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Plantar fascia pain plagues countless runners, but finding its root cause and treating it effectively can feel like a frustrating trial-and-error process. On a notable episode of The Strength Running Podcast, host Jason Fitzgerald brought on Dr. Mandy Riehl, a rehab chiropractor, former D1 cross-country athlete, and running specialist—to dive deep into what actually causes runner's heel pain and how to solve it for good.

Rather than relying on temporary fixes like aggressive calf stretching or resting, Dr. Riehl emphasizes the need to evaluate total foot load tolerance, intrinsic foot strength, and running gait biomechanics. A critical step in true recovery is establishing an accurate differential diagnosis, ensuring that persistent heel pain isn't actually medial calcaneal nerve entrapment, tarsal tunnel syndrome, or referred lumbar radiculopathy masquerading as classic plantar fasciopathy.

To build long-term capacity in the foot, treatment must transition away from passive modalities like ice and orthotics toward heavy slow resistance (HSR) and progressive loading. Heavy loading systematically rebuilds damaged fascial tissue and increases lower leg stiffness, which drastically improves energy return, lowers ground contact time, and enhances overall running economy. Endurance athletes often shy away from heavy weight training due to the common myth that lifting will make them bulky.

However, because of the interference effect, the metabolic tug-of-war between anabolic and catabolic signaling during endurance volume, runners can safely perform heavy resistance training without adding unwanted mass, gaining vital structural resilience instead. Building this lower-body foundation not only resolves heel pain, but also protects against other frequent overuse conditions like patellofemoral pain syndrome, Achilles load, and plantar overload.