Can I Run with Plantar Fasciitis?

Dear MyRunningDoc,

I am a runner who has been suffering with plantar fasciitis for several months. I tried couple of different things myself to get the heel pain to go away but it still continue to bother me. When I went to see my doctor, she told me that I had to stop running.

Can I run with plantar fasciitis? Will my heel pain get worse if I keep running? Or can I run with plantar fasciitis and still heal.

John H. 
San Jose, CA

Hello John,

Heel pain can be frustrating when you are a runner. It isn't that the heel pain is so debilitating that it stops you from running, but that you are often distracted by it, and concern that the problem will get significantly worse or translate into other overuse injuries.

Plantar fasciitis of course is the most common form of heel pain. But it isn't the only type of heel pain that happens in runners. The short answer is that if it is only plantar fasciitis, you can probably keep running without the problem getting worse. It is also possible to continue running and still heal your heel pain.

This all assumes that you have been correctly diagnosed, and have not been mis-diagnosed. If your doctor mistakenly diagnoses you with plantar fasciitis, when in fact have a calcaneal stress fracture (crack in the heel bone), or a partial rupture of the plantar fascia (a small tear in the plantar fascia), you will have to stop running for some period of time, depending upon the severity of the condition.

It is important to note that stopping running alone will not cure any of the above mentioned causes of heel pain. conditions. Many runners can self-diagnose their heel pain without ever seeing a doctor. But if you have any doubt about the accuracy of your diagnosis, or specifics about how to continue running while you have plantar fasciitis, you should seek a second opinion from a sports medicine podiatrist who specializes in the treatment of runners.

Dr. Christopher Segler is a 14-time ironman triathlon finisher and sports medicine podiatrist who specializes in the rapid treatment of running injuries. He performs remote consultations via Skype for runners and triathletes overseas who do not have access to Western medical doctors and running experts. You can learn more about running with heel pain at DocOnTheRun.com or learn more about plantar fasciitis at AnkleCenter.com

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Will orthotics help heel pain when running?

This morning I received an inquiry from a runner in Marin who is training for the Dispea. He asked a common question:

"I have severe left heel pain especially after a 5-8 mile run. I am training for the Dipsea. Advice? Should I consider orthotics?"

Answer:
Custom orthotics can certainly help to alleviate many forms of heel pain including the most common type which is plantar fasciitis. Custom orthotics in fact are one of the best ways to slow do pronation and decrease stress to the large ligament on the bottom of the heel called the plantar fascia. If you over-pronate and repeatedly tug on the plantar fascia as your arch height changes, you get inflammation of the plantar fascia... known as plantar fasciitis.

A long run can place a tremendous stress on the plantar fascia and the heel bone. Most people with plantar fascitis will have pain in the bottom of the heel on days following running. Usually the pain is worse with the first couple of steps when they get up out of bed. They can also get a sharp pain in the heel when they start walking after sitting at a desk for a while.

Custom orthotics are one of the best treatments for this type of running-related heel pain. But that doesn't necessarily mean that it is best to get custom orthotics and keep running. You must get an evaluation with a running focused podiatrist first.

The concern is that you might have something worse than plantar fasciitis. In this case, the runner reports heel pain that is "severe" following long runs. Plantar fasciitis would usually be worse (and more annoying) the day after a long run, but not necessarily severe. It would be important to get x-rays and take a look at the heel bone (calcaneus) to be certain that you are not at risk for stress fracture in the heel bone (calcaneal stress fracture).

It is also possible that there is a cyst in the heel bone that is causing the problem. In the simplest of terms, a calcaneal cyst is a hollow or fluid filled pocket that develops within the heel bone. When running, the walls of the cyst can flex slightly causing pain and inflammation in the heel bone itself. In some cases the heel bone can flex so much that it cracks or fractures. This is actually much worse than a calcaneal stress fracture.

With a quick set of x-rays and an exam by an experienced running podiatrist, heel pain can be effectively treated. With all of the conditions that effect the heel, the sooner the best treatment is chosen and starts, the faster you will finish your goal race, wether it is the Dipsea, the Vineman or the San Francisco Marathon.


Dr. Christopher Segler is an Award Winning Foot & Ankle Surgeon, 5-Time Ironman Finisher and a sports medicine podiatrist who makes house calls for busy runners, triathletes and active professionals in San Francisco, Marin, the East Bay and the Peninsula. If you have a question about running related heel pain, you can call him directly at (415) 308-0833. You can also learn more about custom running orthotics at AnkleCenter.com and DocOnTheRun.com.

Stay Fit. Go Long. Run Fast. Be Strong.

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San Francisco Podiatrist on Difference Between Heel Pain and a Heel Spur

Heel pain is the most common form of foot pain that causes people in San Francisco to make an appointment with a podiatry clinic. In fact, nationwide, about 40% of all visits to podiatrists are due to heel pain diagnosed as plantar fasciitis. As a podiatrist in San Francisco myself, the thing that I find interesting is that most people with plantar fascitis think they must have a heel spur to have heel pain. But that’s not always true.

So what is the difference between plantar fasciitis and a heel spur?

To begin with, let’s explain how to tell if you have plantar fasciitis. Anyone with plantar fasciits will have pain in the bottom of the heel or in the arch. In most cases this pain is worse when you get up and step out of bed in the morning. The heel may also hurt when you get up from your desk after working at a computer for a couple of hours.

As you start to walk, the first step is usually a sharp pain or sudden ache in the bottom of the heel. After a few steps, the heel pain starts to subside and feels better. In many cases, it may not even hurt at all while you are walking around or even running. But when you sit still and get back up again to start walking, that’s when the heel pain returns.

If you have this kind of morning heel pain and simply push on the bottom of the heel (and it hurts) you most likely have plantar fasciitis.

Many people in the San Francisco Bay Area seem to believe that heel pain is due to a sharp heel spur poking down and causing pain. But in fact about half of all people who have this kind of heel pain don’t have a heel spur at all. And about half of people with no heel pain, happen to have a heel spur that will show up on x-ray. So the two problems aren’t necessarily related.

The most common cause of heel pain is plantar fasciitis, which is simply inflammation of the plantar fascia. The plantar fascia is a big ligament attaching to the bottom of the heel and extending out to the toes. If you put too much stress on the plantar fascia, it can become inflamed where it attached to the heel bone.



With improper biomechanics, such as excessive pronation (flat feet that roll inward as the arch collapses) the plantar fascia ligament may tug away at the heel bone. With tension applied to the plantar fascia, the attachment may cause the heel spur to form.

The way this happens is that the ligament pulls the covering (called the periosteum) of the heel bone away. A small blood clot forms and then becomes calcified as it heals. If this happens again and again, the heel spur gradually grows. Because the heel spur is caused by the pulling on this big ligament, you can understand why a heel spur points out toward the toes and not down toward the ground.




Any podiatrist in San Francisco can simply take an x-ray of your heel to tell whether or not you have a heel spur. But the reality is, it doesn’t matter.

In the last 7 years, I have only surgically removed 2 heel spurs. Both of them were broken and wouldn’t heal. One was an young ironworker in San Francisco who fell off some scaffolding while working on the Golden Gate Bridge retrofit project. The other was a woman in her sixties who has some osteoporosis and broke the heel spur while doing high impact aerobics.

But most people with plantar fasciitis can get better on their own, even if they have a heel spur. In the vast majority of cases, spending a few minutes doing our San Francisco Podiatry Heel Pain Recovery Stretches will make the heel pain go away. The spur just simply doesn’t usually need to be removed in surgery.

Dr. Christopher Segler is a nationally recognized expert on conditions affecting the heel bone. In 2006 he was awarded 1st Place at the National Meeting of the American Podiatric Medical Association for his research on diagnosing heel bone infections with magnetic resonance imaging (MRI). He offers podiatry house calls in San Francisco for busy athletes and people who just think it is ridiculous to take half a day off work just to see a foot doctor. You can reach him through Doc On The Run: San Francisco Bay Area Podiatry House Calls.You can also learn more about the causes and available treatments for heel pain at AnkleCenter.com.

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APMA Creates New Patient Education Brochure on Heel Pain

Did you know that plantar fasciitis is the number one condition treated by foot doctors? In fact, plantar fascitis (the most common form of heel pain) accounts for about 40% of all visits to podiatrists. In response, the American Podiatric Medical Association has recently created a 12-page "patient eductaion" brochure on heel pain. It has been released to member podiatrists as a marketing tool to lure lucrative heel pain patients into their podiatry practices.

The bottom line is that many people can treat plantar fasciitis themselves using simple at-home treatments that are non-painful. No shots. No surgery. No expensive shoe inserts. Very few patients with plantar fasciitis every need surgery. If you have heel pain that has been bothering you for a short time and a podiatrist tells you that you need heel spur surgery...RUN!

Dr. Christopher Segler is an Ironman Triathlete and award winning foot and ankle surgeon who specializes in providing self-treatment for heel pain caused by plantar fasciitis. You can learn more about heel pain (especially morning heel pain) as well as request a FREE copy of his book on heel pain at http:www.NoMoreHeelPain.com.

Can Runners Heal Heel Pain?

What could be worse than a runner with heel pain? Answer: a runner who has heel pain and can't run. In this excerpt from a video interview with Ironman finisher and award winning podiatrist, Dr Christopher Segler discusses heel pain.





Dr. Christopher Segler is an Ironman Triathlon Finisher and award winning foot doctor specializing in elite athletes. His podiatry sports medicine house calls practice is located in San Francisco, Marin, Oakland and Berkeley. You can register for a FREE membership and will receive the monthly newsletter “Finisher’s Circle,” which provides expert advice on increasing your running efficiency and preventing injuries and foot pain by visiting http://www.AnkleCenter.com .

Achilles Stretches for Runners Recommended by San Francisco Podiatrist

If you are a runner, the Achilles tendon is crucial to your sport. You simply can't run without it. When it gets tight, it is more prone to injury. A tight Achilles tendon can also lead to heel pain. Most heel pain related to a tight Achilles tendon is called plantar fasciitis. It may or may not be related to heel spurs. In most cases, it doesn't matter if you have a heel spur or not, Achilles tendon stretches are the first line of treatment.

The following video will demonstrate both the best Achilles tendon stretches to keep your Achilles tendon injury free, and prevent plantar fasciitis. Always warm up before stretching. Don't stretch if your Achilles is painful or sore. Always see a foot and ankle specialist immediately if you notice any bruising around the Achilles tendon, or if it is sore fro more than a couple of days. Run healthy!



Dr. Christopher Segler is an Ironman Finisher and award winning foot and ankle surgeon specializing in elite athletes. His podiatry practice is Doc On The Run: San Francisco Podiatry Sports Medicine House Calls. To learn more about Achilles tendonitis, runner’s heel pain, stress fractures, bunions and other common causes of foot pain, you can register for a FREE membership and copy of his monthly newsletter “Finisher’s Circle” by visiting http://www.AnkleCenter.com .

Runners Heel Pain

Heel pain is common complaint in runners. Actually, heel pain is common in all people.  40% of all visits to podiatrists in the U.S. are because of heel pain.  Of all of the different causes of heel pain, the vast majority is due to a condition known as plantar fasciitis.  This is the most frequent cause of pain on the bottom of the heel and is an inflammation in the band of tissue (the plantar fascia) that runs from the heel to the toes. This condition is most often caused by a tight achilles tendon or poor foot structure such as overly flat feet or high arches. It can also be caused by wearing non-supportive footwear on hard surfaces, spending long hours on your feet, or obesity. 

The pain from plantar fasciitis is usually a sharp, stabbing pain on the inside of the bottom of the heel that can feel like a knife sticking into your heel. Pain from plantar fasciitis is usually most severe when you first stand on your feet in the morning.  Many people complain that the first step out of bed is the worst.  Many also have pain as they get up and start to walk after sitting for a period of time while working at a desk or computer.  This heel pain will usually subside as you walk, but can return with prolonged standing, walking or running. 

For runners, the plantar fascia may become inflamed after a period of running hilly courses or running in excessively worn shoes or the wrong type of shoe for your foot type.  Once this happens, a cycle of inflammation ensues.  There is a nerve (called the medial calcaneal nerve) that runs along on the inside of the heel bone and actually curves down around the bottom of the heel between the bone and the plantar fascia.  As you walk and place stress on the plantar fascia, the tugging of this ligament where it attaches to the heel bone stimulates inflammation.  The inflammation results in fluid being collected around the nerve between the bone and the plantar fascia.  When you get up and step on the heel, the nerve gets compressed by the collection of fluid.  This causes the sharp pain. By stepping on the heel, some of the fluid is pushed out of the area and away from the nerve.  The second step may also hurt less as even more fluid is pushed away from this space around the nerve. Once you get moving, the pain then usually subsides.  Once you go to sleep the whole cycle begins again. 

In short, plantar fasciitis is a combination of two separate problems.  First, there is a tight Achilles tendon that can lead to abnormal tension on the plantar fascia when you walk or run. Second, there is inflammation from all of the tissue damage as the plantar fascia is tearing away at its attachment to the heel bone.  You must address both in order to get better.

The main question I get from patients about treating plantar fasciitis is “will I need surgery?”   The answer to this is almost certainly not.   Based on the results I have seen among my patients at the Ankle & Foot Center of Chattanooga, 98-99% of heel pain sufferers can effectively self-treat their heel pain and get permanent relief without ever visiting a doctor.  The reason I know this to be true is that I have tracked the progress of those patients that have been seen in my office.  I see several patients with heel pain every single day in my office.  In the last year I only performed surgery on four patients for plantar fasciitis.

My treatment philosophy and practice style is simple.  I firmly believe that simple, reliable, cost-effective treatments should always be attempted before expensive and evasive treatments like surgery.  Although I am an award winning foot and ankle surgeon (and admittedly love doing surgery) I truly believe that surgery is just a bad idea if any other treatment will work.  For that reason I wrote a book called No More Heel Pain which we make available free to anyone in Chattanooga.  

The main question I get from runners is “can I run with plantar fasciitis?”  The answer is yes, provided it has been diagnosed as plantar fasciitis.  As I said earlier, plantar fasciitis is by far the most common form of heel pain, however there are other causes.  Stress fractures of the heel bone, bone cysts (weak areas) and bone tumors can all mimic the symptoms of plantar fasciitis.  The difference is that they are usually more painful when you run and will not subside (but instead get worse) while you are walking or running. These can also lead to serious problems such as a fracture of the heel bone.  A fractured heel bone will definitely interrupt your training schedule.

Provided that it is in fact plantar fasciitis, the first and most often effective treatments for plantar fasciitis include stretching, icing, and anti-inflammatory medications. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence. Achilles tendon stretches are essential to eliminate heel pain. Perform the Achilles tendon stretches twice-a-day; morning and evening. This will only take 1 minute in the morning and 1 minute at night.

Stand upright about one large pace away from the wall with your feet parallel and about hip width apart. Keep your feet in line as shown. Place your hands against the wall, at shoulder height. Move your right leg half a pace forward. Lunge forward on your right leg so that the knee is brought directly above the ankle. Stretch your left leg back as far as is comfortable with the foot and heel remaining flat on the floor. Slowly lean forward to stretch the left leg calf muscles and tendon. Hold the stretch for 10 seconds, relax, and repeat on the other leg. Perform each stretch three times per side. You can find additional helpful stretching videos on our website at www.MyRunningDoc.com. 

Icing your heel is vital to decrease inflammation that accumulates while you walk during the day, and to prevent more inflammation while you sleep. Apply ice to the sore area for 20 minutes two or three times a day to relieve your symptoms.  Do not go barefoot.  Do not wear flip-flops or house shoes while recovering.  Only wear shoes with a moderate heel that do not bend through the arch.  Always wear shoes when walking, even in the home.  If you have our recommended custom orthotics, or over-the-counter inserts, wear them in your shoes at all times.  Most people with plantar fasciitis improve significantly after two months of initial treatment.

Keep on running, but seek help if your heel pain gets worse while you run or if the heel pain just won’t go away after trying the treatments described above.  Once you get rid of the heel pain, keep stretching your Achilles tendon periodically and you can prevent your heel pain from coming back.  No more limping out of bed before your morning run!

Christopher Segler, DPM, AACFAS

Award Winning Foot and Ankle Surgeon

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