Without a doubt plantar fasciitis is the number one pathology that walks into any foot specialists practice on a daily basis. It has become an epidemic in our society here in the United States most likely due to the type of shoe gear we wear. Contrary to what many believe, there is no scientific evidence that supporting the arch of a normal foot type (or even a mild flat foot or high arch) will reduce plantar fasciitis. I would like to share with you my personal situation of battling plantar fasciitis during this winter’s training season and how I was able to still run a spring marathon.
I know what most of you are thinking. One of the following- 1.) How does someone who claims to know so much about running injuries, especially plantar fasciitis get it, or 2.) It must have come from those minimalist shoes you tell everyone to wear (I don’t force anyone to wear minimalist shoes, I just advise against shoes that can inhibit one’s ability to run naturally). Well here’s what probably happened. You have to remember I test a lot of shoes and this involves running in them. There are many times I will get a shoe sent to me and instead of doing an easy mile on the treadmill to see how they respond, I’ll take them for a 5-6 mile run or even a 10 mile run. This can be detrimental because it can change my gait. Why would I do this? It’s much easier to tell a patient or a runner what is right then it is to adhere to your own advice. With that said, changing shoes for a single run is only one variable of many that can lead to injury from overuse. How is this overuse if it’s just one run? Because it’s one run of six miles with your body encountering a whole new way of running as a result of the shoes influence. This is were my statement of “a shoe should allow you to run, not enable you to run” comes into play. So was it the shoes that created my plantar fasciitis? Probably not entirely. I was also introducing some speed workouts that I had not been doing during my base training in the winter. So my base training for the winter consisted of running at an aerobic heart rate of 140 to 145 beats per minutes. For me this translates into a nine minute mile to sometimes a 9:45 minute mile depending on how I was feeling. In mid to late January I started to introduce tempo runs again into my weekly workout. Prior to beginning these I did a few mile runs at a 7:30 pace to help get my legs ready for running the tempo runs. I was feeling great doing 2 miles at this pace and decided to go up to 4 miles of what I had been doing in the previous training period that fall. This is when the problem started. I began experiencing mild pain to the plantar lateral aspect of my left heel. Instead of stopping my speed workouts and tempo runs I continued them. Eventually the pain worsened to the point why had to take time off. I am fortunate enough to have a spinning bike at home so I resorted to spinning in the same time allotment that I would be running. Twice in the week that I took off of running I did high-intensity spinning where my heart rate was kept a high rate of approximately 170. My heel began feeling better with the rest and obviously stretching exercises and wearing a night splint. Once I resumed my running routine it began to occur again. Instead of taking more rest I decided to run through it. I was now incorporating more interval workout combined with my tempo runs which was really aggravating my heel. I was now approaching a second long run of 18 miles ( I had already done one 18 miler and my foot was fine ) and it was really painful. I decided at this point to have a Cortizone injection. The Cortizone injection reduced a lot of my pain and I took three days off. On the fourth day I decided to do my 18 mile run. The run went very well I had minimal pain to the heel however in the subsequent days and followed my pain returned. More time off was needed. Early in this training season I had also incorporated strengthening routines which I have posted here on YouTube. I was now unable to do these as hopping on my injured foot was impossible. The plan was two weeks of no running. One of those weeks required another long run which I was concerned I would need to do. I again resorted to my spinning bike which sometimes entailed two and a half hours of spinning in a given session. I really wanted to keep my legs moving in preparation for the marathon and my feelings were that time on the bike would be the only way to do this. During these two weeks off I continued calf raises and toe crunches with a towel and when my foot allowed I began doing the plyometrics hopping exercises again. I had also been taking Celebrex 200 mg a day and icing my foot anywhere from 3 to 4 times a day. Not to mention I was married to my night splint every night. For my 18 mile run that was scheduled during this 2 weeks hiatus of running, I pushed it back to the end of two weeks and decided to do a mix if biking and running to see how it went. I did 10 minutes of spinning followed by a mile run at marathon pace. I completed 10 miles on the treadmill and the remaining 90 minutes was on the spinning bike. My heel held up.
I returned to running 2 days after this workout and was able to run with minimal pain, but speed workouts were tough. When I pushed my pace with tempo runs, the heel hurt, especially after my run and for the rest of the day. My training period for this marathon was focused around getting more recovery runs in (I’ll blog about recovery runs in an upcoming post) as well as running a lot of miles at marathon pace. I was forced to minimize my tempo runs and do more marathon pace workouts. The recovery days were real slow runs. Sometimes even an 11:00 mile pace! The idea is to get miles in, yet recover for a hard workout. In my case I really needed to rest my heel.
I was able to get in a final 19 mile run which felt great. The heel was sore later that day but no issues on the run. I continued to sleep in my night splint, ice 2-3 times a day, use a foot roller, take 200mg of Celebrex, and do my strengthening exercises 5 days a week. I really feel for me the strengthening exercises were key. Especially the plyometric running exercises. As I had mentioned previously I couldn’t even do one when the pain had first started. As time went on, I was able to get 5-10 hops in and eventually 30 hops in all directions.
My last two weeks of training entailed marathon paced runs on the weekend. One at 12 miles and one at 8. They felt great. A bit sore after the run, but the run itself was good. Instead of tapering I more then cut my miles in half the last 3 weeks. Many of the runs consisted of short sprints and intervals to get my legs moving faster. The final week before the marathon I stopped running altogether. On three of the days I did a one mile jog on the treadmill, sometimes doing a 400 at 7:30 pace.
Marathon day came and I felt great. There’s something to be said about showing up on race day with no injuries. I was able to PR by 2 minutes but for me the most important aspect was that I ran pain free all 26.2 miles. It was a great feeling. Had my training gone better with respect to the plantar fasciitis, I may have been able to run it faster but I was thrilled! It’s now been 5 days post race and I have jogged twice. The heel is a bit tender but nothing like it was leading up to the race. Looking back at what happened I can pinpoint the injury to my increase in speed training too far too soon. As for what helped me the most? The time off was crucial. Strength training helped but had I not rested I’d still be dealing with it.
The moral of the story- this is an overuse injury which responds to rest and strengthening. There, of course, has to be a proper balance of rest and strengthening as well. One final thought – this will take time. Sometimes several months so be patient and I advise running through it when possible. You’ll be surprised at how the pain will subside after a mile or so then resume later in the day. This is an expected part of the healing process. If the pain is too bad to continue a run then rest is needed. This may be a week or two. Don’t get caught up with resting one day and running the next. It usually takes more then a day to get physiologic results. Use a week and bike for cardio if possible. Hang in there. It’s tough injury and it takes time!!
Dr. Campitelli is a podiatrist in Akron, OH specializing in foot and ankle surgery with an interest and enthusiasm for running as well as helping runners with injuries. For the past several years he has been treating running injuries in patients by fixing their form and transitioning them to minimalist shoes. Having treated runners with all types of injuries through conservative measures with orthotics and shoe gear changes to reconstructive foot and ankle surgery, Dr. Campitelli has brought what works best and is most current to his practice as well as the Akron and Cleveland running communities.