Today on the Doc On The Run Podcast we’re talking about the top three mistakes runners make with plantar fasciitis.
You may well know that plantar fasciitis is the most common condition that affects a foot in runners that causes pain that might keep you from running. There’s all kinds of stuff published about plantar fasciitis. It is very, very common. It’s about 40% of all visits to podiatrists in the United States, according to the American Podiatric Medical Association, but what’s really interesting is that I see runners who have often made at least one, if not many of the three biggest mistakes I see in runners.
I often get invited to lecture at medical conferences, teaching physicians about runners heel pain, and one of the most important things is that I explain there’s big differences between the way runners kind of show up with symptoms of heel pain that might be plantar fasciitis or something else and the really important differences in how you treat them. So, I think these things may actually help you.
The first thing is that if you think you have plantar fasciitis and you’re a runner, you have to avoid mistake number one that is ignoring it. There’s a couple of ways people ignore it. For one, when you’re a runner, if you go run a long run, you do a hard speed session or hill repeats or something. Well, you’re sore all over and sometimes you have a little kind of notable achiness in your heel, or your arch and you think well I trained really hard so I’m just going to wait a few days and see if it goes away. You don’t really do anything initially. That’s okay, I’m not talking about that.
What I’m talking about is when you read online where somebody says plantar fasciitis is self-limiting, meaning that eventually it will just go away. Well, if you ignore it and you continue to run you continue to strain and you continue to strain the plantar fascia ligament as you train, what’s happening is you’re getting more and more chronic inflammation around the ligament, and that chronic inflammatory fluid actually damages the collagen fibers in the fascia itself. And then it’s more prone to developing problems that can plague you later.
So that’s the first thing, don’t just ignore it, you need to do something about it, you need to treat it. And again, not running is not a treatment plan. So, you need to figure out what to do to get it better. I talked about all that stuff in the runner’s heel pain course. But don’t just wait and expect it to go away, that’s a terrible idea.
Mistake number two is stretching too much. There are lots of ways you can stretch too much. One time I saw a runner who was a very experienced marathoner, who basically did the exact right stretches that I teach you in the runners heel pain course. But what he did was that instead of holding the stretch for 10 seconds at a time, he held it for one minute at a time because he said, “I believe that if 10 seconds was good, a minute would be much better.” What happened is that about two weeks of doing that, he actually had Achilles tendinitis. That’s actually a way worse problem than plantar fasciitis.
The other thing is that sometimes patients will do the stretches where you put your foot on a baseboard and you’re pulling up with the toes and you’re sort of jamming the fascia there and trying to aggressively stretch out the fascia. You can do that. But it is very risky because I often see that as something that actually inflames the plantar fascia and in some cases even causes a very small tear in the plantar fascia.
So, you can’t stretch too much. You got to make sure that you’re doing the right stretches and you’re doing the right amount of them and you’re not aggravating or irritating the plantar fascia further with those stretches.
The third one is the worst mistake you can make as a runner, that is getting a corticosteroid injection. A cortisone injection is actually very effective to reduce the amount of pain and inflammation in and around the fascia. So, if you’re maybe a couple of weeks out from the Boston Marathon, and you’ve spent your whole life trying to train for it, well, maybe it’s worth it to do that so you can get through the race and run but you might make things worse. The majority of the runners I see, that had been diagnosed with plantar fasciitis and then don’t get better and call me for a second opinion or do a webcam consultation, it’s crazy how many of them have had at some point a corticosteroid injection and then when I actually figure out what’s going on with them, they don’t have plantar fasciitis at all anymore.
What they actually have is a partial rupture or a tear in the plantar fascia and sometimes you can get that because you got a corticosteroid injection that weakened the collagen in the plantar fascia. And then because it suddenly didn’t hurt anymore, you start ramping up your training, you’re working out, you’re stressing it, you’re straining it and eventually you rip it. That’s a big problem and that is not the same thing as plantar fasciitis. It’s worse, way worse.
I typically do not, as a general rule, I do not inject runners with corticosteroids. Now, that does not mean that it’s malpractice or something if your doctor does. However, if you’re a runner, the mistake many runners make is they go to the doctor and they just tell them they have plantar fasciitis but they don’t tell them they’re training to qualify for the Boston Marathon. They don’t tell them they’re trying to qualify for Western States 100. They just tell the doctor they have foot pain, and the doctor suggests an injection. Sounds like it might help so they do it kind of innocently many times. But that can lead to big problems.
Hopefully you understand a little bit about these three mistakes that runners make when they have plantar fasciitis will help you get back to running in spite of your heel pain as quickly as possible. If you haven’t checked it out, you might want to check out the runner’s heel pain course that teaches you all this stuff to really consider if you’ve got plantar fasciitis, you’re a runner and you’re trying to get back to running.
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