Plantar Fasciitis is a very common, painful condition of the foot which affects runners, but also those who don’t run. It is closely linked to calf muscle flexibility and foot type.
The symptoms of plantar fasciitis are pain which develops gradually for no apparent reason, although may come on after a particularly long run or walk or over a period of increased training. Pain is felt mainly underneath the heel and may radiate into the arch of the foot. It tends to be worst first thing in the morning, with most sufferers saying it takes them a while to get up and about. The foot then warms up and symptoms ease. They may deteriorate again when getting up and walking after long periods of rest or during or after long periods of activity. It may be tender to palpate under the heel.
What is it?
Plantar fasciitis is a degenerative condition of the fascia (thick connective tissue) which runs the length of the sole of the foot. This fascia supports the arch of the foot.
In cases of plantar fasciitis, the fascia suffers microscopic degenerative tears due to repeated straining with every step. This is why it is more common in those who spend a lot of time exercising on their feet. The causes of this vary and why one person may develop this condition but another not is explained below.
Plantar fasciitis is caused by additional stress on the fascial attachment to the medial calcaneal tubercle on the heal bone (calcaneus). There are many factors which can cause an increase in stress to this structure:
- Tight calf muscles
- Inadequate footwear
- A heel spur
Overpronation is a common problem and most runners will know what is meant by this. But for those who don’t, pronation is a normal movement, required when walking and running which is the rolling inwards and lowering of the arch of the foot. However, overpronation occurs when there is too much of this movement or it happens too quickly. This overstretches the fascia with every step.
Tight calf muscles can actually contribute to increased overpronation and so the two are often linked, but not always. Tight calf muscles affect the fascia in two ways. Firstly, there are fascial fibres which are continuous between the achilles tendon and the plantar fasciia. So tightness in one can cause tension in the other. Secondly, tight calf muscles mean reduced ankle range of motion. The additional required movement is gained through overpronation rather than dorsiflexion.
Footwear is another big cause of plantar fasciitis. In runners, it is vitally important to ensure you get the right running shoes. These will support the arch of the foot and prevent overpronation as you run, thus reducing the stress on the fascia. For day-today use, avoid completely flat shoes such as ballet shoes, plimsoles, flip flops and ugg boots! Instead go for trainers, and other shoes with a built in arch. Also avoid wearing high heels too often as these shorten the calf muscles.
A heel spur is a bony growth found underneath the heel bone. It develops due to increased tension from the fascial attachment on the bone. A heel spur can sometimes cause plantar fasciitis, but this is rarely the case. A heel spur may be present, but may not be the cause of the condition and similarly a heel spur can be present with no symptoms at all. In most cases, a heel spur is only detected on x-ray and so most plantar fasciitis sufferers do not know if this applies to them or not. It is only in severe or persistent cases that an x-ray may be requested.
Treating Plantar Fasciitis for Runners
Plantar Fasciitis treament for runners should focus on easing pain as well as correcting the cause of the problem.
Start with resting the injury as much as possible. This is difficult for foot injuries, but avoid all unneccessary walking, don’t run and wear supportive shoes at all times – even when in the house – to support the arch and reduce overpronation.
Ice can be applied to the foot to ease pain and inflammation. The best way I have found to do this is by filling a 500ml bottle with water and freezing it. Once frozen, sit in a chair and roll the bottle backwards and forwards under the arch of the foot to provide a cooling massage which offers a good deal of immediate relief. Do this for 10-15 minutes at a time, repeating as often as you wish.
Start stretching the calf muscles immediately when you feel plantar fasciitis symptoms. This shouldn’t cause you any pain. Make sure you stretch both the Gastrocnemius and Soleus muscles. Here’s how:
- Stand facing a wall, about a foot away, with a wide stance.
- Keep the back leg straight and the heel down as you lean forwards, pushing against the wall until you feel a stretch in the calf.
- Hold this for 20-30 seconds.
- Then move your back leg in slightly.
- Bend both knees a little to squat down slightly.
- Again keep the heel down, but shift your weight forwards onto your forefoot until a stretch can be felt in the achilles area.
- Again hold for 20-30 seconds.
- Repeat both of these stretches twice.
- Do this at least 3 times a day, but more like 5 if you can!
Stretching the calf muscles can be complemented with sports massage therapy. This works really well for the calf muscles and can very quickly help to increase ankle dorsiflexion. An experienced sports therapist may also be able to apply sports massage to the plantar fascia to encourage blood flow which aids healing and break down adhesions in the fascia. A therapist may also use electrotherapy treatments such as ultrasound, again to increase blood flow and ease inflammation and pain.
Along the lines of stretching, a plantar fasciitis night splint or strasbourg sock can be worn overnight to stretch the calf muscles and fascia whilst you sleep. This helps to decrease pain first thing in the morning and contributes to the overall rehabilitation of the condition by increasing ankle flexibility. They can take a little time to get used to, but bear with it and you should see results.
Insoles or heel pads are often recommended for plantar fasciitis and in many cases do make a big difference. Just make sure you get something suitable for your feet. If you are not sure if you overpronate or have a fallen arch, visit either a sports therapist, physio, podiatrist or specialist running shop for a gait analysis. They will be able to tell you what you need and recommend either pre-molded off the peg type shoe inserts, or custom made orthotics. If you don’t overpronate and have good, strong arches, then a heel pad may be sufficient to just give you some cushioning around the painful area.
Acupuncture is recommended as a form of treatment for plantar fasciitis. Several of my clients have had acupuncture treatment with very positive results.
If symptoms continue to persist, despite rigorous stretching, rest and correction of causes, a corticosteroid injection may be recommended by your Doctor. These are anti-inflammatory injections which are often effective, in the short-term at least. However, they are usually pretty painful at the time and any relief in symptoms is usually short-lived. My opinion is that they should only be resorted to once all other conservative forms of treatment have been applied for a continuous period of at least 4, if not 6 months.
Returning to Running
As with all injuries, a slow and steady return to running is recommended. Doing too much too soon can easily result in a return to the treatment couch sooner rather than later.
Don’t even consider returning to running until you have absolutely no pain when walking. If you still have pain, running will only make this worse as it further stretches the fascia and tightens the calf muscles.
Once you are pain-free on a daily basis, attempt a short jog. And I mean short. 10 minutes tops! Stretch your calf muscles before and after and ice roll the foot for 10 minutes after the run. Carry on with all stretches as normal for the next two days. Provided you get no resurgance of the pain, try another short run on day 4 – no further than the first and repeat the icing / stretching.
If again you have no flare up of pain, try a slightly longer run, say 15-20 minutes. Don’t be tempted to keep going if you are pain free. You are more likely to feel it in the 24 hours after a run than at the time.
Again have two full days rest and then repeat this run. If all goes well still, gradually increase the time you are running for over the next few weeks. It may take a month of more for you to get back to the distances you were doing, but don’t rush it!