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Expert Q+A on plantar fasciitis: what it is and how to treat it

Treating plantar fasciitisPlantar fasciitis (PF) is one of those dreaded running injuries that can affect any runner – from beginner to veteran – and the painful symptoms can last for months. 

We talked to two certified running coaches –  Meredith O’Brien in Virginia Beach, Virg. and Denny Krahe in Lakeland, Fla. – about the topic and got their advice on treating and preventing PF.

What causes plantar fasciitis?

  • O’Brien: PF is caused by inflammation of the plantar fascia – tissues that connect your heel bone to your toe bones and support the arch of your foot. This inflammation is typically caused by too much stretching, tearing, and non-healing of the PF tissues. 

What are the first symptoms of plantar fasciitis?

  • Krahe: Initial symptoms may vary, but often show up first thing in the morning when you are getting out of bed. For more minor cases of PF, the pain and discomfort [in the bottom of your foot] will dissipate within the first couple of steps in the morning and be gone for the day. At this point, PF is very easy to treat and be rid of if we take the steps to work on it, but too often it’s out of sight out of mind until the symptoms get worse.

What should a runner do as soon as they start experiencing symptoms? 

  • O’Brien: Back off the training schedule and evaluate what has changed recently in their program. Seeing a physical therapist or qualified coach who can help you determine what is causing the PF and then help you fix it is the best way to stop its progress.
  • Krahe: Massaging the tissue is, in my experience, the best way to break up the adhesions in the tissue and help the plantar fascia regain its elasticity. My favorite massage tool is a golf ball. I keep one in my desk, so while I’m working I can slip my shoe off and roll my foot. Roll from your heel to the balls of your feet and back, and pay special attention to the areas that hurt the most. Also make sure to spend extra time stretching your foot, calf, and Achilles.

What is more effective – stopping exercise or modifying exercise and adding specific exercises to deal with PF? 

  • O’Brien: Modifying activities and adding exercises to strengthen feet, ankles, and lower legs will do the most good.  Spending as much time as you can barefoot while working toward running in zero-drop shoes are important steps to take.  Create this strength and form program by performing a gait analysis with a physical therapist or qualified coach to find the cause of your PF to treat it –rather than the symptom.
  • Krahe: Anything that “treats” the symptoms is a complete waste of time in my opinion. So things such as the Strassburg sock, night splints, insoles, KT tape, and so on and so forth range from a band aid to completely worthless. They might help alleviate the symptoms, but they aren’t solving the problem. As soon as you stop using the product, your pain is going to come right back. I advise my athletes to take the time to truly treat PF by addressing the causes of the symptoms and then incorporating some simple tips, tricks, and exercises into their regular routine to prevent the PF from coming back. 

At what point do you recommend runners see a doctor? 

  • O’Brien: If seeing a doctor will make you feel better, go for it. Ruling out a stress fracture is important if you’re having serious pain. If a fracture is ruled out but a doctor says stop running or pushes orthotics on you, get out of that office as quickly as you can. It’s preferable to see a physical therapist or qualified coach who will help you discover what caused the PF and fix the source instead of the symptom.
  • Krahe: Most doctors are simply going to tell you to not run for two weeks. With that “prescription” you either say screw that and run anyway, or after two weeks the inflammation has calmed down and things feel better but symptoms return quickly once you start running again. That said, you could think you have PF but it could be something else entirely, so seeking out medical advice (preferably with an orthopedist that specializes in sports/running injuries) is never a bad suggestion.

But wait … how do I prevent Plantar Fasciitis in the first place? 

Prevention for PF is consistent with most other running injures caused by overuse and/or poor form:
  1. Gradually increase your mileage or intensity of running.
  2. Do lots of calf and foot stretches, and look for stretches that strengthen and improve the flexibility of the foot, ankle, heel, and arch.
  3. Be mindful of your running form. Many experts will point to excessive heel-striking as a possible cause of PF and that transitioning to a more mid-foot strike (and shoes that promote this strike) is one way to prevent PF. This is not bulletproof, however.
  4. Strength-training and cross-training that improves core strength and aids in keeping proper posture while running would be a good place to start.

Written by Rob Haneisen.