Jody (aka @Jodyrunssahara) is an ultrarunner and freelance journalist. He writes for Men's Running UK and founded his own site, adventurerunner.co.uk. He's kindly agreed to share his injury story with RunningPhysio. Firstly though we'll look at the back story of Jody's heel pain;
In October 2011 Jody started feeling heel pain after increasing his weekly mileage to around 40 miles per week. Jody continued running and in March 2012 the pain worsened after a punishing 15 miles on hard paths. Not deterred he kept going and ran the Isle of Wight Ultramarathon in July and the symptoms have been more constant since then.
Jody self treated with a pedi-roller, calf stretches and an orthaheel orthotic in his running shoes but symptoms remained. In late July we chatted on Twitter and I tried to persuade Jody to get his heel examined – he wasn't keen. The reason, as often is the case in runners, is he was worried a Physio would tell him to stop running. With the Transalpine multi day ultra event on the horizon in September this wasn't an option.
With a little persuasion I managed to convince Jody to come in for an assessment and saw him at the beginning of August. We took a history and examined Jody's foot and ankle. Our first aim was to rule out anything serious that might stop Jody running. In this case, our main concern was a calcaneal stress fracture (stress fracture of the heel bone). There was no evidence of this on examination and firm palpation of the heel bone caused no discomfort. He was, however, very tender over the attachment of his plantar fascia – a classic sign in plantar fasciitis (PF). His symptoms were also typical of PF – walking barefoot hurt and it felt tight first thing in the morning.
With running injuries we look to identify causes to address as well as treat symptoms. The causes in Jody's case appeared to be,
- High mileage – training for multiple ultramarathons and endurance events
- Slight overpronation on the symptomatic left side (which was different to the right foot)
- Weakness in the left calf (which Mrs Jody described as 'lady calves!')
- Reduced movement in the left big toe (decreased extension in the big toe joint but also less movement of the 'first ray')
It appeared that the overpronation, coupled with slight calf weakness and high mileage was placing a lot of stress on the plantar fascia. The stiffness around the big toe may have also caused the problem, but could have happened as a result of the PF.
Jody's treatment included;
- Continuing stretches of both calf muscles (gastrocnemius and soleus)
- Adding a specific stretch to the plantar fascia
- Manipulation of the big toe and first ray to improve flexibility
- Supportive taping to offload the plantar fascia and reduce overpronation
Further details on these treatment techniques can be found in our guide to treating plantar fasciitis.
Our initial aim was to settle symptoms as Jody's next running event, the North Downs Way 50 miler was just 9 days after our first appointment! Because of this and the Transalpine event on the horizon we discussed whether anti-inflammatories (NSAIDs) might help. There are mixed views on NSAIDs and plantar fasciitis. In theory there is little inflammation so why would NSAIDs help? However research by Digiovanni et al. 2003 combined calf stretches, plantar fascia stretches and NSAIDs and got good results so they may have a role. I gave Jody the option and he chose to try a course of NSAIDs to help settle his symptoms. We also looked at Jody's training schedule and shoe selection. He ran the NDW50 (in Hoka One Ones) with the foot taped and, in his words “didn't suffer at all during the race – only the occasional twinge”. Jody wrote about having physio for plantar fasciitis and did a cracking write up of the NDW50 on his site.
So, onto The Biggy, four weeks later Jody ran Transalpine 2012, an 8 day endurance event involving around a marathon distance each day, combined with huge climbs and leg sapping descents….here's how he got on, in his own words…
In a nutshell – it worked.Before I set off I was still having a bit of heel pain on the Friday despite the taping and the fact I was wearing the Orthaheel. I also took the anti-inflammatories right up until the evening of the last day before the race. For the first day we were on our feet and moving around quite a bit and somehow it just kept being aggravated so I was a little worried with the first stage of the race the next day. In the morning the strapping was still nice and tight, so I decided not to re-tape. As I was walking around the start I could still feel twinges and was a bit worried but as soon as we set off the pain dissipated. That was the last I felt of the pain for most of the race.
Each evening I made sure I removed the tape and re-applied it so that it would be ok overnight. (I also cut the back of my heel slightly on a bath so wrapped a piece of tape around the heel horizontally to stop the cut rubbing!). When I could I also took a cold bath quite soon after the race which did make my feet throb but nothing particularly painful to do with the heel. The substantially amount of ascent and descent didn't seem to exacerbate the issue.
There were only a couple of times when I felt the twinge of heel pain again and that was coming down after being up one of the high 2,800 metre summits on a hard stone path where I was heel striking while coming down at speed. The only other time was on the last day when i was running the last 5km on chalk. Neither times were cause for any problem and I didn't need to take any painkillers or ibuprofen during the race to sort these out.
So, all in all, a huge success. Thank you Tom. The tape and your magic hands did it.
Since being back I've taken the tape off and removed the orthaheel and have been walking around normally. No problems so far. Just that little problem of the marathon in under two weeks and then the ultra two weeks after that. I'm not going to do much on it for the next few days and rest it as much as I can over the weekend with probably some light jogging next week before the race.
Typically, as I writing this, it's starting to hurt again. I just think I have an emotional heel…
Jody has written a great race report for his epic Transalpine experience, be sure to give it a read!
Final thoughts: plantar fasciitis can be challenging to treat, but with only 2 treatment sessions we were able to get Jody through an 8 day ultra event with minimal pain. Our next aims would be to concentrate on rehab, deal with any calf weakness and address any remaining symptoms. Plantar fasciitis can often be self treated successfully but will often benefit from an assessment to guide this process. In truth, Jody did most of the hard work with his treatment, we just pointed him in the right direction!