Overcoming plantar fasciitis to run a marathon.
|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!!
Hello Doctor Nick,
Great article on plantar fasciitis. I decided to go from running in New Balance Minimus 1010’s to the Newton Distance 3’s. Since this purchase, I THOUGHT I was taking it easy, breaking them in little by little. Well, I’ve been dealing with plantar fasciitis for the past 3-4 weeks. I tried to maintain a slow pace for the first few weeks, but once I started to pick up the pace, I’ve had painful heel pain that keeps coming back. I’ve done SMR on a roller, rolled by plantar fascia on lacrosse ball, and iced it. I guess it’s time to slow it down, or should I just stop for a few weeks and hit the spin bike? Plus, would there be any chance that Newtons aren’t for me? Thank you. Have a great day.
Carlos
It’s probably the change in shoes and increase in pace that flared this up. Hit the bike for 10-14 days then get back by doing a mile run/ 10 min bike reps for as Lin as you think you can safely. Stop the rolling. May aggregate. Try to get night splint as start calf raises. It will resolve. Newtons are fine. Focus on form. Rest!!
Thank you very much for the information. Should I stop rolling completely all together (SMR roller on the calves and lacrosse ball on the bottom of my foot?) I’ll search for an affordable splint. Thanks again.
If it feels good to roll that’s fine. Sometimes people roll to the point of pain. That can be bad.
Can high cushion shoes cause this injury also? I have been battling plantars facititis for months. I have a night splint and roller for my foot only ice 1 time a day and had grastin done on my achillis tendon. I am wondering if my shoes are the problem. Tried Brooks and Ascics.
Shoes can definitely cause this, but it’s typically due to a an overuse combined with improper form. Shoes can lead to improper form. You would have to look at your strike patterns, as well as training intensity to get the true cause. You can still do all the PT, but if you keep aggravating with form or certain shoe gear it’s difficult to resolve.
Dr. Nick
I wouldn’t blame the shoes. Although they may be too rigid or have too much of a heel. Many times runners who get PF do so from improper form and more importantly improper training patterns. If you run the same pace everyday that could be bad. Try easy miles. Strengthen your foot. Don’t rely on fixing this with a shoe. Save your money!!
Found out I gave some Achilles tendonitis. Is there a ankle brace that you can run in? I have one that is really bulky. Would like a little extra support for the ankle while training.
I think your comments on training has a lot to do with it. I have seeing a doctor who has been doing the graston on my achilles tendon which has helped some. I did some exercise also to strengthen my foot and boy did that hurt. Have MRI done to make sure I have not torn something.
Great article. I ran a half marathon 4 days ago. The first mile was so painful, but I was able to run through it. When I got done.. with amazingly a new PR I had bruising along my PF and by evening swelling. Today I am able to walk (kinda) and the swelling is almost gone. I have my first FULL marathon in 16 weeks. Feeling very frustrated that I can’t train. I know if I push it, it will only make it worse. I wear Mizuno waverider 17. Same shoe I have been wearing for a couple years.
Hello,
I’ve been recovering from plantar Faciitis. The doctor gave me custom inserts and I’ve been taking it slow. When I have pain it is in the arch of foot, is this something else or plantAr Faciitis?
Hello, Thank you for your article I had not ever had a problem with my feet hurting, I ran my first marathon in 2014 and then the second one in 2015 but just a week before the 2nd one the running store recommended arch support since I have high arches. now ever since that run in October 5 months ago, my left heel has been giving me trouble. I can’t run or walk or else the pain comes back bad and I have to limp. high heels makes it feel better. I’ve been swimming and biking, I’m signed up for a 10 miler in less than 2 weeks. I really want to do it. Would it be okay to try taping it and doing it, or do you think it would cause permanent damage? I’ll work on icing, even when it doesn’t hurt. Thanks for your time and consideration.
Obviously I can’t give complete advice over the Internet without seeing your feet, but there is no sound scientific evidence to support the use of orthotics solely because if having a high arch. Sounds to be like your suffering from plantar fasciitis as a result of possibly changing the mechanics from the inserts. I would try to gradual transition out of them. Strengthen your feet with barefoot strengthening exercises. Tape could relieve some stress but I would think that would make or break you. As for permanent damage? Anything could happen by running with a sore or inflamed plantar fascia such as even rupture (which doesn’t need repaired as it will heel on its own) but this is extremely rare. Many would run in this situation. Listen to your body. Good luck!
Dr. Nick- Thanks for this post. I am going through a similar experience in my buildup for a January marathon. I am wondering what the risk of permanent damage to the fascia is in the face of continued training. I have been diagnosed with low-grade plantars fasciitis but am able to run with little to no pain, whether for a short run or a long run. It is after the runs and in the morning that the pain returns, and when it does return, it is about a 2 or 3 out of 10 in severity. I am inclined to continue training as planned as long as the pain does not intensify, but I wonder if there is any significant risk of permanent damage or injury if I continue doing so.
More than likely no. The biggest risk could be a rupture and that’s rare. More likely would be that you would alter your gait and injure something else. But, if your not experiencing pain during a run that’s very unlikely. Many people run marathons with plantar fasciitis.
More than likely no. The biggest risk would be a rupture of the plantar fascia and that’s extremely rare to see. I see them but few a year. Most likely would be to injure something else by altering your gait but if your not experiencing pain while running then that is even unlikely. Many people still run with plantar fasciitis – even marathons and iron mans. I injected an elite iron man before an iron man race and he PRd. Good luck!
Thank you, Dr. Nick. That is helpful to know. One more question for you. What is your view on therapeutic massage (by a massage therapist – not just self massage) on the calf and foot in order to address plantar fasciitis? I was thinking of getting one but did not want to do so if the massaging could potentially cause more inflammation or problems. Thanks again.
I have ran a couple half marathons and am training for a full in January. I have developed plantar fasciitis. I have had one injection, iced, NSAIDs and stretching / strengthing. My favorite shoes to run are brooks pure flow 4. I am currently wearing hoka clifton 4 (same weight and drop) with orthotic inserts. Injection was 11 days ago. Ran 11 miles 3 days after with only mild discimfort after, and short runs as long as I dont run faster than a pace of 8:00. That is until today. Tried some
box jumps which were painful. Next tried to run. Started out ok but about a quarter mile in sharp shooting heel pain stoped me dead in my tracks. I am supposed to have the second injection Wednesday. I cross train with crossFit, hot yoga, and isolation weight training. This week I am supposed to have a 13mile training run. I live in WV-lots of hills. Any suggestions?