After waiting months to see Ryan Hall compete in the Olympic Marathon, it was heartbreaking to see him walk off after running 10 miles. Months, or you could also say years, of training were sacrificed for this one event, only to have it come to an end by an injury. Marathon training does take years to “build the engine” to get you to peak performance levels, but it most likely wasn’t this one event that lead to his injury. Hall had been dealing with plantar fasciitis according to the media for months. There are even photos of him standing next to MRI images of his foot ruling out any underlying stress fractures most likely as he continued to run.
The question that I have is what caused his plantar fasciitis. This is an epidemic seen amongst our country most likely due to our unnatural shoe gear that is dictated by our society. Why would such an elite athlete develop something like this? His reason for dropping was not foot pain, but hamstring pain and tightness which would lead one to suspect there were gait changes along the way as he was dealing with the fasciitis causing his hamstrings to become overused. As many have heard, Ryan had abandoned his coach to use a more unorthodox training method described as “faith based training” where he listened to God’s word to help his training regimen. One specific training technique that Hall implemented was done in an attempt to see if he could break 2:00 hours in the marathon, a feat that has never been done. This requires maintaining a pace of a 4:40 mile. Ryan admitted to having a training partner get on a bike and ride at a 4:40 pace and he would follow for as long as he could. This became an unsuccessful attempt although he still believed the feat to be possible. Would this have been his “overuse” that led to the development of the plantar fasciitis? Or, and I hate to say this, but could it be is traditional cushioned heel running shoes that he wore for training runs? I had discussions with Asics representatives (Hall’s number one sponsor) prior to the Olympics as to what shoes he was running in and what he will wear for the Olympics. They showed me the sample shoes that they had which were size nine’s for Ryan of course, and admitted that he runs in a variety of models that Asics has and that “he could pretty much wear any shoe he wanted to with his gait.” While racing, Hall wears the Asics Gel-HyperSpeeds which are a racing flat very much like a minimalist running shoe.
Despite the large incidence of plantar fasciitis seen in our society, I truly believe it is an epidemic that should not exist. Over the past 60 years it has been described as many different diagnosis ranging from heel spurs, plantar fasciosis, plantar fasciitis, to in more severe cases- calcaneal stress fractures (heel bone.) We have since demonstrated that heel spurs that arise on the calcaneous bone have no direct correlation to heel pain, and symptoms resolve in these patients without surgically removing the spur. Studies have even demonstrated the non existence of inflammatory cells in the plantar fascia that was surgical released for treatment purposes in those suffering from heel pain. Treatment regimens that exist utilizing custom orthotics, motion control running shoes, and stretching exercises combined with injections and NSAIDS, do not always prove successful. Routinely these patients present to my practice with bags of shoes and inserts who have been suffering for years asking for help.
So why do so many people suffer from this chronic heel pain? A new theory exists that most likely will become more prevalent as we see more people transition out of motion control shoes. There are two important muscles in the foot that originate on the heel bone in the exact same position as the plantar fascia. The abductor hallucis (ABH) and abductor digiti minimi (ADM) muscles. The ABH muscle is the main supporting muscle of the arch. If this muscle is not fully functional or utilized as a result of wearing motion control shoes, then it becomes very weak and very prone to overuse. It is this reason that we see so many people who immediately begin wearing flip flops in the summer months develop heel pain. Their foot is used to being in a more supportive shoe during the off seasons, and when they place on their flip flops for 8 hours of wear, the muscles haven’t had a chance to adapt. Especially the ABH. The muscle then develops an overuse syndrome much like that of a tennis elbow which causes a tendonitis like reaction. We see the classic pain and stiffness associated with movement of the foot after arising in the morning of after periods of rest, which is followed by relief only then to have the pain return later after being weight-bearing for a period of time. These are the exact same symptoms that plagues someone with a typical tendonitis anywhere else on the body.
Could Ryan Hall’s plantar fasciitis been the culprit of a traditional running shoe? I don’t think it is right to directly blame the shoe, however, our foot does not function the way it was intended to when we place a large cushioned heeled shoe under it.
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.