What to Do About Foot Pain From Running

I’m training for a 3.5-mile race in September. I’ve run several marathons and half marathons in the past, but for the last year I had only been running about five miles a week until the beginning of July when I started training for this race. Last week, towards the end of a fast training run, I thought to myself “ya know, if I took fewer steps to go the same distance, I’d probably expend less energy.” Then I felt a sharp pain on the arch of my left foot. Naturally, I finished my run as planned and limped home. The pain eased, but was worse the next morning, before easing again. What’s my problem?

The internet says this is a textbook case of plantar fasciitis. Runner’s World, liberally quoting sports doctor Jordan Metzl, says that abruptly increasing mileage or speed work, running without stretching your calves, or taking strides that are too long – all of which I’ve done in the last six weeks – damages the tendon between your heel and the base of your toes. When you lie down to sleep and take pressure off your feet, your body starts to heal the damage, somehow causing more pain when you first step on your feet in the morning. The Mayo Clinic says being over 40 is a risk factor for plantar fasciitis, so I guess I’ve aged terribly.

Now that I know what I have, what should I do about it? I guess I’ll be more conservative with my speed work. Intervals make me feel like I’m going to puke anyway, so you don’t have to tell me twice. What else? The Mayo Clinic suggests “ice massage,” rolling a paper cup of ice on the bottom of your foot for five minutes, three or four times a day. My office mates will love that.

I’m especially interested in recommendations about stretching, because in the past I’ve heard that stretching before running either doesn’t help or might even be bad for you. This Metzl fellow from Runner’s World recommends the following stretches:

Achilles Tendon Stretch: Stand with [one] foot behind the [other] one. Point the toes of your back foot toward the heel of your front foot and lean into a wall. Bend your front knee and keep your back knee straight, heel firmly planted on the floor. Hold for 10 seconds. Repeat.

Plantar Fascia Stretch: Sit down, and place [one] foot…across your knee. Using your hand on [that] side…pull your toes back toward your shin until you feel a stretch in your arch. Run your thumb along your foot—you should feel tension. Hold for 10 seconds. Repeat.

Is there actual research behind these recommendations? Dr. M doesn’t say. This nice paper, which includes helpful photos of the stretches, compared calf stretches to foot stretches in an 8-week 100-person randomized controlled trial. People in both groups reported being better off than when they started, but the people in the foot-stretching group felt they benefited more than people in the leg-stretching group. I’ll do both.

For a more extreme measure, this blog cites four RCTs that found night splints are useful for plantar fasciitis. This 2014 Clinical Practice Guideline from the American Physical Therapy Association also recommends night splints. I’ll splurge and spend $20 on a night splint.

For my future self, my treatment plan is the following:

  • Ice massage after runs
  • Stretch your calves and feet every day
  • Get a night splint or Strassburg sock
  • Don’t increase your speed or mileage too abruptly and don’t make an effort to take long strides

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