- Kate Mihevc Edwards PT, DPT
Plantar Fasciitis: Is This YOUR Foot Pain?
By: Dr.Leda McDanial PT, DPT
There are many different causes of foot pain and in runners’ one of the most common causes is plantar fasciitis. A more general term that you may not have heard about is “plantar fasciopathy,” that includes not just a bout of acute inflammation (technically, -itis refers to an inflammatory process), but also includes longer lasting conditions that may have some sort of tissue weakening, degenerative changes, or repeated bouts of inflammation over time, “acute on chronic,” responses at the tissue level. As you can see, not all heel pain is created equally!
In Episode #35 of the More Than Miles Podcast, physical therapists Dr. Kate Mihevc Edwards and Dr. Kacy Seynders have an in-depth conversation about plantar fasciitis, plantar fasciopathy, and other types of foot and heel pain. First, they talk about some common signs and symptoms of plantar fasciitis, such as those included on the list below:
Common Signs and Symptoms of Plantar Fasciopathy:
Sharp (or achy) pain at the heel or bottom of the foot
Pain that gets better during a run or walk (“warms up”)
Pain with “first steps” out of bed in the morning or after sitting for a while
Pain that worsens in proportion to loading (i.e., the more you run or walk the more it hurts either during or after)
Pain that stays in the foot (i.e., does not travel up the leg or emanate from the back)
Dr. Kate and Dr. Kacy also break down potential treatment techniques. One of the first factors they consider is how to keep an endurance athlete as “fit” as possible (and as happy as possible!) by adjusting training variables but keeping that athlete training in some capacity! These recommendations are on a case-by-case basis. So, in some cases athletes can keep running but just reduce mileage. However, in other cases taking a break from running while working on addressing any weaknesses that may be contributing to this foot pain may be necessary. Some advice that Dr. Kacy often gives runners is this, “My number one rule is if you have pain with walking, you are not going to run!” She elaborates on this by saying that she understands the athlete mindset of wanting to keep running, but explains the importance of adjusting loading to what is appropriate for healing and recovery. She says, “If we think about injuries as a load tolerance problem, we need to find a level that is safe and appropriate depending on where someone is in their healing process…”
Taking a break from running may be easier if an athlete is able to embrace the chance to improve some of the factors that may have initiated this injury in the first place. Some factors that may predispose athletes to plantar fasciopathy may be beyond their control (e.g., extremes of foot type such as very high arches or flat feet). But some factors could be addressed and improved to help in the healing process and reduce risk of injury in the future. These controllable factors could include weakness in gluteal muscles or foot intrinsic muscles, poor motor control of foot muscles that provide arch stability, or excess pronation while the foot is trying to dissipate shock from the ground during running.
In the podcast, Dr. Kate and Dr. Kacy explain the purpose behind these treatments to address risk factors and also talk about other common treatment options for plantar fasciopathy that physical therapists could provide. Check out some of these on the list below:
Possible Treatment Techniques for Runners with Plantar Fasciopathy:
Strength exercises for glutes and foot intrinsic muscles
Mobility or strength exercises for other leg or foot muscles if needed
Manual therapy and/or dry needling from a licensed physical therapist
Manipulating training variables to mitigate load (how far and how fast your runs are, integrating recovery techniques and/or strategic recovery days, etc.)
Blood flow restriction training
Orthotics (in the short term!)
As you can see, there are a variety of treatment options that may be effective to help someone recover from this type of foot pain. Seeing a physical therapist early for a comprehensive evaluation of leg and foot muscle strength, mobility issues, and any form breakdown in running could all be useful. Dr. Kate and Dr. Kacy perform very thorough evaluations to match specific treatment approaches to each unique athlete. These assessments take into consideration the athlete as a whole, because even if someone is having foot pain, it does not mean the “foot is at fault,” and it is important to address any compensations from other muscles or body areas. Dr. Kate explains some of this line of thinking by saying, “…so you really can’t just treat the foot, because it’s all continuous if you think about the anatomy (the fascia and soft tissue structures on the back of the leg).”
For more on different types of foot pain and a comprehensive discussion of plantar fasciopathy, check out the full podcast episode:
More Than Miles Episode #35: Heal Your Heel: Plantar Fasciitis
And remember, this blog is NOT intended as medical advice and should not be a replacement for seeking out a trained physical therapist or medical provider if you have foot pain. Often, a physical therapist can help with this sort of issue and help get you back to running as quickly and safely as possible!
To learn more about Gait Analysis, listen to Episode #19:
More Than Miles Episode #19: Gait Analysis: Behind the Foot Strike
To book an in person or online gait analysis with Dr. Kate or Dr. Kacy, check out: