Plantar fasciitis is a common yet often misunderstood injury that affects many runners. Characterized by pain in the heel and arch of the foot, this condition can significantly impact your running routine and overall performance. In our latest episode of the Movaia Running Podcast, host and Movaia founder Thomas Butter and expert physiotherapist and coach JP Gloria dive deep into what plantar fasciitis is, how to recognize its symptoms, and most importantly, how to prevent and manage it effectively.

Whether you’re a seasoned runner or just starting, understanding this condition can help you maintain your training and keep you on the road.

Listen to the Podcast

You can catch our latest episode on your preferred platform:

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Full Podcast Episode

In this episode, Thomas and JP discuss:

• Understanding Plantar Fasciitis: “Plantars fasciitis with the ending being ‘itis’ assumes inflammation. A lot of times, it’s actually more of a degenerative condition.”
• Symptoms and Risk Factors: “Typically characterized by arch pain, especially when you wake up in the morning and take your first few steps.”
• Prevention and Treatment: “Getting comfortable with being barefoot or doing some intrinsic foot strengthening exercises can be really helpful.”
• When to Seek Help: “You should probably see a professional when you start feeling pain consistently for a number of weeks.”

Key Takeaways

• Early Recognition: Identifying the symptoms early can help prevent long-term issues.
• Strengthening: Incorporating foot strengthening exercises is crucial for prevention.
• Professional Guidance: Don’t wait until the pain becomes unbearable; consult a professional early on.

Verbatim Quotes:

• “A lot of runners are very good at enduring things… but when you get to the point of feeling that pain consistently, it’s time to see a professional.”
• “Just because you have plantar fasciitis doesn’t mean you have to stop running. I try to keep runners running as much as possible.”

Conclusion

Don’t let plantar fasciitis sideline your passion for running. Tune in to our latest episode for expert insights and practical tips to manage and prevent this common injury.

For more information and resources, visit Movaia.com for your own running form video analysis to identify risk factors related to your running technique.

Listen or watch now

Your feet deserve the best care, and understanding how to prevent injuries like plantar fasciitis is the first step toward a healthier running journey!

Further resources

Go her for more on plantar fasciitis and videos of exercises to prevent plantar fasciitis:

⁠https://movaia.com/the-ultimate-guide-to-plantar-fasciitis-for-runners/⁠

Get your own running form analysis to see if running form could be a reason for knee pain: ⁠⁠https://movaia.com⁠⁠

More from DPT JP Gloria: Youtube: ⁠⁠ @JPGloria ⁠⁠ Instagram: ⁠⁠jpgloria.dpt⁠⁠

Transcript

And here’s the full transcript:

Thomas Butter (00:07)
Hello everyone, welcome to another episode of the Movaia Running Podcast where we discuss all things running and running form. And as usual, my guest today is physiotherapist, running form expert and coach JP Gloria. Hi JP.

JP (00:24)
Hi, nice to see you.

Introduction to Plantar Fasciitis

Thomas Butter (00:26)
Today we will be discussing the foe of many runners, plantar fasciitis, a very common running injury. And we’re going to cover it all from what it is to what to do when you have it and how to avoid getting it in the first place. JP, when we talk about plantar fasciitis,

Number one, how do you pronounce it correctly? Number two, what is it?

JP (00:49)
Well, you could call it plantar fasciitis, what I typically call it or what’s more proper would be plantar fasciopathy. You know plantar fasciitis with the ending being itis assumes inflammation. But a lot of times especially with the plantar fascia, it’s more of a degenerative condition. So actually there’s no inflammatory marker.

How is it typically characterized? Typically characterized by, that arch pain, but closer to the heel area of the foot. And typically people most notably feel that, you know, when they wake up in the morning and they take their first few steps and those are usually when it’s most painful.

Thomas Butter (01:25)
Why do we need a plantar fascia? What does it do? Couldn’t I go through life without it?

JP (01:30)
Plantar fascia is an interesting area. Similar to tendons, it’s responsible for energy storage and release. We have that big toe, right? We have that big toe and when it bends, it ends up…

causing a little bit of a stretch to the plantar fascia. We call that the windlass mechanism. So now it’s tightening up that area and it’s storing energy. Then during the moment of propulsion, it’s able to release that energy, therefore helping us move forward.

I think there was a research study on this where it can involve three times body weight when you run. So it basically stores a tremendous amount of load and it’s able to release it to help us move forward.

Thomas Butter (02:08)
And during that movement, so when I do have a of fasciitis, that windlass mechanism is at work and how does it cause pain? How do I feel the pain?

JP (02:20)
Right, so you’re talking about the windlass mechanism itself. It causes pain because essentially it’s deforming or stretching that plantar fascia when you go through that movement. So that’s actually one of the ways we try to figure out if, whether or not you have plantar fascia or plantar fasciitis or fasciopathy is through actually having that foot go through that windlass mechanism.

So we could do that by having someone sitting and then stabilizing that ankle foot area and then bending that toe into extension.

Thomas Butter (02:49)
I’m assuming you’re doing this assessment because there could be other potential injuries that you might be mistaking for plantar fasciitis. What would those other things be and how would they present slightly differently compared to plantar fasciitis?

Diagnosing Plantar Fasciitis

JP (03:06)
My job, especially with working with injured runners is figuring out if it’s actually plantar fasciitis or fasciopathy. Because depending on what it is, you treat it differently.

There’s a lot of different conditions, but I’ll name off some common ones, specifically in adults. So the first one that I’m always cognizant of is having some form of calcaneal stress fracture. So basically a fracture around that heel region. There’s another interesting one, which I find gets mislabeled quite a bit. And actually I was working with a runner the other day who was told she had plantar fasciitis by a number of physical therapists and this pain wouldn’t go away. It actually came off as like a pain in the arch, but also like a tingling sensation. So when I reassessed her, she actually had something called Tarsal Tunnel Syndrome.

And that essentially has to do with the nerve that kind of, goes around the medial malleolus, you know, around that inner ankle area, there’s like a nerve that goes through that. And if there’s some form of trapment that can actually refer pain into plantar fascia. So that’s something else to watch out for. Other things to think about also are, certain tendons that also cross the plantar fascia. So specifically the flexor hallucius longus or let’s say the Postier Tibialis Tendon. So those are also things that I’m looking for.

Thomas Butter (04:29)
So the prime test for you to decide or to indicate whether it might be plantar fasciitis is, or fasciopathy would be to put your foot in the ground and then extend your toes. I’m imagining lifting it upwards. Am I imagining this correctly? And then if that produces pain, there’s a good likelihood I might be dealing with plantar fasciitis.

JP (04:50)
Right, there’s, sensitivity ratios or likelihood ratios. But something that I just add to that is actually, we call it touching or palpating. You know, like that kind of that inner heel area, like, you know, where that fascia attaches. Because a lot of the time if it is plantar fasciitis or fasciopathy, you will have pain, you will have tenderness in that specific area.

Risk Factors and Causes

Thomas Butter (05:13)
Okay, this is a running podcast, and we know it’s common in runners. So I’m assuming running might be one risk factor, but maybe zooming out a bit. Who is getting it and why?

JP (05:29)
This is a good question. For plantar fasciitis, I think we, we do have to consider the population as you said, right? You know, the plantar fascia pain can essentially happen in both in more sedentary and active populations. And those risk factors are a little different depending on what you’re looking at. So, and let’s say in the more sedentary population, increased risk factors would be increased waist circumference or increased BMI.

Also there’s a thing on like metabolic health as well. Looking at the other side of things, for the active population, it typically is considered more of an overuse type of thing going on. And some of the things that we look for in that aspect is training.

So things that I think about is increase in training loads, The foot strike can affect things as well. So having more of a forefoot strike and having more of a usage of let’s say minimalist shoes can also impact this as well.

Thomas Butter (06:27)
Okay, so we discussed increased training load, so suddenly running a lot further or maybe a lot harder than you’re used to, more of a forefoot strike and minimalist shoes. Is that because they tend to have less of a toe-to-heel drop or is this due to other factors? Or is it less arch support?

JP (06:45)
Yeah.

I mean, it’s like a combination of things with this one. Something that I consider especially in rehab is that if you want to work the plantar fascia or any of intrinsic foot muscles, you want to have your shoe off ideally or have more of a minimalist shoe. However, if that area is strained or irritated and we need to get it to calm down, perhaps we should keep the shoes on initially and use maybe a little bit of an orthosis, especially if it’s very flared up.

Thomas Butter (07:13)
So if you wear a minimalist shoe and you’re not having issues, it probably helps you to avoid plantar fasciitis because you’re building those muscles. But if you have it or at risk for it, then it’s actually a bad thing because you don’t get that support which might help you to overcome it. Is that a way to think about it or am I getting it wrong?

JP (07:32)
Yeah, I mean that is way to think about it. Wearing minimalist or barefoot shoes or walking around barefoot can be helpful to help build up the capacity of the plantar fascia. However, if it’s irritated, perhaps you should not force yourself to like go barefoot despite what because people always talk about, oh, go barefoot. And I think there’s a time and place for all of that.

Prevention Strategies

Thomas Butter (07:55)
So maybe that’s a good bridge into how can I avoid plantar fasciitis? I’m assuming it would then have to do with trying to strengthen those foot muscles and how would I go about it or are there other strategies I could also use?

JP (08:13)
I mean, the thing with like any type of injury prevention type research is it gets very like muddy and murky. However, we could think of things as building capacity. So perhaps, what I like to think about is, maybe getting comfortable with being barefoot or doing some intrinsic foot strengthening exercises. I think that can be really helpful or exercises that bias that plantar fascia or load that plantar fascia. Because initially for short-term release relief, you know, a foot orthosis can be really helpful.

Right? Because they could put it in a way where it reduces the amount of strain that plantar fascia works. And again, I think researchers said that’s effective up to like a year. However, I’ve seen plenty of people that have been wearing their foot orthoses for like ever since they were like 10 years old or 12 years old, they’ve had it for like 20 years.

As long as they’re not dealing with too much pain in the area, I want to work on taking out that orthosis and start building up that plantar fascia so it has the capacity to work for itself.

Managing Existing Pain

Thomas Butter (09:12)
Makes sense. Okay, let’s go right into the scenario where we’re already dealing with plantar fasciitis. I’m assuming there’s maybe a point just before the point of no return, when I’m feeling the first niggles, what would I do then? And when is the time to actually go and get professional help.

JP (09:34)
I mean, the reason these injuries happen is just you push a little too much. Usually you already noticed the achiness or pain and then it just puts it one step forward. A lot of this ends up being not really listening to your body. Cause the clients that I see for plantar fasciitis they’ve had that pain, you know, they’re running.

You know, they’re getting usually training for a race or, they’re getting ready for this marathon or getting ready for this Ironman. And they go from like not doing too much training to now doing quite a bit of it because of the demands of being ready for that race But along the way maybe you start noticing achiness in the foot and you know what? That’s normal.

When to Seek Professional Help

Right? If you feel it and then it goes away, you know, that’s fine. Something I always mention with runners or just athletes in general is we get too caught up in the numbers that we neglect how we feel during those things. So we focus on the quantity, like, you know, how many miles we ran or what’s the pace we’re running. And we don’t really spend as much time thinking about like how did that feel when I ran or how is this area feeling as I’m running or even after I’m running? Because again, these things are more of an overuse. It’s usually more of a gradual onset of things. Things just get more sore. You’re noticing, I’m getting up in the morning, my arches are a little bit sore, but I could still walk. But the thing is it’s like, I’m gonna go continue progressing on my training routine because that training program online said. And then now that arch pain starts to get worse. Now they’re noticing that pain not just when they’re waking up, but now they’re noticing it when they’re running. But again, you keep trying to stick to that program because you want to do really well in this next Ironman marathon or whatever race is coming.

So then you keep pushing and then you realize, actually now it doesn’t not only hurt when I get up and you know, don’t not only feel soreness when I get up in the morning, not only do I feel soreness when I’m running, but I also now feel soreness when I’m walking. Because essentially just putting on that weight on that leg you know, it stretches that plantar fascia a little bit, but if it’s really irritated, it could hurt at that point. And that’s really frustrating. mentioned when should you see physical therapy? You should probably see physical therapy way before that. A lot of runners are very good at enduring things. That’s why we’re called endurance athletes. Typically wait until they can’t walk, essentially. But I would say, when you get to the point of feeling that pain consistently for a number of weeks you know, for let’s say one, two weeks consistently already when you’re running, you should probably see a professional to help adjust the plan.

Thomas Butter (11:59)
Before that, don’t blindly follow your plan, maybe scale down the volume a bit or the intensity. Is there anything else I can do? Is there a role for stretching or is the main thing to think about modifying the training load?

Treatment Options and Interventions

JP (12:16)
I mean, stretching can help with the tightness, typically that’s more short-term relief. I would say, you know, talking about the orthoses again, that would be helpful for short-term relief. Should we completely get rid of them?

Not necessarily. I know a number of runners, especially when we’re let’s say getting them ready for a race in particular, especially with like things that require a lot of time on feet, like an ultra marathon Sometimes during those peak weeks when they’re, doing like, 50, 60, 70 plus miles a week.

Maybe they’re getting arch pain, maybe an orthosis can be helpful initially for that, but it shouldn’t be something you rely on. Other things that a lot of runners ask me about is cortico steroid shots like an injection in the area because that’s a popular intervention for plantar fascia. However, I have a few thoughts on that.

Specifically, we have to be very careful with that. Now it depends on the population. Remember the beginning of the session, I talked about two different populations. You have one that’s sedentary and one that’s active, like your running population. It seems like with more of the sedentary population, the cortico steroid, the injection can be quite helpful.

However, when it comes to runners, we have to be very careful about plantar fascial ruptures. So the fascia actually rupturing. What that injection does is while it helps with the pain, it can weaken the structure around there. And a lot of times when these ruptures do happen, it’s typically as a result of you know, they have the plantar fasciitis, they get the injection, the pain’s gone. So they decide to go back into their training program. And that injection is just masking the pain, right? And that pain’s important because it tells us how to respond appropriately to our body. And now they continue running and that’s how the rupture happens. So typically when someone has an injection, I wait a number of weeks, it depends on the person, but I might not have them run for two to four weeks initially. I’ll have them do other things bit more lighter, that don’t require as much weight bearing, but that’s just something to consider, especially with injections.

Thomas Butter (14:21)
I think the injection is already on the more intensive range of interventions. What would it typically start with? So, okay, someone has had these niggles for a while, they’ve maybe modified the load, it hasn’t been really working, now they come and see you.

What would be some things you would typically do or tell them to do as you try to bring them back to running?

Running with Plantar Fasciitis

JP (14:46)
So you know besides the big things, right because everyone talks. what do you do for plantar fascia? you know decrease the mileage, you know Fix your training years. Let’s say but you know, that’s all individualistic But in terms of the details, what can we do besides those things? Right?

We talked about the foot strike, right? Yeah, if you land a little more on that forefoot area, that puts a lot more strain on that area. So perhaps we should modify to more of a mid-foot landing and that might help with the pain. Another detail that we could consider is the shoe itself. So…

we talked about, guess, heel to toe drop. Maybe you want a little bit of a higher heel because, you know, because those zero drop shoes or barefoot shoes, like they put you more onto a forefoot. So that’s something to consider. But the thing that I’m thinking about particularly is the geometry of the shoe, finding more rocker shaped shoes. Cause you have a more of a rocker shaped shoe, basically it will reduce the amount of work that plantar fascia has to do. So that can be helpful in the case when it’s irritated and can offload that area so you can continue running. I mean, we could talk about cadence. That’s a popular topic.

Cadence is just an interesting, I get like mixed results with cadence, particularly with plantar fascia. I think the the common tip or advice is to increase your cadence by five to 10 % to reduce loads on the plantar fascia. Now you can change your cadence and you could, and for certain people, find that it helps, but

I do have a little bit of a problem with saying that increasing your cadence decreases loading on the plantar fascia. Because if we manipulate the cadence and there’s research on this, you’ll find that when you increase your cadence by let’s say five to 10%, you’ll see that most of those changes or reductions in loading don’t actually happen around the ankle foot area. It actually happens more so around the knee hip area.

And actually in certain cases, when you increase your cadence by 10 to 15%, you could look at the research on there from, I believe, Heiderscheit you’ll see that there actually is an increase in loading around the ankle region. So if increasing your cadence helps, great. But I wouldn’t say that increasing your cadence would necessarily decrease loading on that area per se. Yeah.

Thomas Butter (17:12)
So running form wise, check your running form, which of course you could do with Movaia.com which we encourage you to do. If it’s much of a forefoot landing, then see if you can go more towards a midfoot landing. Cadence is a bit more experimental, see if it works for you, but that might not be the right intervention for you and might not work that well as a change in foot strike.

So, from a training load perspective, the fundamental question, if you have plantar fasciitis, can you actually keep running?

JP (17:44)
my rule of thumb, or at least I try to do for most runners is just because you have plantar fasciitis doesn’t mean you have to stop running. I actually, try to keep runners running as much as possible. However, if you already get sharp pain when you’re walking, maybe running isn’t the best idea at that point.

Thomas Butter (18:05)
Let’s talk about some criteria that you would use and different treatment phases.

JP (18:12)
I’m not really timeline based unless it comes to the corticosteroid, you know, the injection, then I’m a little bit more timeline based before we start running again, just because I want to reduce the risk of any type of rupture of the plantar fascia. But I am very criteria based.

Navigating Plantar Fasciitis: A Case Study

JP (18:28)
I had a client referred to me you know, there’s a triathlete that does Ironmans and he referred his friend to come see me because it was like eight weeks.

Essentially we didn’t have that much time. before Ironman California and this person, you know, he’s done the injection. He’s gotten the compression socks. He’s done the stretching. He’s gotten the devices for that. He’s gotten laser and it’s now eight weeks before Ironman California and he could barely take a step. He gets a sharp pain in his foot the moment he walks for like two minutes. But somehow in two months, he has to get ready to do a full IronMan, which includes, you know, the 26.2 mile run at the end. So how did we have to navigate that? The first thing that I always want to do is I want to calm that thing down, because right now for him, he has pain with running, but he also has pain with walking.

Let’s not even worry about running right now because every time you run it just gets worse But right now you can’t even walk so let’s focus on calming things down so you could walk again So We did include the you know the usage of an orthosis. We did talk about the usage of a rocker shoe when he’s walking or moving So it’s not as painful when he’s not even running, but just walking around. For him, we also incorporated foot strengthening exercises. We started with foot strengthening exercises like your toe yoga, working the big toe, your foot, your toe spreads, the short foot exercise.

We did still work on strengthening all the other parts of the body too. So we did do general strength, all the whole body essentially, especially as an Ironman, So let’s say we did those, it started coming down. Now it was at the point where, Okay, he doesn’t have that much pain with walking and let’s just say now he got better. He got to the point where, you know, I continued his swimming and cycling because that didn’t bother him. So there was a lot of things he could do too. It’s not that he just rested, but now he’s at a point where, walking doesn’t feel as bad. Like it doesn’t, you know, it’s like a little bit of discomfort. Um, but now we could hop on one leg and it’s not really painful. So now we were transitioning into more capacity related stuff, right? So further building strength. So we could do more planar plantar fascia based exercises.

Remember I talked about that big toe that Windlass mechanism? Essentially, we could use that to our advantage by putting that toe in an extended position when you do something like a heel raise, because actually there’s some evidence to show that, loaded plantar fascia exercises are really helpful for managing plantar fasciitis. So we started incorporating more specific strengthening of the plantar fascia, and we did it loaded and we started moving toward heavy resistance training. Obviously, as he got back into running, we were really mindful with how we approached it.

I try not to change things unless it really mattered, unless it really helps. It actually didn’t make a difference whether I changed his foot strike in his particular case, but there were a number of things that other things we cared about, right? We did more run walks to make sure that we eased into running appropriately. We talked about, we were using the rocker shoes for the running as well, but we avoided hills, particularly uphill. Because if you think about uphill, that’ll actually put that toe into an extended position and that would actually stress the plantar fascia a little bit more. And eventually, what can I say? Like, it’s all, you keep progressing things. We do it based off how he feels. It’s not all linear, right?

I think that’s something to know about rehab, especially for plantar fasciitis is there’s ups and downs and we just have to navigate it appropriately. But guess what? You know, with that plan of just consistently building it up and navigating the highs and the lows, we came up with a plan to run Ironman California. Like people think, just run, you know, just do the whole thing. But we did come up with a run plan where we incorporated run walks, we incorporated something where, you know, he’d run for essentially each aid station and then walk for like 60 seconds and then repeat that. And guess what? He actually, I was watching, you know, he was able to finish it in his goal time.

I mean, he just wanted to finish, but he still finished in his goal time. And honestly, I think the most important thing is there was pain and soreness through the whole body, but not actually directly just in the plantar fascia. And honestly, then, you know, the next few days, yeah, he wasn’t dealing with the foot pain still, even though he finished Iron Man. So that’s a little bit of a condensed version of the, of the story but I hope that was helpful in kind of understanding a little bit of the dynamics involved with applying the knowledge that we’re talking about.

Pain Management and Recovery Guidelines

Thomas Butter (23:10)
Definitely, related to that, so when you bring people back to running if they haven’t been running because it’s too inflamed, is there like a pain scale or some guidance that you give them, know, run but stop if it causes a certain threshold?

JP (23:25)
Yeah, I mean, I for every runner we need to set parameters or what I call pain guidelines. You know, if there’s a pain scale from zero being no pain to ten being the worst pain, I don’t want that pain to go past, let’s say, a four out of ten.

People have problems with Navigating, like, I don’t quite know what a four out of 10 means, but I like to just say as long as it’s discomfort and doesn’t feel like it’s aggravating. So that, that’s one intensity.

So we talked about the intensity, but the other thing specifically for plantar fascia and a lot of tendon related things is that sometimes you don’t get the pain initially, you get the pain later. And I think that’s something important to understand with the plantar fascia. So I like to say, you know, it’s normal to get some pain or soreness afterwards, but the pain should return to baseline or the increased pain should go away within 24 to 36 hours. I think that’s something important to note because sometimes, yeah, I didn’t feel the pain during the run, but my foot was sore for the next three to four days. Okay. I think we did a little too much.

Do Massages and Foam Rolling work for Plantar Fasciitis?

Thomas Butter (24:26)
So during that recovery process, is there a role for things like, massage or foam rolling, are those things that help more psychologically than they actually might help the condition?

JP (24:29)
Mm-hmm.

I do incorporate, I think there’s a place for it.

Because if anyone’s had, if you’ve ever had plantar fasciitis or plantar fasciopathy, it’s painful. So, you know, people say, it just helps with pain. No, but if it could help with pain, that’s really nice. So I think there is a place with foam rolling. You know, I say foam roll the calves. You could use a ball or, you know, like an ice bottle and you rub it on the plantar fascia. Now, what I like to say though, is that’s really good at calming it down. And that can be really helpful in the early stages of rehab when you’re trying to get someone back to running. But the big thing we need to do is to not only calm it down, but also get that person ready to run. I think people think, I run to get fit, but no, you need to be able to handle the demands of running.

So you need to also be fit to run as well.

Thomas Butter (25:32)
And that fit to run, those are the strengthening exercises that you mentioned earlier.

The value of strength exercises for plantar fasciitis

JP (25:37)
I think the issue with planar fascia is because I see a number of people, You know, they’ve had PT before if they’ve done, you know some form of rehab, you know I the biggest issue is not rehabbing it all the way Like I think when people think of strengthening the foot You know, we just mentioned those exercises right the toe grabs or maybe you do toe yoga or you know short lever or whatever but that’s only the starting point. That’s like early stage rehab. I’m talking about like, you should be comfortable with heavy resistance training. Like I really do work people into utilizing weights let’s say we do a heel raise, I put people, let’s say under the barbell, like in a squat rack, I’m doing supported, you know, doing heel raises, single leg heel raises.

but maybe with the big toe extended so it works that area more. Obviously we work up to that, but it is important to progressively build up the area, even beyond when the pain is gone. Like even when you don’t get that sharp pain anymore, that’s not the time when you stop working it, you really need to keep on doing it.

That’s just something I bring up because I feel like a lot of times people stop doing the exercise too soon or they just give up too soon too. Cause I think something that we didn’t, you know, touch on is, navigating plantar fasciitis or fasciopathy does take time. You know, I mean, obviously everyone’s timeline is different. I know I’m very objective based, but you know, it could take four weeks, but it could easily take up to like six months. Or honestly, for some people years. But I would say maybe less time when you’re navigating it properly.

Thomas Butter (27:17)
Yeah, and I guess if you’re not doing these exercises to properly rehabilitate it, there’s also a risk of it coming back, which is quite frustrating as a runner.

JP (27:27)
Yeah, I mean, that’s kind of thing. Like, you know, the, what is it? The, the, of the number one predictors for injury is having a previous injury in that area. I think I mentioned this before, is there as high demands on the body specifically that plantar fascia. I think there is a research study by like Virginia Giddings and her colleagues where they saw like three times body weight was imparted on that area while running. So we can’t really take the avoidance strategy. We instead need to take more of that restorative strategy that we’re talking about. That’s why I find that, when people get injured with running, what do they end up doing? When they kind of give up, they end up just going to cycling. So they completely give up on running because it hurts.

But I would say, you know, to build appropriate fitness or longevity, sure, you don’t always have to run, but you want to make that choice for yourself, not because you can’t necessarily do it. But again, you could take that avoidant approach, but I find that that only works for so long. And instead take that restorative, that we were talking about, like really building up the strength around, you know, building up the strength around the foot. Challenging the foot, you know what, hill work while it might irritate in the beginning, I think that would help create a more robust foot when running. Those are just my thoughts. you know, going further than that, it’s like, sure, I said in the beginning, like maybe if you have plantar fascia pain, maybe it might not be the greatest to wear like a zero drop shoe or more of a barefoot or minimalist shoe. But you know, to build longevity as a runner, you should be able to run in those shoes, or any other shoes without issues. Because something that we’ve talked about with shoes before is that it’s not necessarily a low drop shoe or a high drop shoe or a carbon plated shoe or not that reduces injuries. None is better than the other, but rather it’s a combination of being able to use multiple pairs of shoes, that seemed to correlate with the lower risk of injury.

Thomas Butter (29:26)
Now, there are some more maybe exotic treatment periods that you can read about like boots that look a bit like ancient torture instruments that I think pull your toe while you’re sleeping, there is also shock wave therapy, Any thoughts on these methods or any other ones that come to your mind?

JP (29:48)
Yeah, I mean the boot is a popular one. You know, we’re talking about runners, but you know, for certain runners it can help, but I find maybe it’s more so helpful for maybe on the sedentary group that I mentioned before. thing with the boot is I find that people are highly non-compliant.

With the boot, they always end up taking it off. So it doesn’t seem like it’s helpful. So it means well, because essentially it’s keeping that foot like in that kind of stretch position and not in that tightened position, which would be nice if it was kept on. But again, that doesn’t really treat the root of the issue. That’s more so to help calm it down. So maybe, you know, when you wake up in the morning, it’s already in that stretch position. So the moment you take that step, doesn’t hurt as much

But again, it doesn’t necessarily do anything to build the capacity of the foot per se. So it’s great for early stages of navigating the injury, but it’s not a means to an end, especially when we’re getting into getting back to running and running pain free.

Thomas Butter (30:49)
Do you any thoughts on shockwave therapy?

JP (30:49)
The other thing was oh, yeah,

I find shockwave therapy. I’ve seen it be helpful. I’ve seen like mixed reviews with it Again, I would imagine that it seems to be more helpful on the sedentary people. Has it been helpful with runners? I’ve seen it helpful But again, I have also seen oh it feels better when they do the shockwave temporarily and then they go out for run it still hurts so again, helpful for calming things down, but not necessarily actually, you know, creating those physiological changes of making the area more resilient.

Collaboration Between Coaches and Physiotherapists

Thomas Butter (31:29)
I mean, you’re in the luxury position, you’re both a physiotherapist, but also a coach, right? But if you’re physiotherapist and maybe you work with someone that has a coach, then I guess some of the things you would tell them are then related to training load, maybe, you know, being careful in the beginning with, letting that athlete run on hills, but maybe more later, giving them some exercises, is that the type of thing you would tell a coach or is there anything else to think about?

JP (31:56)
I would talk about all these things actually. I work with a lot of coaches I’ve worked with some professionals as well. And usually again, it’s a it’s a team right? There’s a ecosystem around the professional athlete My typical role in those scenarios is understanding the injury and how do we navigate it. And usually I talk with the coach because they typically know, let’s say that person best, right? And we usually chat about these exact things as, okay, well, based off what I see here, you know, the information I get, come up with a plan together. And yeah, it is all those things, understanding, okay, well, if it hurts, let’s say, you know, if it already hurts to walk or hop on one leg, maybe we should create a timeline to forego running for now, or really minimize running and work on more cross training at the moment that has lower impact, right?

But you know, we figure out something that combines all the things together. So we do talk about shoes. We talk about, you know, possibility of orthotics. We talk about how do we incorporate foot specific exercises in their training, in their strength training regime. yeah, so stuff like that. When do we navigate, when should we incorporate hills, especially with trail runners? know, hills are really important, especially if you have to deal with a lot of elevation.

These are all things to think about, but obviously how you approach it can be different person to person.

Thomas Butter (33:23)
One area that we have only slightly touched upon is, let’s say, warm-up, cool-down, does that play any role in the likelihood of getting plantar or in recovering from it?

The Role of Warm-Up and Cool-Down in Recovery

hJP (33:39)
I don’t know if having a specific warm up for the foot we can can we can we necessarily say that it reduces injuries or prevent it. However, it can be helpful to give more information on it. So something even post, when we’re not really dealing with the plantar fascia anymore, I will incorporate plantar fascia specific movements or warm ups more so to scan the body to see how it’s feeling.

You know, one, it warms up the plantar fascia because it does kind of act like a tendon, it helps it warm up. But two, it helps you be cognizant of how it’s feeling at that moment. Because if you’re starting to notice certain, let’s say, plantar fascia biased exercise, they’re starting to get a little bit more might be a little bit of a yellow light or a caution. We should maybe exercise caution with the training and be a little bit more mindful with what’s happening during that moment. In terms of now navigating the injury, I do incorporate specific warmups. Honestly, I’m a fan of keeping warmups as simple as possible. I think people overcomplicate a lot of warmups, but I will say especially for plantar fascia I will incorporate specific exercises for that area to help it warm up so running actually feels a little bit better and it’s less painful.

Thomas Butter (34:51)
Can you spill the beans on some of those secret warm-up exercises that you would use for someone dealing with this condition?

JP (34:57)
I like to keep them light. I’ve done things where starting with toe yoga, then we’ll do the big toe push. know, pressing the middle of the big toe down into the ground, not necessarily the tip, but what I’ll end up doing from there is I’ll have them maybe stand on one leg and do like something called passes where they move an object side to side. So that’s kind of actually making that foot state, you know, it’s kind of working the muscles around the foot, but it’s also making that arch lengthen, under stability demands. And then something I’d incorporate from there is, some light heel raises, but with the big toe elevated, so that puts the plantar fascia on stretch. We can incorporate some hopping, stuff like that, depending on where the person’s at.

I mean, they could incorporate other things for the other parts of the body, but sometimes it is that simple. So try not to overcomplicate things.

Thomas Butter (35:49)
Alright,

yeah, yeah, I think that’s always a guiding principle for you that makes a lot of sense. Are there any final thoughts that you would like to share or anything that we have not covered yet that you would still like to get in?

Final Thoughts on Resilience and Injury Prevention

JP (36:07)
You know, talking about the plantar fascia I find that people end up taking more of that avoidant route only to end up going on more of that restorative approach anyway. So that’s something. And then I guess the other thing especially with most injuries is don’t get so hung up on the quantity of things like the miles and the pace and think more about how things feel. Cause again, this thing’s more of a overuse thing that happens. It doesn’t typically happen all of a sudden. You might notice it all of a sudden, but it probably didn’t happen all of a sudden. So taking time to really reflect on your running and how things feel can be actually a pretty good approach in navigating and preventing these running injuries that happen in the first place.

Thomas Butter (36:51)
That is some very wise words, thanks a lot for that. yeah, as always, check out our blog at Movaia.com slash blog (Movaia.com/blog), where we also have more information and some exercises for plantar fasciitis. We’ll make sure to drop down JP’s socials into the show notes. And as always, if you want to know more about the running form and if it maybe is a factor for plantar fasciitis, make sure to get a running form analysis at Movaia.com

Alright, thank you a lot JP. Looking forward to our next chat. And if any of our audience has input, feedback or would like us to discuss the topic in our next podcast, then please leave us a message at community at movaia.com. Thanks a lot. Ciao JP.

JP (37:37)
Take care, bye.

Thomas Butter (37:39)
Thank you.