Diagnosis: Plantar Fasciitis

It looks like I'll have to put my running on hold for a few weeks. It turns out that I've got plantar fasciitis in my right foot.

The Stubborn Runner

Shortly before Christmas I started getting a dull, throbbing pain in my right heel. The pain usually occurred after a long or hard run, but after some rest, it would subside. The issue continued through the early weeks of January and slowly started to worsen. It wasn't bad enough to stop me from running, but at times the pain was debilitating - mostly first thing in the morning, or the evening after a long run. I remember one night in particular, I got up in the middle of the night to use the washroom, and as soon as I put weight on my right foot, I almost fell over. Despite this, I kept running 50-60km a week. I am your prototypical stubborn runner. 

On a long run a few weeks back I was listening to episode 32 of The Runner's World podcast. In the episode, they featured a runner who had been dealing with plantar fasciitis. I'd never heard of it, but the symptoms they described were all too familiar. Subsequent trips to both my massage therapist and a foot specialist confirmed my fears - I had plantar fasciitis, an injury that many runners deal with at some point.

Plantar fasciitis

For those of you who don't know, plantar fasciitis is essentially damage to the fascia, which is a band of fibres that run along the bottom of the foot from the heel to the mid-foot. The stress of overuse (over-running), over-pronation, or overused shoes can rip tiny tears in it, causing heel pain and inflammation. It can be very painful at times, usually first thing in the morning (or after long periods of inactivity.) The confusing thing is that the pain often fades when you're actually using your foot - during a run, workout, volleyball game, dog walk - as the area has begun to warm up and is getting blood flow. That's what makes this injury so challenging for a runner since it doesn't actually prevent you from running - the pain actually goes away while running. But man oh man, does it ever come back afterwards. It's horrible.

"Can I still run?"

Once I was diagnosed, the first question I had was "Can I still run?". After all, I've been running through it for the last 4-6 weeks...but it was getting worse. I'm just starting out my marathon plan for the year, so taking time off now isn't ideal, but it's better than taking time off later. But I'm just getting started! I just want to run - run fast, run far, run often. The thought of no running really bums me out. Here's what my experts told me.

Freya, my incredible massage therapist, spent almost a full hour working on my right calf. The tightness in those muscles pulls on the fascia in the foot, which contributes to the stress and micro tears. Ensuring that my calves are nice and loose will be key to recovery and prevention in the future. She said, "no running until you come back" which is in a few days. More treatment from her will surely help.

The foot specialist diagnosed the issue within seconds of me explaining my symptoms. After a quick look at my foot and a few routine exams and exercises she concluded that I did in fact have plantar fasciitis. She scanned my feet to get me some orthotics made and gave me a bunch of stretches to do at home. She also had a look at my old shoes, which I had run far too many miles in. "Wow, these are toast! Get rid of 'em!" she exclaimed.

I'm such an idiot. I knew for a while that I needed new shoes and I just put it off. Most experts say that you should run around 500-600km in a single pair of shoes before replacing them. I was over 900km on these bad boys. They definitely contributed to this problem. Last week I bought myself a new pair of New Balance Fresh Foam 1080's. They have far more structure and cushioning than what I'm used to, but I need it. Especially for long training runs.

Once diagnosed on Friday, I emailed coach Dave to tell him what I was dealing with and to ask for any advice that he had for me. I was dejected, frustrated and a bit pissed off. As always, Dave was great. He empathized with the injury (he's had it in the past) and confirmed that I should take a break from running until I sort things out. He gave me very specific tactics for dealing with the injury, and a plan of attack for my training plan moving forward without running in the near future.

Dave's an excellent coach. He's a teacher, a motivator, and a leader. When he talks, people actively listen. He also has a great way of putting things in perspective. He helps manage expectations and reactions. He's got a calming influence. Despite not being able to run, I feel pretty okay with the position I'm in, thanks to Dave.

Moving forward without running

So with no running for the next week (or two...hopefully no longer than that), my focus will be on treating the injury while keeping my fitness up. To treat plantar fasciitis, Dave recommended the following:

  1. Stretch the entire posterior chain (from foot through the hip into the lower back), so there is less tension on the fascia. Both my massage therapist and the foot specialist gave me a bunch of great stretches to do.
  2. Ice the damaged area regularly to limit inflammation (rolling a frozen water bottle on the bottom of the foot works well)
  3. Minimize further damage. Once I'm pain-free, then strengthening the foot is very important to prevent future injury.

Okay, got it. This has become my obsession. There isn't a moment at home when I'm not either stretching or icing this bloody thing.

Now, what do I do about my fitness and training without running? What do I substitute in for those 60km a week I'm supposed to be running?

  • Increase other cardio activities, so long as they don't cause pain. I plan on riding the bike a lot and doing some intense spin classes at Spin City to keep my cardio up.
  • Continue with my regular strength and core training, while avoiding any heavy pressure on the foot (i.e. no jump squats or squats with heavy weights.) Volleyball is also fine, as long as it doesn't hurt.
  • Promote regular stretching and recovery workouts - yoga, massage therapy, foam rolling, frozen water bottle, etc.

Both Dave and the foot specialist recommended that do some foot stretches before getting out of bed in the morning. This will help "warm up" the muscle before putting any pressure on it. Also, keep a good pair of running shoes or slippers at my bedside and wear them right out of bed. Avoid walking around barefoot as much as possible. Those first few steps in the morning are one of the leading causes of further damage, so this is really important.

Next steps

Hopefully this issue resolves itself soon, but I'm trying to be patient with it. I already ignored this long enough and even managed to break one of my marathon commandments - If it's broke, fix it. I wrote this post a few weeks ago with the purpose of reminding myself of the thing to do - and the things not to do. And I didn't listen. So please, if you're a runner dealing with a nagging injury, don't run through it. Get it checked out and fix it before it becomes a permanent or nagging issue. Easier said than done, I know.

Plantar Fasciitis is brutal - hopefully you never have to deal with it. But, instead of being mad at myself or dwelling on this, I've decided to accept it and just move forward. I've got some great advice and motivation from those around me and feel like I have a good plan moving forward. I'll finish off with a snippet from Coach Dave's note to me:

"I know it's frustrating, but one thing I learned from my plantar fasciitis experience, is that you can't run through it. Take some time now, treat it with respect and you will be back running more quickly than if you try to manage the pain through running."