As runners we tend to develop a love-hate relationship with our feet. We love them as they can carry us for miles, after all an average human will walk 5 times around the world in their lifetime. Imagine how this number will increase if, on top of that, we run two, three, four times a week! As Leonardo Da Vinci put it ‘the human foot is a masterpiece of engineering and a work of art.’ However, given all the mileage we do – things sometimes do go wrong. From blisters and black toenails to unexplained pains and aches.
In this series of articles, I will describe the most common injuries I see in runners who enter my clinic. Today I will talk about Plantar Fasciitis.
As you learn about each of the conditions and the treatment options, please keep in mind that I would always suggest consulting your podiatrist prior to initiating any rehab or treatment at home.
- Do you feel a stabbing pain in the bottom of your foot near the heel?
- Do you hobble for a while each morning when getting out of bed?
- Is the pain worse after a longer period of rest?
What is it?
‘Plantar’ refers to the bottom of the foot while ‘fascia’ refers to a thick band of collagen fibres which run from your heel to your toes. This fascia begins at the heel bone, as shown in the image below, and widens as it spreads out and attaches to your toes.
Plantar fascia not only helps to maintain the arch of the foot but it also plays an important role in foot stability and movement. As the foot moves, so does the plantar fascia.
As Mr. Langdon explains in the video above, plantar fascia stretches and contracts with each step. Walking or running just a few miles causes this band to stretch and contract thousands of times which may cause tiny tears, called micro-tears, to develop. These micro-tears tend to occur near where the plantar fascia attaches to the heel bone, which is why pain is felt in the heel.
In the past it was thought that these micro-tears caused inflammation in the area which brought on the pain. However, recent research (Schwartz & Su, 2014) suggests that there is no signs of inflammation present and, hence term plantar fasciosis is more correct, rather than plantar fasciitis.
Why it happens?
It is thought that excessive pressure from running or standing for long periods of time puts a strain on the attachment of the fascia to your heel bone. There is a few risk factors associated with development of plantar fasciosis, for instance, excessive weight, poor foot alignment, different leg lengths, tight Achilles tendon, weakness in the foot muscles or poor footwear. Training errors such as sudden increase in the work-out intensity in terms of mileage or speed and change in the running surface all play a role in the development of plantar fasciosis.
I often recommend my running patients a multipronged approach when treating plantar fasciosis such as cutting back on weekly mileage, a new stretching routine, icing, footwear change and often, but not always, orthotics depending on the foot structure and posture.
- Rest. You don’t have to stop running but decreasing your mileage for a few weeks will give the plantar fascia time to recover. Also switching things up will put less stress on the tissues. For example, if you always run a loop clockwise around the park, you are putting different biomechanical loads on the right foot and the left foot. Try switching the direction and also, if you are a road runner, switch to running on the grass. Low impact workouts such as cycling or swimming are a good choice to keep fit while letting your fascia recover.
- Ice. Icing helps to reduce the pain. Apply ice wrapped in a towel to the heel twice a day for 20 min at a time. Never apply ice directly to the skin. You could also roll your foot over a plastic bottle filled with cold water. Try placing the bottle in the freezer for a few minutes to make it that bit colder.
- Footwear. Supportive running shoes with a strong heel counter and strong soles will hold your foot in a better position. Some runners find that changing their footwear alone helps to alleviate the majority of pain or discomfort related to plantar fasciitis.
- Taping. Your podiatrist may use different taping methods which will support the plantar fascia, enabling it to rest and heal.
- Stretching and Strengthening. Plantar fasciitis is often associated with tightness in the calves and weakened intrinsic muscles of the foot, hence your health care professional will recommend exercises to both strengthen your feet and to stretch your calves.
- Orthotics. If the reason behind plantar fasciitis lies in the poor foot structure, for instance someone with flat feet or high arches, your podiatrist may recommend you shoe inserts. These may vary from over the counter inserts to custom made orthotics. At South Dublin Podiatry, we provide both types.
Plantar fasciitis is the most common cause of heel pain, however there are other reasons why your heel might be sore. For example, fat pad syndrome, stress fracture or Achilles tendonitis, to name a few. Hence, it is important to consult your doctor or podiatrist who will assess your feet and advise you on the best treatment approach.
Schwartz, E. N & Su, J. (2014) ‘Plantar Fasciitis: A Concise Review’, Perm J, v.18(1)
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