Has this ever happened to you?
Winter is finally over! (or close enough.)
You're excited to start adding up the miles again.
You've been dreaming about swapping out your gortex covered shoes for something more breathable.
And your new, super-light, track day, speed workout shoes are calling you from their (mostly) unopened box in the closet.
You give in.
You warm up.
You have a couple uninterrupted, speedy, running weeks of joy until…
A nagging, stabbing pain in your heel greets you one morning with your first step of the day (how rude).
You try to walk it off, but it's not budging.
And the more you try to ignore it and hope it'll go away on its own, the more it comes back with a vengeance day after day after…
Did I describe you perfectly?
Congratulations; you've got plantar fasciitis.
Now, let's fix it.
What is Plantar Fasciitis (PF)?
"PF is an overuse injury that occurs due to excessive loading of the plantar fascia, possibly related to pronation and low arch height, which flattens the medial arch and increases stress on the fascia"
you have this thick band of connective tissue at the bottom of your foot responsible for absorbing load and creating tension so you can walk, run, sprint.
When the origin of the plantar fascia becomes irritated (maybe because you have flat feet, wore the wrong shoes, been walking or running more or faster than usual etc), it starts to let you know by causing pain.
What Does it Feel Like?
"PF is characterized by pain concentrated at the medial calcaneal tubercle that increases with weight-bearing following periods of non-weightbearing."
Usually plantar fasciitis is experienced as a sharp pain somewhere around the heel.
Could be located: direct center of the heel, off to the inside of it, all around it, etc.
Typically hurts the most in the morning and when you begin walking after sitting/resting for a period of time.
Often the pain actually improves as you walk, get warmed up, etc.
What Causes It?
We have guesses, but no true black and white answer as to WHY It happens
Possible causes: flat feet, low arches, over pronation (blah blah blah…the usual)
BUT…we really have no stinking idea. We have correlation but not causation.
What Causes RUNNERS to Get Plantar Fasciitis?
THE OLD USUAL REASONS (that you already know):
Usually doing too much, too soon.
Increased speed work
THE NEW REASONS (why you're here reading this):
Decreased foot dynamic stability (balance) resulting in "altered neuromuscular control of whole-body dynamic stability"
Altered gait pattern (i.e. slightly funky-fied running form)
Decreased intrinsic foot muscle volume (i.e. you need strong feet) (NEXT WEEK'S BLOG!)
All of which are potentially brought on by previous cases of PF
Guess which ones we're talking about here? Yup, dynamic foot balance and funky running form.
Why do I keep getting plantar fasciitis? It might be because your balance isn’t great…
"Maintenance of stability during dynamic tasks is essential for task completion. During gait, maintenance of stability relies on the structural integrity and functional ability of many structures including the plantar fascia."
It's hard to run if you keep falling down, right?
I know, this seems awfully basic.
But what's actually keeping you from falling down every time you take a step?
It's whole-body stability.
Your foot bone is connected to your ankle bone which is connected to the knee bone…
You get it.
The exact same thing applies to aaalll the tissues and muscles from the itty bitty ones in your foot to the giant, glute max.
All of them are TEAMMATES.
Including, the plantar fascia.
Every single tissue (bone, muscle, ligament, etc) relies on the other teammates to do their own individual job.
What's the plantar fascia's job?
"The plantar fascia is proposed to operate like a windlass to provide stability and prepare for propulsion, occurring when there is dorsiflexion of the digits that decreases the length of the plantar fascia and increases its tension"
In other words, it absorbs and stores energy so you can run. And in order to do that well, effectively, and pain free it works alongside other body parts…and forces (the ground, gravity, etc)
"In heel-toe running this occurs during the foot contact stage and later at toe-off is coupled with plantarflexion of the metatarsals (toe bones). During running, plantarflexion of the metatarsals is resisted by the ground reaction force (the other forces I was talking about)…",
But this is where it gets more exciting:
"…maintenance of the arch is assisted by foot supination and external rotation. Plantar fasciitis may decrease the ability of the plantar fascia to create tension for effective propulsion. Thus, dynamic flattening of the arch may occur, and stability of the foot may be negatively affected. Stability of the foot is necessary for whole-body dynamic stability during running as running consists of cyclical periods of single leg stance."
If you've been around here a while, one phrase in particular should stand out to you right away: Single leg stance
Remember where we started?
You might be getting plantar fasciitis because your dynamic balance might not be real great.
Let's break this down more.
This important connective tissue that absorbs load and helps create explosive power (propulsion) so you can run and sprint, is irritated and it hurts.
Because you're in pain, but you still want to run, your body is going to find a way to cheat.
This cheat code results in an attempt to NOT use the plantar fascia (or at least not as much). And because of that, your overall foot stability (balance and strength) are taking a hit.
And because the foundation of your body-your foot-isn't solid, your entire "whole-body dynamic stability" is also going to take a hit, especially while running...which is a single leg squat over and over again (thank you, jay dicharry).
Make a little more sense now?
Let's add one more layer to this to really drive home the point of how important dynamic foot stability, balance, and strength are:
We observed a shorter Time-to-Contact in [the plantar fasciitis running group] compared to the other [uninjured] groups during midstance which may be indicative of a loss of dynamic stability. This loss may lead to increased risk of injury due to decreased ability of the runner to adapt to external perturbations"
the group of runners who either currently had or previous had plantar fasciitis all demonstrated not-so-great dynamic foot stability/balance during the point of their stride where their entire foot was in contact with the ground.
At the MOST stable part of their stride, they were not so stable (at least compared to never-ever-have-i-ever-had-plantar-fasciitis-runners).
WHAT THIS TELLS US:
if you're not rock solid stable at the MOST stable part of your stride, you have a potential higher likelihood of getting injured because you're not very good at adapting to external perturbations...meaning not falling when you step on rock or tree root or something over than a smooth surface.
(Me. I'm literally talking about myself here. So don't feel attacked.)
So how do we work on this?
We'll talk all about it in next week's blog post. But if you don't want to wait and want immediate, actionable exercises NOW, jump into my Stronger Feet Workshop!
Can I still run through plantar fasciiits? What are signs I should STOP running?
"[The pain from PF] may cause runners to decrease mileage or stop training, but some runners choose to proceed with training despite pain or injury."
It is possible to still run through plantar fasciitis.
I've treated a 4x Boston marathoner who was training for #4 and coming to PT for plantar fasciitis as the same time.
But how was she able to keep running? Because her symptoms:
Did not get worse with running
Felt better after a warm up
Low grade pain of 1-2/10 mostly with occasional 3/10 but went away almost immediately
Gradually felt better with every passing morning
No increased symptoms the following morning after a workout
Compare that with signs you should STOP:
The pain doesn’t gradually disappear after walking
No amount of warming up makes it go away
You can't walk normally because of pain
Pain is regularly 4/10 or greater
It's hard to ignore the symptoms during daily life
And if that's not quite enough to convince you:
"Continuing to run through pain with PF could result in altered gait. Compared to healthy runners, individuals with PF have been shown to have [altered foot mechanics such as]…greater rearfoot eversion, forefoot sagittal range of motion, and first metatarsal phalangeal joint range of motion.
Further, individuals with PF have lesser vertical ground reaction forces during propulsion, reduced rearfoot center of pressure (COP), reduced impulse, and reduced peak vertical ground reaction force at loading response as compared to healthy individuals "
when you have a rough case of plantar fasciitis, your foot mechanics are not what they should be.
This can lead to funky running form, inefficient running, and general compensations that can get you more injured than you already are.
"Regardless of injury status, altered gait in runners, especially those in COP trajectory, may reflect altered neuromuscular control of whole-body dynamic stability"
How long should you take off from running when you have PF?
Acute PF: can clear up in 1-2 weeks with 3-4 rest days, decreased mileage, stretching, foot exercises, cushioned shoes etc
Chronic PF: can take 1-2 years
It just depends on what you have.
Start with the suggestions in the acute phase. If it doesn’t clear up in 2 weeks, get into your PCP, start PT
You're already way ahead of the game from where you started at the beginning of this post.
Just understanding HOW plantar fasciitis can change your running form, affect your single leg balance and stability, and create neuromuscular control changes...IS A HUGE WIN!
NEXT STEP: What do you do about it?
We'll dive deep into this next week.
Get ready for immediate, actionable exercises.
In the meantime, here's your CHALLENGE: test out your balance.
Stand on one foot.
Hold it for 10 secs.
Was it equal? Or was it harder on the right vs the left foot?
Take it to the next level!
Stand on your tip toes. On only ONE leg!
How long can you stay there?
Is it the same right vs left?
Keep all this is mind for next week...it'll come in handy ;)
Until then, Dare to Train Differently,
Marie Whitt, PT, DPT
P.S. Want to get a head start on making those single leg balance tests better IMMEDIATELY? Then check out my Stronger Feet Workshop! You already know, building up those foot muscles is MANDATORY for preventing plantar fasciitis!
Cheung, R. et al. (2015) “Intrinsic foot muscle volume in runners with and without chronic bilateral plantar fasciitis,” Physiotherapy, 101. Available at: https://doi.org/10.1016/j.physio.2015.03.414.
Kelly, D.K., Wiegand, K. and Freedman Silvernail, J. (2022) “Dynamic Stability in runners with and without plantar fasciitis,” Gait & Posture, 96, pp. 301–305. Available at:
Osborne, J.W.A. et al. (2019) “Muscle function and muscle size differences in people with and without plantar heel pain: A systematic review,” Journal of Orthopaedic & Sports Physical Therapy, 49(12), pp. 925–933. Available at: https://doi.org/10.2519/jospt.2019.8588.
Wiegand, K., Tandy, R. and Freedman Silvernail, J. (2022) “Plantar fasciitis injury status influences foot mechanics during running,” Clinical Biomechanics, 97, p. 105712. Available at: https://doi.org/10.1016/j.clinbiomech.2022.105712.