Jill Murphy, DPT, LAT, CSCS
Plodding onward in our series of common running injuries, one injury that cannot be missed for both the pain it causes and the limitations it presents is plantar fasciitis. The plantar fascia is a broad, fibrous piece of connective tissue that supports the longitudinal arch along the bottom of the foot running from the calcaneus to the ball of the foot. Its job is to assist in both foot stability and flexibility as a runner moves from heel strike to toe-off, supporting the arch step after step for miles and miles.
Plantar fasciitis is inflammation in the plantar fascia typically caused by excess tension that creates micro-tears in the tissue over time. Overuse and/or over-training, poor foot mechanics, and even lack of range of motion or flexibility elsewhere in the big toe, ankle, calf, hamstring, hip, or even in the sciatic nerve may contribute to this injury. Poor muscle strength in the hip, calf, ankle, and foot also can contribute to this injury. Runners with other issues such as chronic low back pain, hip pain, and fibromyalgia may be more at risk for plantar fasciitis, due to the leg tightness and tension created by these other diagnoses.
Typical symptoms of plantar fasciitis are arch pain or heel pain, especially with the first steps out of bed in the morning and/or after prolonged sitting. Other symptoms include difficulty with any activities involving prolonged weight bearing, such as prolonged walking, running, and standing, especially on hard, unforgiving surfaces.
Early treatment and modification of training programs is essential for anyone, but especially for runners who wish to minimize the overall effects of plantar fasciitis on their training schedule. This is not the type of injury that one can run through and tough it out, as it is unlikely that self-treatment will be effective unless it is begun very early at the first signs of injury AND is accompanied by a significant reduction in mileage.
There are many simple things that can be done to address plantar fasciitis, starting with icing. The best way to ice the plantar fascia is with a frozen water bottle massage while seated, which is easy to make by freezing a water bottle ½ full of water. Ice for 10-12 minutes, up to once per hour, but at least three times per day to settle down the tissue. Icing after performing exercises and stretches and after prolonged time on the feet is most beneficial. Plantar fascia stretching (see instructions and photo for this stretch below), especially before taking the first step out of bed in the morning and after prolonged sitting throughout the day, is very important for pain relief and restoration of tissue length. Calf stretching (including gastroc, soleus, and Achilles stretches), big toe extension stretching (pulling your toe up towards your knee), and general lower extremity stretching for the piriformis, IT band, hamstring, and glut max will also be helpful. Utilizing a night splint that holds the foot in a dorsiflexed or less plantarflexed position while sleeping can reduce early morning symptoms. Wearing supportive shoes with a good arch support which may include a custom or off the shelf foot orthotics is very beneficial. Finally, strengthening the foot intrinsics (pick up pennies or dried beans with your toes), glut med and glut max, and calf muscles are also key to solving the problem of plantar fasciitis, as this along with normalizing flexibility in the foot and ankle should reduce the strain the plantar fascia undergoes with each step.
When these basic treatment ideas fall short, it is important to consult a physical therapist or licensed athletic trainer who has experience in treating this injury with manual therapy (soft tissue mobilization) and for a complete biomechanical analysis to help determine the possible reason for this condition. Some common direct contributors to this injury include training errors, running on old, worn-out footwear, poor arch support in shoes, bunions, obesity, running on hard surfaces, and poor running mechanics. Thankfully, the overwhelming majority of plantar fasciitis cases are solved with conservative treatment that may include injections of corticosteroids to address the inflammation. However, a few patients with chronic plantar fasciitis unresponsive to treatment may benefit from surgery to release the plantar fascia. Recovery from this surgery is still long and progress is slow, but patients may be able to return to their prior level of activity even if surgery is found to be necessary.
Plantar Fasciitis Stretch
1. Cross the affected leg over your other leg, and pull up on your toes at the ball of your foot using the same side arm as the affected leg. Pull up until you feel a pain-free stretch in your arch.
2. Hold stretch for 30 sec. Repeat several times throughout the day and before and after exercise.