The moment Becky Vander Zwaag crossed the starting line for the Amway River Bank Run, she called herself a winner.

Just to reach that point, she faced some big hurdles, including a double mastectomy and a bout with plantar fasciitis.

She overcame them—fueled by her love of running, the expertise of her medical team and the support of the River Bank Run Road Warriors.

“I’m excited. I’m just ready to do an in-person race again,” she said prior to the event. “I am a people person and I love that aspect of the race.”

Becky, a 38-year-old hair stylist from Zeeland, Michigan, started running in 2009 after her second son’s birth. She’d head out early in the morning, while her husband, Eric, watched the kids.

She grew to love the sport.

“For me, it’s a mental health thing,” she said. “I find solace in it. Every time my foot hits the pavement, my stress kind of melts away.”

She ran on her own and with community running groups. She took part in local races—from 5Ks to half-marathons. She ran the River Bank Run eight times.

In 2018, however, new health concerns sent her running game on a detour.

Assessing her risk for breast cancer

“I grew up with a mom who had a mastectomy when I was in third grade,” Becky said. “I remember going to the hospital every day after school with my dad to see her. Breast cancer was something we talked about for a long time.”

The experience inspired her to be proactive as a young adult about her risk for breast cancer. She performed self-exams. She had her first mammogram at age 27.

In 2018, her mom, Bev Vanden Bosch, was diagnosed with breast cancer a second time—28 years after her first diagnosis.

Becky decided to undergo genetic testing to assess her own risk for the disease.

She received the call while at work one day: She carried a BRCA-2 gene mutation that puts her at increased risk for breast cancer.

“It was so weird. Girls I was working with started crying. But I said I was relieved,” Becky said. “I felt like I’ve just always known.”

Over the next six months, Becky helped her mom through surgery, chemotherapy and radiation.

She also scheduled a preventive double mastectomy for herself in January 2019.

After she recovered, she returned to running.

In June, she underwent reconstructive surgery. Again, she returned to running.

That fall, she applied and joined the Road Warrior team for the River Bank Run. The team members serve as ambassadors for the race and train with the help of coaches.

The team camaraderie gave her an extra boost of motivation.

“My team is amazing,” Becky said. “They have become some of my best friends. We are from all walks of life, but we mesh really well.”

A painful heel

Soon, Becky’s running game hit a new detour: She developed plantar fasciitis. About 2 million people in the U.S. are treated each year for the condition.

She began to feel an ache in her left heel during runs. The pain grew worse with time.

“It felt like walking on a knife sticking in your heel,” she said. “It was quite awful.”

In February 2020, Becky met with Jason Lazor, DO, a Spectrum Health sports medicine specialist. The Spectrum Health orthopedics and sports medicine team provides support and treatment for athletes of the River Bank Run.

The condition affects the plantar fascia, a tight band that attaches to the bottom of the heel and goes to all of the toes.

When the fascia becomes inflamed, it causes pain at the bottom of the heel, as it did for Becky.

“The pain tends to improve with light activity, but it gets aggravated with more aggressive activity, such as running,” Dr. Lazor said.

Pain often is noticeable in the morning, also.

“When we sleep at night, our toes often are in a pointed position,” he said. “It shortens the plantar fascia.

“When you first get out of bed in the morning and put weight on your foot, your arch falls and that stretches out the plantar fascia so quickly it can result in a lot of significant irritation.”

The cause is largely unknown. Sometimes, he said, it can be linked to overuse or over-stretching of the fascia, ill-fitting shoes or improper running form.

Dr. Lazor provided a home exercise program for Becky that included stretching hamstring and calf muscles, foam-rolling of the plantar fascia and ankle strengthening with a therapy band.

For some runners, Dr. Lazor advises an evaluation by physical therapists, who analyze their running form and help runners strengthen weak muscles and stretch tight ones.

“Sometimes we have patients bring in their running shoes, so we can see the wear pattern,” he said.  “If we see significant abnormalities, we can look at doing custom orthotics for their shoes.”

He also advises rest. He encourages patients to avoid exercise that irritates the plantar fascia and to find other activities that do not cause pain, like biking or swimming.

“Movement in general helps with healing,” he said. “But if it’s painful, the movement gets in the way of healing.”

Those with an acute episode of plantar fasciitis may need four to six weeks of activity modification.

In some cases, plantar fasciitis is treated with surgery to lengthen the plantar fascia. But that is rare, Dr. Lazor said.

“That is always your last-resort treatment for it,” he said.

Preparing for race day

Becky, who had chronic plantar fasciitis, took a nine-month break from running. She did the exercises Dr. Lazor recommended.

She is diligent about stretching and strengthening exercises. And she is careful not to go barefoot.

“I have a special pair of shoes for the house,” she said. “I step into the shoes first thing in the morning.”

Since she returned to running in June, Becky has been careful not to push herself to do too much too soon.

“I’m taking it easy. I tend to be an over-doer, and I think that is part of the reason I got plantar fasciitis in the first place,” she said.

Although she has run the 25K route with the River Bank Run seven or eight times, she set her sights on the 10K race this year.

Her mom and dad, her husband and her sons, Cohen and Easton, were there cheering.

Just to be on the racecourse, after a long break, was rewarding. Through the years, she has persuaded several friends to run the River Bank Run for the first time. Watching their success reminds her of the first time she ran the race—and the pride she felt to accomplish a goal she once thought impossible.

“I think my favorite part is when they cross that finish line,” she said. “I love watching people come in.”