By: John Crawley, PT, DPT, OCS
Attention, fellow runners! Have you ever wondered how your training volume and running form might impact your risk of developing plantar fasciitis? A recent 1-year prospective cohort study titled “Running Distance and Biomechanical Risk Factors for Plantar Fasciitis: A 1-yr Prospective 4HAIE Cohort Study” provides some valuable insights. This research tracked over 1200 participants, including both runners and non-runners, to identify key factors that either contribute to or protect against this common and often debilitating running injury.
This study revealed some interesting information for runners looking to prevent plantar fasciitis. One of the most significant findings was the strong correlation between weekly running distance and the risk of developing PF. Runners who logged over 40 kilometers (approximately 25 miles) per week were found to have a six times higher risk of PF compared to those running a more moderate volume of 6-20 kilometers per week. This suggests that there might be an “optimal dose” of running, where the benefits are maximized while the risk of injury, specifically PF, is kept in check. Furthermore, the study also delved into biomechanical factors. They observed that runners with a greater maximal ankle eversion angle (meaning their ankle rolls inward more) during the stance phase of their gait had a higher risk of PF. Conversely, a greater maximal ankle abduction (a slight “toeing out” motion) appeared to be a protective factor.
So, what does this mean for your running routine? As a physical therapist, I interpret these findings as a strong call for mindful training. Firstly, gradually increasing your running distance and being cautious about exceeding 40 km per week too quickly can significantly reduce your risk of PF. If you’re planning to run higher mileage, ensure you do so with proper progressive overload and listen to your body. Don’t increase your running volume by more than 10% per week. Secondly, paying attention to your running form, particularly how your ankle moves, is important. While we don’t want to drastically change your natural gait, understanding if you have excessive ankle eversion could lead to targeted exercises to strengthen supportive muscles or even a discussion about footwear that offers more stability. Incorporating strength training for your foot and ankle, and considering a gait analysis with a physical therapist, can help you optimize your running mechanics to keep you on the road and pain-free.
To build your foot strength try these exercises:
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Citation:
- Plesek J, Hamill J, Burda M, et al. Running Distance and Biomechanical Risk Factors for Plantar Fasciitis: A 1-yr Prospective 4HAIE Cohort Study. Med Sci Sports Exerc. 2025;57(4):756-766. doi:10.1249/MSS.0000000000003617