What If Your Heel Pain Isn’t Plantar Fasciitis and What to Do About It

Nothing ruins a perfectly good runner like plantar fasciitis, the dreaded snake bite of the heel and arch of the foot. In essence, its nasty foot pain–particularly heel pain–that prevents us from running. Once it sets in, is one of the most menacing and stubborn conditions.

Ultrarunners seem particularly prone to heel and arch pain. Both uphill and downhill running stresses the foot: the ups stressing the soft tissues of the plantar arch, and the downhills providing ample pounding for the joints.

It’s okay to call your foot and heel pain plantar fasciitis–just like that Coke at the aid station that might be Pepsi or RC Cola. But be sure that you–and your doctor, PT, chiropractor, LMT or other healthcare helpers–are aware of all of the different sources of foot pain. Awareness is the first step in comprehensive treatment and fast recovery from the dreaded “PF” and its brethren.

Plantar Fasciitis, Defined

The plantar fascia is the thick connective tissue that runs from the base of the heel, to the bones of the forefoot. Collectively, with intrinsic foot and ankle muscles, it supports the arch of the foot and helps transfer energy from the forefoot to the rearfoot and ankle, and up the leg.

By definition, in a truly literal sense, fasciitis is an active inflammation of that tissue.

But is foot and heel pain always plantar fasciitis? In a clinical sense, one can only have fasciitis if an active inflammatory event is occurring. Since inflammation only lasts twenty days, indeed, not everyone with persistent foot pain truly has fasciitis.

Not all tissue paper is Kleenex. Not all lip balm is Chapstick. And so it goes, not all heel and arch pain is plantar fasciitis. But as Shakespeare once said, “Is foot pain by any other name, any less excruciating?”

However, to label all foot pain as plantar fasciitis possibly limits one’s ability to quickly and effectively recover from it. Below are some other, equally common causes of foot pain.

Foot Pain: Differential Diagnosis

There are a many possible sources of persistent heel pain and arch pain. Here are the most common I see, clinically:

Soft tissue sprains and strains. There are several major muscles, tendons, and ligaments that span from the heel and ankle to the toes. Besides the plantar fascia, there are several flexor tendons–of muscles originating on the lower leg–that course their way into the foot. Any number of these tissues can become strained under the load of road and trail running. A review of the Rules of Tissue Loading explains how a plantar surface tissue can become irritated.

However, since soft tissue tends to heal quickly given proper treatment, these causes tend to heal rapidly. Those with persistent heel pain and arch pain–who see me and other medical folks after weeks, months, and even years of pain–tend to have a pain generator of different origins:

Joint Pain. There are over two dozen joints in the foot and ankle complex. With the extreme stress of ultra trail running, these joints could become stiff, irritated, or both.

Joints–articulating surfaces of two bones–require but two things to be happy:

  • Full range of motion
  • Symmetrical, equal loading of surfaces

Seems simple, but running hard and long on uneven surfaces can strip a joint of those two things.

Range of motion loss. Joints get the bulk of their nutrition from range of motion. The vast majority of joints in the body are synovial: two bones surrounded by a leathery capsule filled with fluid. The cartilage surfaces receive very little blood flow. In order to receive nutrition, the joint must “lubricate” itself with the fluid of the joint, absorbing nutrients from the fluid along its surface–via regular, full range of motion.

When joints stop moving through their full range, elements of cartilage do not get this nutrition. The cartilage dries up. And it is replaced with bone. This, by definition is osteoarthritis. Preceding that, is pain.

Asymmetrical loading. Joints have the ability to move–sometimes small amounts in one plane; sometimes substantial amounts in many directions. But when running, joint surfaces are designed to be loaded so that the entire surface of one bone impacts flush against the other. This promotes maximum stability; it also ensures that cartilage receives a steady dose of hydration and nutrients.

Asymmetrical loading occurs as the result of abnormal running surfaces–uneven, rocky trails, or a cambered/slanted road–or with inefficient running mechanics.

And when a joint becomes unhappy, it causes pain. Typically, a painful joint will hurt at its precise point of irritation. But joints of the ankle and foot will frequently refer pain to adjacent areas, out the sides or beneath the point of irritation, at times mimicking soft tissue pain.

How can you tell if you have a soft tissue or joint issue? Below are some comparisons:

Soft Tissue Pain Characteristics

  • Succinct, reproducible, palpable tissue pain. Can you find the one spot that is tender?
  • Pain with active use: when you do a toe curl or use the muscle (absent weightbearing), does it hurt?
  • Pain with passive stretch: is pain produced when you bend back your foot and toes? (again, without weighbearing)
  • Pain with resisted testing: when flexing your foot and toes, is there pain?

Joint Pain Characteristics

  • Dull, diffuse pain: no discernible “tender spot.” Rather, it hops around and you can’t put your finger on it.
  • Pain with weightbearing through the joint.
  • Pain is worst in the morning, after prolonged weightbearing, or after resting, then bearing weight through the joint.
  • Non-weightbearing testing–actively flexing and passively stretching the foot–is pain-free.

If your symptoms align with the joint pain characteristics–and if your foot pain fails to respond to soft tissue plantar fascial treatment approaches–you likely have joint pain.

The three usual joint suspects–the talocrural, the subtalar, and the talonavicular–can all become painful and mimic plantar fascial pain. Each joint lies on the medial plantar surface of the foot, and each is prone to stiffness and asymmetrical loading during running.

Medial view of a foot and ankle model, identifying three common problems joints for runners.

Above shows a medial view of the foot, showing three main joints of the foot. The talus plays a role in all three: it is the go-between from the foot and leg bones.

From above, it forms the talocrural joint. The main motion for this joint is “up and down”–it allows the toe up/toe down action that occurs in the run stride.

This joint is prime to get stiff, especially with repetitive downhill running: rather than smoothly sliding and gliding, hard downhill trail running can cause jamming forces of the talus into the tibia and fibula. And when this joint gets stiff, it can refer pain in any direction around the talus–front or back of the ankle (mimicking both anterior tibialis tendonitis and Achilles tendonitis, respectively), or it can spit pain out the side–namely the medial ankle and arch.

Between the talus and the calcaneus–or heel bone–is the subtalar joint. It is designed to move in several axes, but its primary axis of motion is medial to lateral. This joint is of little consequence to the healthy, normal runner: minor motions occur depending on the gait cycle. However, deviations or inefficiencies–namely in the foot strike pattern–can cause significant pain emanating from the subtalar joint. Excessive lateral foot strike can cause stressful joint compression to the medial aspect of the joint–mimicking plantar fascial pain!

Lastly is the talonavicular joint. This joint is the primary conduit from the fore and midfoot to the ankle and leg. The navicular bone is the “keystone” of the arch. Stiffness or irritation here can also cause significant arch pain.

The following are some illustrations of how mechanical forces can cause joint and soft tissue pain:

Over-pronation, as shown with shoe and joint model.

Medial view of a collapsed arch.

Excessive medial foot landing leads to over-stressing of the medial arch, or “arch collapse.” This stresses all tissues of the plantar surface and is the primary etiology of true plantar fascial pain.

Equally common, especially for faster trail runners, is excessive lateral foot strike:

Excessive lateral foot strike/supination, as shown with a shoe and joint model.

Excessive lateral striking significantly compresses the medial joint surface of the subtalar joint. This compression accounts for a large percentage of non-plantar fascial foot pain cases. It refers pain at its site, but also farther down into the arch and along the heel bone.

Too much lateral strike can also cause plantar fascial torqueing: the heel rotating to the right (in the above picture), but the forefoot rotates to the left as it contacts the ground – adding a twisting force to the fascia.

Nerve pain. Perhaps the most unrecognized and overlooked factor in heel and foot pain is nerve pain. The peripheral nerves of the ankle and foot originate in the brain, course through the spine, exit the low back and pelvis, and must course–fluidly–through the soft tissues of the entire leg.

Repetitive impact forces from running–often combined with compromised spine posture from running all day (or, in our normal lives, sitting)–can cause these nerves to develop “hitches.” This is a concept called nerve tension.

Nerve tension accumulates in the spine and legs with age, injury history, and running volume. When nerves lose mobility, they begin to create pain–often very similar to soft tissue or joint pain, including plantar foot pain.

And because the same repetitive or excessive impact forces that create joint and soft tissue pain also create nerve tension, it is very common for a runner to present with both joint/soft tissue and nerve pain overlay at the same time.

Almost every runner (and most other folks) has some degree of nerve tension. Here’s a test:

Sit with your back against a chair, head and shoulders upright. Extend your knees straight, with toes up. Note the degree of “stretch” in the back of your legs. Then, slump your head and shoulders. Any increase in stretch sensation is nerve tension from tensing the nerve at the head and neck.

Nerve Pain Characteristics

  • Pain at rest–the hallmark sign of nerve pain overlay: do you have any symptoms in your foot when at rest, namely sitting (specifically, with prolonged sitting, long after you’ve stood on it)?
  • Symptoms described as burning, buzzing, or dull aching.
  • Other symptoms higher up the leg, specifically: lumbar, buttock, posterior thigh, calf or shin pain.

Very often, a runner who applies soft tissue or joint treatment concepts will get partially better, but fail to fully recover because they fail to address the nerve tension component.

Runners and clinicians, alike, need to recognize the existence of nerve tension and treat it concurrent with any soft tissue or joint irritation.

Treatment Approaches

Please discuss any of the following treatment approaches with your doctor, physical therapist, or chiropractor before performing.

Soft tissue

These are straightforward because everyone who [thinks they have] PF does them:

  • Rest, ice, soft tissue mobilization, stretch, strengthen.

Real, actual soft tissue plantar pain will heal rapidly, given correct doses of the treatments above. Those who do not respond to that approach likely have a joint or nerve issue.

Joint pain

The two treatment approaches to joint pain in the foot include full restoration of joint range of motion and symmetrical loading.

Range of motion restoration

Ankle dorsiflexion. Normal ankle dorsiflexion is about 20-30 degrees beyond a 90-degree bend at the ankle. If you cannot stretch this far–or if you have symptoms in front, or anywhere around the ankle joint–your symptoms might be due to stiffness there. To mobilize a stiff talocrural joint, try the following:

Perform a standard calf stretch, with a few minor adjustments: be sure your stretch foot is perfectly straight ahead. Keep the foot flat, lean forward with a straight knee until full tension. Then, slowly bend the knee as much as possible without allowing the heel to rise. Slowly oscillate between bent and straight knee. This mobilizes the tibia and fibula over the talus, restoring motion to this joint.

Wall ankle stretch – straight knee.

Wall ankle stretch: bent knee. Keep the heel as flat as possible.

Subtalar inversion and eversion. A normal heel bone should be able to “wiggle” about 10-20 degrees side to side. To self-test, cross your ankle over opposite knee. Grasping hold of your ankle with one hand, drive firmly downward with your opposite hand on the inside of your heel bone. Can you move it, at all? If not, and you have heel and arch pain on the bottom/medial side of your foot, your symptoms may be coming from stiff subtalar joint.

To self-mobilize, perform the maneuver described above with firm, slow, on-and-off downward pressure. The degree of motion will be slight, but the potential for pain relief is substantial when motion is restored here.

The author applying a straight-downward pressure to the heel bone, stabilizing at the ankle. A normal heel will “wiggle” a few millimeters in both up and down directions.

Midfoot arch. A normal midfoot will have some degree of give, both to the hands and when standing on it. In standing, a normally mobile foot should “sink” a few millimeters to the floor.

Shoe orthotics are intended for those who are hypermobile in their arch: their arch joints are excessively flexible, and the arch “collapses” (typically defined as one centimeter or more) in weightbearing.

However, far more often than not, runners have hypomobile arches–they simply don’t move enough. These folks typically respond poorly to orthotics (often with no improvement, and sometimes they worsen pain).

A hypomobile, stiff arch will benefit from self-mobilization. If you have symptoms that originate farther down the foot, near the apex of the arch–and your foot lacks any give in standing–try the following mobilization:

Stand with stiff foot down. Place your opposite heel directly on top of the stiffest area–typically the navicular bone, which lies directly in front of the tibia-fibula complex. Gently, then progressive bear down with substantial weight onto the navicular. This may seem scary–test it first. A stiff navicular will give very little, even with full pressure. Pain usually comes from skin compression. “Stomp” on and off 10-20 times. Perform before and after running, and/or in the morning, when stiff joints tend to be stiffest.

The author, performing a mid-foot self-mobilization in standing. Try with soft-heeled shoes on, if too sore with direct skin contact.

Joint Loading Factors

Loading the joint equally is vital to joint happiness. Orthotics can be helpful for those with hypermobile feet, as they can prevent arch collapse. They are also helpful for slower runners with shorter stride lengths. A short stride tends to include excessive vertical forces (up and down motion). This vertical loading bears down on the medial arch–beyond the capability of muscles, tendons, and the plantar fascia to support it. An orthotic can aid in sustaining the arch. But ultimately, an efficient stride that emphasizes normal hip mobility with greater forward momentum is most important in preventing arch collapse.

Other important factors for symmetrical, low-stress loading include the position and angle of foot strike. The foot should always land as close to directly beneath one’s center of mass as possible. A foot that strikes in front, tends to strike:

  • On the heel;
  • On the outside edge of the foot (heel or midfoot); or
  • On the mid or forefoot, laterally-biased.

A heel strike creates considerable stiffness through the talocrural and subtalar joints. A lateral strike might cause asymmetrical loading of the subtalar joint, and/or a twisting, torqueing force through the midfoot and plantar fascia (see photo above). A midfoot or forefoot strike–significantly ahead of the body–will stress out those joints or strain the plantar fascia.

The most simple, sustainable and important way to correct a foot strike issue is addressing it proximally with:

  • Proper forward trunk engagement, and
  • Moving the hips such that the foot is “pulled” beneath the body

After ensuring proper foot placement beneath the trunk, shoot for a whole-foot strike, where all elements of the foot are absorbing and sharing impact forces.

Nerve Pain Treatment

To treat nerve tension, refer to the test above, except make one slight adjustment:

Sit in a chair, slumped forward. Slowly extend the affected leg with toes up. As the foot and lower leg rise, slowly extend your head at the same speed. The degree of stretch should be significantly less, but still present. Hold one second, then slowly lower. This is referred to as a “nerve floss” exercise: the head gives the nerve slack that is taken by the foot, and vice versa. Repeat ten to twenty times, and perform three to four times a day, especially before and after running. Here is a video link for the exercise.

Call for Comments (from Bryon)

  • Have you suffered from heel pain, plantar fasciitis, or other foot pain?
  • How did you heal your plantar fasciitis, heel pain, or other foot pain?
Joe Uhan: is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

View Comments (164)

  • Awesome!

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  • This is very useful information.

    I notice that badly cut single track trails can lead to overpronation or oversupination. Imagine "fisherman" trails near a lake or fireroad trails that come down a mountain at a slant and for miles. I find that running on these type of trails leads to some pain in my feet. These type of trails are utility trails, just used for a purpose and for a "short" time, i.e. access to a fire/stop the fire or to go fishing for a few hours.

    I think mountain bike trails are some of the best out there. They are mostly constructed using a McLoad Tool. Trail runners are great with removing blow downs with chainsaws and maybe we can incorporate trail work days that include McLoed Tools.

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  • Mic-

    Thanks for the comment. I agree 100% - narrow trails + a slower "trail pace" can definitely create a "compenstatory lateral strike" due to having a narrow stride WIDTH, plus the difficultly of opening up the stride!

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  • I agree that soft tissue injuries can be very hard to diagnose. I went to Physical Therapy for weeks with no improvement for my "PF". Turns out the diagnosis was incorrect and after an MRI, it was determined to be a plantar fibroma. Had cryosurgery done on it last week and the pain seems to be dissipating.

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  • These "Stay the Course" articles continue to be super informative. The photos and captions also really help, thanks for spending the time to add those!

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  • Great material here, OOJ. "PF" is something that has nagged me on and off for several years. I really like the details in your explanations. It is helpful to see how various parts of our anatomy can have similar affects. Good to see the whole picture!

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  • GREAT article. I've been suffering for years. I feel terrible after sleep and coming down the stairs in the morning. Crippling foot pain. It gradually subsides until I feel mostly fine, although walking around barefoot on our slipery hardwood floor feels not so great. Really never affected my running too much, only occasionaly do I even feel it. Rest doesn't seem to help, infact, it almost seems worse after time off (perhaps a year off would help, but I'm talking about a week in this case). Sitting in a chair causes pain upon standing (office job sucks).

    Footwear seems to make a difference. Obviously barefoot would be the way we were designed to move, but that option is out if you really want to move fast over rough terrain for hours.

    Hoka's are nice for the plush ride, and seem to help in that regard, but the wide platform causes excessive pronation (for me) on narrow trails, and the soft foam exaggerates that as it's easier to compress the inside edge of the sole. That pronation causes pain, and seems to bother a touchy knee (knee cap not tracking right?).

    I like the Montrail Badrocks for stability and toe box room, but notice the decreased cushion. Knee and ankle feel better, heel hurts more!

    Dumb question: Is there a good way to select a health care professional? Most seem to have two answers: Orthotics, or stop running ('running is hard on your joints'). NO! I need a therapist who IS a runner! It would be nice if there was a good sounding board for runners in various areas to ask/recommend therapists. Right now it seems to be totally trial and error, and I think most people just blow it off and run.

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    • Jason-

      Thanks for the comment - sorry to hear of your ails!

      Feet: chronic foot pain could involve elements of all three issues: soft tissues (ROM, strength), joint mobility, and perhaps some nerve overlay (possibly). But it sounds like this is a foot strike issue. I would say the wide platform of the Hokas might not cause the pronation - it only brings the pronation issue to your attention.

      Selecting HC folks: GOOD question. Here are some recommendations:

      - Word of mouth. Who is everyone else seeing? And more importantly, what do they do? Do they take a big picture approach? Are their interventions grounded in either research or solid clinical reasoning (e.g. no snake-oil salesmen)? More importantly, can they look at your running? MOST importantly: can they help you effectively change it (without making you mental)?

      - Professional affiliations. For PTs, who typically are most experienced in movement, and have the time to devote to you, I favor two different professional affiliations in physical therapy: the North American Institute of Orthopedic Manual Therapists (NAIOMT), and the Certified Functional Manual Therapists of the Institute of Physical Art (CFMT).

      These groups offer credentialed certifications involving years of training in hands-on techniques - not only to "move stuff" but also to retrain. If you're devoid of any recommendations, seeking out one of these folks in your area is a safe bet.

      NAIOMT: http://www.naiomt.com/index.cfm?fuseaction=page.viewPage&pageID=770
      CFMT/IPA: http://www.instituteofphysicalart.com/ipa/referra...

      Good luck!

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      • Thanks for the reply Joe! That's some great info, and should help at least direct the search.

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  • Joe, thanks so much, your articles are the best addition to iRunfar, even if don't generate much comments. Most useful for us all.

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    • Thanks for the feedback and kind words, Olga! Maybe I'll see you in Bandera in a few months? -OOJ

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      • Totally, I am working start/middle/finish AS, you'll hear lots of screaming in the morning too! But, speaking of the issue at hand, had it backwards: stress fracture and early running on it lead to PF, not tending to it lead to Plantar Tear! Then misplaced cuboid, nerves bundled into scar tissues - and a year and half later I am still often in pain on that foot. So, from personal (bad) experience I highly recommend to everyone to treat the injury - and the underlining issue - ASAP and fully!

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  • Then there's also bursa issues. My arches are ok, just have heel (right), pain on sides & back of heel. With overuse it sometimes transcends up the lwr. achillies a few inches.

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  • Great article! Not only i had this problen myself back in spring (hope it never comes back!) but I also sent this ling to my non-running co-worker who is also suffering from PF. Question: what do you think of cortizone shots to treat PF and other soft tissue problems? I had one and it seemed to help, but I heard all sorts of opioons on that topic.. Thank you!

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    • Elena-

      Thanks for the comment.

      Cortizone injections: GREAT "fire extinguishers": they put out the inflammatory fire (if there is one). But as my saying goes, "A Joint Problem* needs a Joint Solution".

      (*...or nerve)

      A cortizone injection will not mobilize a joint. It also won't properly align the joint or change your running stride. The most important job of the runner + healthcare helper, then, is to be sure that, once the "fire is out", that it does not re-ignite".

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      • ...if it IS soft tissue, the shot will help, but only temporarily unless the conditions that caused the irritation are changed (training factors, stride, etc).

        If it is joint, it will help, but be less effective unless inflammation is present. If it is nerve - it is less likely to help at all.

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        • Thank you so much for your response!!! The shot helped me - in less than a week the pain was gone completely. I am lucky and my doctor is a competitive marathon runner himself and he immediately told me what the problem was: too many miles on roads at too hard of a pace.. And the shoes that I didn't change in 2 years.. So, now I am trying to do exactly what you say here - change the conditions that originally lead to the problem: fewer road races, more quality in training and better shoes.. So far so good.. Hope it stays that way. Thank you again!! Hopefully see you in Bandera in Jan.

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  • Dayum! Wish I had this column a year ago:) Timing is everything...

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    • This IS dedicated to AJW! As I posted on FB, I began to write this in the fall/winter of last year, but by then you'd moved up the ladder from foot to knee issues! Here's for next time. :)

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  • I was surprised when Iron Mike (Wardian) came down with mild PF this year, and then of course he got the stress fracture. I thought the man was invincible. But it just shows...if you stress the body and "go for it", noone is safe. I am not even half the runner Mike is, but when I trained for my first 100 miler, PF was the result. Too much pounding, too many hills, not enough rest. It was a real painful lesson. Thanks for another great article Olive Oil J...

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  • btw.. my own PF experience lead to a stress fracture as well. I kept running through it for about a month and was compensating with my other foot ==> stress fracture in the other foot. Lesson for sure! :(

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  • Joe, your articles are always so wonderful and helpful, I hope you put them all together in a book some time soon, please! :)

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    • Thanks, Lucy! Maybe I'll co-write with accomplished author/publisher, Bryon Powell! :)

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  • Great info, and the pictures are super helpful, but......as a yoga instructor (who also runs), I think it's important to include information about PREVENTION of things like PF, not just the typical American response of "what to do AFTER you get ailment X". Yoga practices often include foot exercises that can help PREVENT PF-type problems, and I would always recommend a yoga practice to supplement runners' regular mileage. (Heated Power Vinyasa, in particular, is uniquely suited to runners and their needs.)

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    • Excellent point, Erin. I'm a huge proponent of Yoga for many reasons. Other comprehensive prevention things could include small amounts of barefoot jogging (even on the order of 1-2 minutes after a run, twice a week), or simply wearing different shoes. Because of my high volume of training, I will frequently roll my feet with a tennis ball in the morning, in addition to performing the ROM exercises listed above.

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  • i often get problems in my knee that are more pronounced than the "other" problems i feel. these "other" problems, however, are consistently there and are most likely the issues that cause me to change my gait. these issues seem to relate to nerves, as it's slight pain that moves around (could be joint stuff too, i guess, based on what you wrote) and weakness in parts of my foot, with sensations that run into the ankle and up the calf. so it would seem my gait is off to begin with. can one run through these types of problems and solve them with better biomechanics? i'll certainly try. wish i knew what it was about my foot strike (etc) that was causing it though.

    regardless, great article (once again). very informative, through and clear.

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    • For a runner with multi-joint issues and symptoms, I would look proximally to what is going on at the trunk/pelvis: are you strong and efficient in this area? If not, the rest of the leg might be lacking strength and stability, causing a myriad of issues that you describe.

      A thorough examination that includes gait analysis and strength/ROM through the trunk and pelvis would be helpful!

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  • Liquid Gold, OOJ.

    I wanted to say, having decreased range of motion/mobility in the ankle led to the only stress fracture I have ever had. The decrease in ROM, coupled with running on off camber trails with poor flexibility in my calves and hamstrings, led to a severe stress reaction/fracture in my heel. The pain felt like severe PF, without the arch tightness or locked up midfoot. I had the signs/symptoms for a couple of years leading up to this in the form of recurring achilles tendonitis.

    I do the wall stretch daily to work on my dorsiflexion and I struggle to keep it above 20 degrees. I also do a lot of work on keeping my posterior tibs healthy, as a tight joint puts additional stress upon them. My lesson? Don't let it get this bad before you address this issues. Great article!

    MB

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  • Great article, really enjoyable. I seem to be succumbing to PF, have a similar problem to one mentioned above where getting out of bed hurts like hell, but once I move around a bit it gets better. Strangely my knees are now causing me problems, I wonder if this could be linked to running style issues (think: the bells, the bells) caused by the sore feet?. I've started a routine of stretching, cross training and strength training in addition to running, hoping that will help? Cheers, Nick

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    • Nick-

      Stretch, x-train and strength can help bolster your tissue tolerance and increase the margin of error IF there are any gait issues. Stay tuned for next month when we go over some simple form drills that might help both your knees and feet.

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  • You didn't write about tendonitis in the ankle, like posterial tibial tendonitis or Achilles tendonitis. Any suggestions on causes and treatment for them?

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  • Since the trunk and pelvis were mentioned, it reminds me of ab or core work. I recall a cross country friend in college, Div. 1A, always on the floor doing ab work. If you went to visit her - she'd slowly and casually make her way to the floor and socialize while doing crunches. It almost went unnoticed along with the fact that she always carried around a bag of food. She is diabetic and likely needed the food but also needed it for the calories, of course (@ 70 miles a week).

    I mention ab work because - although it may go without saying - among this crowd, ab work seems to free up my lower body to do as it pleases. I recall times of feeling heavy on my feet when I began ultras. My feet were having to run and balance all the while controlling my upper body. After much ab work, I find that my feet are sort of liberated to have fun and maneuver.

    There are definitely yoga poses for the abdominals - leg lifts and resting on forearms, etcs.

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