Maui, Hawaii. Today Doc On the Run (Dr. Christopher Segler) was lecturing to a large group of podiatrists, sports medicine doctors and foot and ankle surgeons at the International Foot & Ankle Foundation’s 36th Annual Hawaii Seminar. Dr. Segler was invited to speak on the topic of “Runner’s Heels: Pearls for Management.”
When asked about the goal of the lecture, Dr Segler replied: “After writing the book, “Self-Diagnosis and Self-Treatment of Runner’s Heel Pain,” I started getting many calls from other doctors looking for tips on helping runners get back to running sooner. The goal of the talk at the medical conference here in Hawaii was to help foot and ankle specialists better understand how to make the correct diagnosis during the initial visit. Of equal importance is to develop strategies to help the runner decrease the stress to the injured heel so they can keep running.”
At the conclusion of the talk, there were two great questions from doctors in the audience.
“Do you recommend runners refrain from going barefoot when recovering from plantar fasciitis?”
The answer from Dr. Segler was, “Absolutely! Most runners with plantar fasciitis will get better if they simply effectively stretch the Achilles tendon. Most podiatrists agree wearing a shoe with an elevated heel will decrease the tension on the both the Achilles tendon and the plantar fascia itself. One of the recommendations I always make to runners trying to heal plantar fasciitis is to wear a standard running shoe with an elevated heel and 12mm drop, even when inside the house. I always tell runners, in fact when I see them at home I even write down ‘do not go barefoot, even in the home!’
Truthfully many runners already understand this concept on some level. Often the runner will tell me that they switched from a low-drop running shoe to a ‘normal’ running shoe in an effort to reduce that stress. But then I when I asked them ‘What are you wearing in the home?’ They will often answer, “nothing, I usually go barefoot at home.’”
Dr. Segler continued, “This is baffling to me. Patients know they should wear an elevated heel, but they are going barefoot at home out of habit. You have to get your patients to understand the importance of always protecting the fascia by never going barefoot until the plantar fasciitis has completely healed.”
“Do you ever do a gastroc recession for runners with plantar fasciitis?”
The answer from Dr. Segler was, “Many years ago, I heard a lecture in which the speaker claimed to get 100% cure rates for plantar fasciitis with a surgical procedure called a “gastroc recession” in which the surgeon cuts the portion of Achilles tendon at the distal aspect of the gastroc muscle. I understand how this works anatomically and biomechanically. I believe this approach would work consistently. However, I also believe it is analogous to killing a mosquito with a shotgun. It just seems excessive.”
Dr. Segler further explained, “In an effort to drive home the therapeutic importance of Achilles tendon stretches, I actually tell runners about that surgery. But I do not do that surgery on runners. There are two reasons I don’t do that surgery on runners. The first reason is that they will get better in most cases without surgery. The second reason is that there was research study that showed runners will often have the ‘perception of weakness’ after a gastroc recession surgery. So even if you cure the plantar fasciitis with the surgery, the runner may still feel weak when they push off and run. Even if you measure them and can show that objectively they have the same strength, most runners are going to be troubled by the perception of lower push-off strength. It may change the perception and feel of running. So I do not do gastroc recession surgical procedures on runners for that reason.”
If you are a runner reading this, what is your answer? What should Dr. Segler tell other doctors? “Why do runners hate it when doctors tell you to swim?” Post your answer on Twitter, and tag @myrunningdoc.