Runners often complain about heel pain. Actually, most people have endured heel pain at some point in their lives. 40% of all visits to U.S. podiatrists are due to heel pain. Of all the different causes of heel pain, the majority is due to a condition known as plantar fasciitis, which is an inflammation in the band of tissue, known as the plantar fascia, that runs from the heel to the toes. Plantar faciitis is most often caused by a tight Achilles tendon or poor foot structure, such as overly flat feet or high arches. Wearing non-supportive footwear on hard surfaces, spending long hours on your feet, and obesity are also causes of plantar faciitis.

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. Each consecutive step may hurt less and less as even more fluid is pushed away from the space around the nerve. Once you get moving, the pain then usually subsides. Once you go to sleep the whole cycle begins again.

Plantar fasciitis is a combination of two separate problems. If your Achilles tendon is too tight, that leads to abnormal tension on the plantar fascia when you run or walk. 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.

The main question I get from patients about treating plantar fasciitis is "will I need surgery?" The answer to this is almost certainly not. Most heel pain sufferers could 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 2007 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.

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 plantar fasciitis, the 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 morning and evening. This will only take 1 minute in the morning and 1 minute at night.

Stand upright one large pace away from the wall with your feet parallel and about hip width apart. Place your hands against the wall, at shoulder height. Move your right leg half a pace forward. Try lunging forward on your right leg so that the knee is aligned over 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.

Icing your heel will 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 or wear flip-flops. 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 custom orthotics, or over-the-counter inserts, wear them in your shoes at all times. The majority of people with plantar fasciitis improve tremendously after just 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!

1.) Not Drinking Water During the Workout

My girlfriend is guilty of this. I notice that when we do our cardio training together, she never sips her water. The bottle just lays in its little cubby-hole on the cardio console and she gulps it down at the end. Did you hear what I said? I said she GULPS it down at the end of the cardio session. Hydration is so important, especially during strenuous physical activity, that even a 2% loss in hydration will affect performance. Dehydration, combined with strenuous exercise, creates an environment of not only physical, but mental stress. How does mental stress affect your performance? If you “feel” that you are over-exerting yourself, chances are you will not increase the level on your treadmill, crosstrainer, bike, or stepper. Chances are as performance decreases, so will your drive to increase the power outage that you may be capable of doing. Hence, steady state cardio work prevails…

The lesson here? Take sips throughout your cardio session every other minute. There are various physical signs that you are beginning to experience dehydration during exercise: 1.) you cannot keep posture and composure during cardio exercise, 2.) your cheeks and face become rosey red and flushed, 3.) you do not sweat normally.

2.) Doing the Same Cardio Machine Day After Day

I know why we all do this. We get good at what we started out doing! Just think 6 weeks ago, you thought level 5 on the elliptical trainer was impossible. Now you are continuously jumping up to level 7 with no difficulty whatsoever. That is a great accomplishment for the standard sedentary individual who has finally adapted daily exercise into their lives and has made some improvements in body composition and overall health. BUT…for the typical hardgainer, this is a carnival merry-go-round. Typically, we need to feel successful to justify the work we put into improving our bodies, increasing strength, or losing fat. I have always said that “success breeds success”. So psychologically, when we “get good” on a particular type of cardiovascular activity (i.e. running, elliptical, rowing, stepper, etc), we tend to believe that we have reached a pinnacle in our training. That’s not a bad thing. But again, for the hardgainer, this can be a vicious cycle of nothingness. This cycle is a result of the body’s specific adaptation to imposed demands (SAID) principle. The hardest exercise becomes easier the better we get at it. Therefore, the better we are at it, the more efficient we become at that particular activity. The more efficient we become at the activity, the less calories we burn. (Read that again if you do not understand) Oh yea…forget the little calorie counter that pops up on the screen. It’s based on total weight and keeps going even when you step on the sides of the treadmill.

3.) Steady State Cardio

We all heard how this one is a waste of time. Let me explain how it is a waste of time in regards to fat loss. The body uses 3 sources of energy to sustain ATP (adenosine tri-phosphate) production. ATP is the body’s end-all, be-all source of energy. In order for the body to live, it must continuously produce ATP. Well, it does this in 3 ways. Our immediate source of energy production comes from creatine phosphate (CP), where a creatine molecule is donated to ADP (adenosine di-phosphate) to create ATP. This action is anaerobic and requires only creatine which the body supplies or is obtained from meats. This immediate source of energy lasts only around 5 seconds and is primarily used for power. The second source of energy is glycolosis—the breaking down of sugars to produce ATP. This process is also anaerobic and lasts usually 3 to 5 minutes. Glycolysis refers to the body using glycogen (stored sugar) in blood and muscles to continuously make ATP. This process is the one we usually exercise in. The third and often never tapped into is oxidative phosphorilization. This process is aerobic and calls upon oxygen to aid in mobilizing fat cells to be used as energy. This process allows the body to last longer in endurance type bouts or high intense bouts of exercise. So…how does this correlate with steady state exercise? Easy. When we perform 30 minutes of walking, we never step out of glycolosis as our primary source of ATP production (energy). We are simply burning off the sugars of foods we have eaten in the last 24-48 hours. We never try to sprint on the treadmill, pick the higher level on the ellipticals, or take a spinning class…we basically do what we have been taught or what comes easiest. This has been my argument in regards to watching TV while doing cardio. If your goal is fat loss, you can try the steady state stuff for a while, but when your cardiovascular system improves and your diet is better, then you need to work harder to expedite oxidative phosphorilization. This fat mobilizing process is also known as EPOC (Excessive Post- Exercise Oxygen Consumption). In simple terms it means that the body continues to mobilize fat as fuel for up to 1 hour after an intense bout of cardio (180+ bpm).

4.) Scared to Do Cardio Before Weights

This is an old bodybuilder’s myth that started way back when. Why do we think cardio (the right kind—not steady state) will cause muscle loss? It is okay to perform your cardio BEFORE your strength training—even if your goal is hypertrophy or strength. Why? Because if you follow the proper food intake and understand the amount of calories you need to sustain lean body mass, than intense bouts of cardio (defined as above 180+ bpm, short duration (12-15minutes)) will actually promote muscle gain. The real fear should come from figuring out the total amount of calories you ingested for a 24 hour period. This is what I used to tell my clients…ever see a sprinter? Ever see how muscular they are?

Doing your cardio first and then performing strength training can lead to the EPOC phenomenon that I mentioned above. Of course, this is dependent on your intensity, rep schemes, rest periods, and fitness level.

5.) Old Sneakers

There is no doubt in my mind that 70% of foot and knee problems come from poor or old sneakers. How many times have you seen gym-goers running on the treadmill with old, beat-up sneakers with grass stains, and cracks all over the “p-leather”? I mean, those sneakers are used for Saturday morning lawn mowing and then taken to the gym to perform your 30 minutes cardio routine? C’mon….

In the last 4 years, every client that I met that had old sneakers evidenced by the condition, wear of soles, and or “lack of bounce”, I had them purchase new ones. I would not start their training program until they came to me with new sneakers. Period. An you know what happened? Knee pain disappeared…foot pain disappeared…and clients didn’t cut cardio out of their workouts. They felt better running or doing inclines. You know that pain you feel on the elliptical in your foot? It disappeared with a brand new pair of Addidas. How does sneaker condition affect lower body function? If your soles are worn, or your have pronated or supinated ankles, chances are your foot strike is not optimal on hard surfaces or a treadmill. What this does is create dysfunction at the ankle joint (usually due to dynamic instability) and weak/tight peroneals and tibialis (ankle muscles). This kinetic chain dysfunction travels up to the next joint, which is the knee and then the hip and causes undo stress on the lower back and entire spinal column. This is another reason why people skip out on cardio or like the steady state easy stuff—because their feet can’t handle it! Besides, a new pair of sneakers gives people the sense of starting something new and committing to a fitness program.

Runner’s Question: Okay, so, I’m working for a 300 for my PT test (army) and the only thing holding me back is my run. I have a couple questions however.

Would whey protein help if i take it after a run? I know it it for primarily for muscle mass but im wondering if it would help with the muscle recovery for the next run as well as improve the primary muscles used via running.

Also my question about glucosamine/MSM. Im running pretty much 4 times a week on legs that have both been broken throughout my life. (amongst other beatings on them)… I am noticing pain more and more lately in my knees as well as a crackling noise when i sit/kneel. Would glucosamine/MSM help with that or is that basically a “placebo” drug?

Thanks for and answers and i apoligize for the long question(s)

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