direct pressure and excess strain on the plantar fascia, that will likely make it worse. So, you have to be very careful about doing some stretches and not doing others.
In addition, you have to make sure that when you’re doing the proper stretches, you’re doing them correctly. And most of the time when I tell somebody either on webcam or in person to do the stretches. I have them demonstrate it; I point the webcam at themselves as they do them. Most of the time they make a subtle mistake in one of two ways and so you have to do it correctly because if you do them incorrectly, it won’t make you bad, it won’t make you worse in the way that doing the wrong stretches can really make the condition way worse. But what it can do is decrease the effectiveness of the stretch so it just isn’t helping you as much.
The next thing is wearing the wrong shoes and so I’m not talking about minimalist versus maximalist. The other thing I’ll tell you is that the shoes that you’re wearing walking many times are more important than what you wear running, because if you’re running and you’re not heel striking and you’re landing as a midfoot or forefoot striker, the actual type of shoe is less important. Unless you have a neurologic disorder, you cannot really walk as a forefoot striker. So, the only people that walk on your tiptoes basically have neurologic disorders and if you’re heel striking during a normal gait cycle, a normal walking pattern with normal walking biomechanics, the lower the heel, the worse it is typically for your plantar fascia. Not so much when you’re running but when you’re walking, you really can wear the wrong shoes.
The next thing is treating the wrong condition. Now this is really the biggest one. It is the most common one too, is where you think you have plantar fasciitis, but you actually have bursitis, neuritis, or a partial tear in the plantar fascia or a calcaneal stress fracture where you actually have a teeny weeny crack in the heel. All those other things are treated differently. So, if you think that plantar fasciitis and you’ve been doing all the right stuff and you’ve been doing it in the right way, but you’re not getting better, maybe not one of those other conditions.
If you want to check this out in more detail, I created something for you. It’s free. It’s running with heel pain do’s and don’ts where I go into a deep dive on some of the big mistakes and some of the things you really should be thinking about if you have plantar fasciitis or you think you have plantar fasciitis as a runner. You can get it for free www.docontherun.com/runningwithheelpain. So, go check it out and I will see you in the training.