I had an evaluation with a runner a few months ago who had been dealing with a pretty bad case of plantar fasciitis that had been keeping him from training for his upcoming marathons. He was pretty beat up about it because he had really hoped that he would be able to qualify for the Boston Marathon at one of these upcoming races, but without being able to train he had lost hope. “Another year down the drain,” he said to me.
I asked him what he had tried so far to get the pain to go away. He started listing a number of stretches and calf exercises that his running friends had suggested, and that he had come across from endless searches on the internet and social media. Finally, after a few months of failing with self-help solutions he caved and went and saw a podiatrist. He mentioned that this was a big deal because he hated going to doctors because “all they do is tell you to stop running, and I am not going to do that.” He said the appointment was pretty much what he expected. The podiatrist suggested he be fitted for a pair of custom orthotics, and switch to a stability shoe. He then finished with, “Oh, and he also said I should get some orthopedic flip flops.” I had expected the first couple of recommendations, however, I was a little surprised by the last one. I asked him why a recommendation for flip flops had come up in their conversation. He quickly replied “if I am not running, I am almost always in my flip flops. I’ve pretty much just worn flip flops for years now.”
At that very moment, I knew how to help him. I looked him in the eye and told him that his $100 orthopedic flip flops were killing his feet. He seemed a little confused by my statement. “How is that possible?” he asked. The podiatrist said that these were the best flip flops money could buy and that they had great arch support. “Isn’t that exactly what I need?”
I answered his question by asking, “would you expect to lose 10 lbs if you did absolutely nothing to change your diet or stopped exercising as much as you normally do?” Again he looked confused about where I was going with this question, but he finally answered “ obviously not.” My question may have been a little harsh, but the point I was making with it was you aren’t going to get the results you are looking for by either not making any changes or by making the wrong changes. Obviously he had been trying to make changes, his problem was that the changes he had made were completely wrong for the problem he had.
After watching him run and perform a few specific movements I evaluate my runners with, it was very clear that though he would need to eventually learn how to improve the stability of his foot, his biggest problem was that his body had forgotten how to let his foot relax and move. Now to be fair, his flip flops aren’t entirely at fault for all his problems, but they certainly hadn’t helped, not even the fancy orthopedic ones.
If you are still reading at this point, I’m going to assume that you have been experiencing foot pain and that you more than likely wear flip flops on a regular basis. I want you to take a second, and if you’re not wearing them, put your flip flops on and take a little walk around. What I bet you’ll realize is that with every step you take you have to grip with your toes just in order to keep your flip flops from falling off your feet as you walk. Now take your flip flops off, and while you are standing grip your toes and you’ll see that your arch raises up and stiffens your foot. Your flip flops have essentially trained you to walk with a stiff and rigid foot. The consequence of this is that your foot now isn’t used to relaxing and stretching out and the muscles and other tissues that run along your calf and bottom of your foot are less able to handle being stretched over and over again.
Now imagine your foot has adapted to stay in a rigid position and you lace up your running shoes to go out for a run. All of the sudden, you are now asking your well-trained stiff foot to allow itself to relax and move in order to absorb the landing forces of each stride. You see your foot needs to pronate (think relax and stretch out) in order for the muscles to be able to be part of the impact absorption process. If your foot stays rigid the landing forces are just redistributed up the chain to the ankle, knee, hip, and low back. This is why so many running injuries start because of issues at the foot.
I feel like foot pronation gets a bad rap in the running world. Many runners come to me and the first thing they tell me is “ I know that I overpronate and that is why I am having all my problems.” Don’t get me wrong, there is a line between healthy pronation and overpronation and there are consequences to crossing that line. But the same is true for under-pronating. Having worked with runners over the past 10 years, my impression is that most runners believe that any pronation is too much. The truth is that foot pronation is not evil at all. It is necessary in order to allow your body to manage the landing forces associated with running, which can be up to 3 times our bodyweight.
Getting back to my running client from earlier. I love working with runners because they will work tirelessly in order to get back to running. They are some of the most dedicated and motivated people I have ever met. This running client was no different. He had done everything he had been told to do and tried everything that he could find that was recommended to solve the problem he thought he had. And this was the biggest issue.
Fast forward to present time, and I am happy to say this runner has been able to learn how to use his foot correctly and has even been able to return to training for his marathons. All it took was for someone to help him identify the right problem and then create a solution for it. Thankfully, that someone was me! For me, the best part now is to hear him talk about his training and how excited he is to be able to run again without the fear of suffering excruciating foot pain. Oh yeah, and it also makes me happy that he is no longer wearing flip flops, not even the $100 orthopedic ones.
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