Where to run with plantar fasciitis: surface, speed and slope

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. We are covering plantar fasciitis and interviewing the trail running doc.

We're going to ask three questions that a lot of you have asked about. First one is, does the surface matter? Then we're covering, does speed matter? And then does slope or camber of the trail or road matter? All right, so this is Mandy Riehl. We are going to cover just a few questions here. And the first one is, does the surface matter when we are actually, I'm talking about plantar fasciitis with trail running. Like running surface, dirt, sand, rocks. Yeah. Like I imagine like, so there's like big boulders, like big steps. There's like the little gravel things. And then what do you call them?

Scrambles? Yeah. Scrambles, like loose rocks. Loose rocks. And then there's like nice pristine sand. Pristine sand. You can tell you're from Southern California. Well, I guess sand in the case that it's like sand in the pines. Sure. Yeah. We'll call it dirt then. Alpine sand. Alpine dirt. Sierra kitty litter. So it can depend, but it doesn't always. So for most people that are pressure sensitive, like if you dig in the plantar fasciitis area, it's usually like right below the heel. If it's pressure sensitive, then it'll matter more. And that's also where shoe choice matters more. I assume we'll go over that later, but if you're pressure sensitive, yes, like in bed rocks will probably be your worst case scenario.

And sand will probably be your best case scenario. If you're not pressure sensitive, it kind of comes down to testing those out and seeing what feels better or not, because it won't necessarily damage anything if you're not pressure sensitive. If you're using those different surfaces, even if it is a little bit more or less symptomatic. So then would, so if I was on a show running and I saw some rocks and I was pressure sensitive, would I just avoid those or just pick a new trail or like, what do you think about? Yeah. I mean, I'm biased in the sense of if I'm choosing a trail, I don't want to deviate from the trail unless I have to.

Like I wouldn't go choose another one unless I really had to. So avoiding the rocks can help. Changing foot strike to a degree can help if you're landing on your toes. Mostly it's watching out for them when you're going downhill. So this is a really good way to practice your technical running of trying to avoid the rocks. But downhill, since you're coming down with gravity, that's where it's more relevant. And does that pressure sensitivity eventually goes away, I'm assuming? Yeah. With the right treatment, it'll go away. Okay. Next question then, does the speed at which you're going up or down matter?

Like going up or down a hill? Yeah. Again, it can. Most people who are symptomatic with hills will feel it downhill or at the beginning of the run, no matter if it's up or down. So the warm-up effect is real if you're stepping out of bed in the morning. It's kind of like a more intense version of that. When you step out of bed in the morning and it hurts and then it warms up a little bit. Same thing can happen with running. So you're increasing intensity. It might be kind of symptomatic in the beginning and then warm up again. That can happen whether you're going up or downhill, but if, say, you're feeling pretty good on the run and then you hit some hills, more likely it will come on the downhill.

And if you're going faster downhill, most people run faster downhill than uphill, depending on the trail, then it can increase that more. So just to make sure to reiterate, is there a logical reason why running downhill increases it? Yeah, it can be from a few, mostly biomechanic reasons. The one I see most commonly is hip extension. So if you lack the hip extension to put the back end of your stride into the position it should be, you're going to dump into something else to extend. So that can be your foot ankle. You'll be pointing your toe to push off more. It can be dumping into your low back.

So if you have like a nerve referral that feels like plantar fasciitis, that's the most common boat that most people are in. So if you're going faster and downhill and you're demanding a longer kickback in your stride because of that, it'll dump more into one of those areas if you don't have the hip extension. Okay. I guess before we go into question three, then we should explore that because that's a tangent. Then you said that some people have back or hip referral to the foot or like what was the, can you give us just a little insight on that? I know we have other videos on it. Yeah, yeah. Yeah.

So check out the other videos. We got really in depth on this, but most commonly folks who we see that have had plantar fasciitis for years and imaging is normal and nothing happened. Most, but not all, most of those people are actually a nerve referral. So if you are a nerve referral case, that means what will make it better or worse may be different than a true fasciitis or irritation of the fascia on the bottom of the foot. I know that I was discussing with someone the other day. They said that they had to, they go in and they could talk to podiatrists about things. They acknowledge that a lot of the foot cases are actually referred to.

And so this individual is surprised by that. He's like, I thought it would just be the foot. Yeah. I was just hearing that a good friend of mine, actually a teammate from college, just went into podiatry in part because of these like misdiagnosed conditions in the foot. He said at the end of school, they finally have put in a little bit about nerve referral, which he was surprised to hear about because he hasn't heard anything about that from his clinical rotations. Yeah. I wish I'd gone back to, there was a consensus statement I saw years ago that was, it was like 10 bullet points. I want to say it was like 10 years ago.

And I think bullet point five was like recognizing that a strong, a strong amount of these plantar fasciitis cases are actually low back referred. Yeah. And then you refer to the according person. Yep. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar, and you've been dealing with some ache, pain, or stiffness that keeps coming back, no matter what you do, and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working.

And we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity. The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. Third question is, so there's the slopes that are up, but then there's like the slopes that are like this, but you're going that way. I've heard of people even saying like the road runners, they're like, well, which side of the street should I be on to help out with this? So is there a part of that with plantar fasciitis?

Yeah. I do want to, it's a slight tangent. I am biased towards it doesn't matter. If you're like injury-free, nothing is hurting. I don't really care what camber you're running on as long as it feels comfortable. So that slope on the edge of the trail or street and that you don't fall off of whatever you're running on. For plantar fasciitis, if it is a, say, a nerve referral plantar fascia, there's a nerve on the outside of the foot, kind of where that ankle bone ends, that can be stretched if you are in supination here. So if you're on a trail where you're almost kind of falling to the outside of your ankle because it's cambered like that, then it can actually produce symptoms because it's stretching that nerve.

If it's a true plantar fasciitis, it won't matter a ton depending on how you're using your foot and the shoes that you're wearing. Okay. Well, I think those are all good points. Also, if you guys are looking for more information about plantar fasciitis, too, we have an e-book that Mandy wrote. It's in the description or somewhere in the corner. If anything in today's episode resonated with you, visit the link in your podcast player. There you'll find any free resource that we mentioned in the show, any guest links, and a link for a free discovery call with us. We're licensed to work with our outdoor active people via telehealth across many states in the U.S. at this point.

In fact, we cover almost half of the population in the U.S., and we add more states every year. Thanks for listening. Subscribe to the show, and we'll see you in the next one.