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Runner’s PSA: your foot pain might not be plantar fasciitis

According to Chris Semenuk, registered massage therapist and certified running coach, many runners' foot pain gets misdiagnosed

runners in a marathon

Plantar fasciitis easily makes the list for the most common complaints among runners, and as soon as someone starts experiencing foot pain, they assume that’s the cause. According to Chris Semenuk, RMT and certified middle-distance coach with Western University, in many cases, the pain these runners are experiencing is not plantar fasciitis, but is being caused by issues elsewhere up the leg.

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Where’s the pain coming from?

Plantar fasciitis means inflammation of the plantar fascia, which is the thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. Semenuk explains it is only one cause of foot pain, but many people associate all foot pain with the condition. In his practice, however, he meets a lot of runners whose foot pain is not caused by the plantar fascia, but by other tissues in the body. The most frequent culprits for distance runners, he says, are the deep posterior compartment muscles that exist under your calves and attach to the back of your shin bone.

“They have tendons that go right under your foot and out to your toes,” he explains, “and movement from those muscles being compromised can then pull underneath the bottom of your foot improperly. It’s the foot where you feel the pain, you feel the problem, but it’s coming from higher up.”

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Semenuk says this problem gets lost and misdiagnosed many times over because the foot is where the pain is felt and indicated, so the foot is where many people will stop and assume the problem must be plantar fasciitis. For this reason, he sees many runners at his practice who have been getting treatment for plantar fasciitis (either self-treating or professionally), but it’s not going away.

“That’s when I do my own assessment and I look higher up, I look into those muscles,” he says. “Many times, it’s those muscles that are causing the problem, so we address them instead.”

Fixing your form

These muscles beneath your calves have two main roles: to maintain your arch and allow you to flex your foot. The most common time for them to become injured while you’re running is when you’re flicking your toe as your foot pushes off the ground. Semenuk says many runners aren’t using their entire leg properly during their stride, which causes them to push off way too hard with their toes. “If you’re not using your hamstrings, glutes and your full calf properly, that group of muscles (the deep posterior) can get over-use syndrome in no time,” he explains.

Semenuk adds this is often a result of improper running form. If you’re not fully extending your leg (relative to your event) through that back portion of your stride, you’re going to “flick” your toe really hard in order to compensate for the opposing knee drive. Retraining runners to get full leg involvement through their stride, then, is one of the most important steps in eliminating chronic foot or calf pain. It takes the pressure off those deep calf muscles, which aren’t designed for that kind of strain.

To retrain running form and fix your stride, Semenuk says you have to go higher up and look at what’s happening in the lower back, the glutes, the hamstrings and so on. For runners who are struggling with chronic foot or lower leg pain, he recommends runners see a therapist who specializes in running-related injuries, like a sports massage therapist or physiotherapist. A proper stretching, mobility and strength training practice where you’re taking your muscles through their correct range of motion is key to preventing improper running form and over-stressing your deep posterior compartment muscles.

The bottom line

Semenuk points out that while these deep calf muscles are the most common cause of foot pain he sees in his practice, there are other issues that could be masquerading as plantar fasciitis. Your calves may not be working properly or you could have problems with your sciatic nerve or your glutes that send referral pain all the way down into your foot — these are just some of the other potential reasons why you might be having foot pain.

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When you’re experiencing an injury, especially if it’s chronic, you should seek out a practitioner who will look at your body as a whole unit, and not just focus on the location of your pain. This will allow you to get to the root of the problem and fix it at the source, so injuries don’t keep coming back.

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