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Notes on Plantar Fasciitis

Monday, February 03, 2014

Plantar fasciitis is a type of tendinitis that affects the plantar fascia connective tissue (a piece of connective tissue that’s most similar to a tendon. It runs from the heel to the ball of the foot and supports the arch). The pain is commonly more severe in the morning and tends to be located closer to the heel of the foot.

It’s caused by continuous and chronic irritation to the plantar fascia without allowing for adequate recovery. As the foot flattens during mid-stance (the plantar fascia acts like a spring and absorbs energy by elongating during the mid-stance phase of gait), this puts additional strain on the fascia. Weak musculature causes excessive flattening and if you’re not strong enough to handle this constant strain, your risk of developing PF is significantly higher.

In addition to weak foot musculature, the following can also contribute to increased strain on the plantar fascia: excessively tight calves, significant pronation, and significant supination. These cause abnormal movement patterns of the foot during mid-stance.

The pain is most commonly located at the heel because this part of the fascia is pulled on the most to lift the body while walking and running. Pronation will also cause excessive pull on the part of the fascia closest to the heel.

Labeling PF as a type of tendinitis is actually somewhat misleading because it implies a level of inflammation. However, your plantar fascia is most likely not inflamed – and therefore can’t be treated effectively with NSAIDs (non-steroidal anti-inflammatory drugs like ibuprofen) or ice therapy.

Instead, plantar fasciitis is more likely a degeneration of the tissue. In other words, the fascia is damaged, due to overuse, by microscopic tears in the connective tissue.

"While ice, rest, orthotics and pain relievers may ease the discomfort, the injury can come back again (and again) unless you address the underlying cause—weak and tight muscles and tendons that make up and support the foot," says Irene Davis, Ph.D., P.T., director of the Spaulding National Running Center, Harvard Medical School in Cambridge, Massachusetts.

As soon as you experience pain on the bottom of your foot on or near the heel, the likely culprit is PF and you should start these treatment steps:

1. Stop running. There’s no getting around this! Running will make it worse – so don’t run.

2. Manage the pain. While PF is not an inflammatory condition, some inflammation exists when the injury first begins. Icing can be helpful to reduce this initial period of inflammation and provide some relief. Just be aware that pain management is not itself a cure for your PF.

3. Evaluate your shoes. This applies particularly to the non-running shoes that you wear most of the day. Shoes that promote poor alignment can not only weaken your feet, they can prolong recovery and further aggravate PF symptoms.

(I find that wearing my Orthaheel sandals all the time really helps when I have PF. First, they support the heel and arch and discourage excessive sideways movement (pronation or supination). Second, they encourage (even require) more flexing and movement of the toes and foot. My foot is more "active" in these shoes.)

"Most people are unaware that the answer to plantar fasciosis is in the toes," says Ray McClanahan, DPM, sports podiatrist, founder of Northwest Foot & Ankle in Portland, Oregon, and long-time competitive distance runner. "Repositioning the toes to the location nature intended--splayed and in line with their corresponding metatarsal bones--reduces tension on the flexor retinaculum and allows sufficient blood flow to reach the plantar fascia tissue."

4. Foam roll the soleus and calf muscles. If these muscles are tight they can exert additional strain on the plantar fascia.

5. Use a small ball (like a golf ball) or a small trigger point roller or a rolling pin to perform light self-massage of the plantar fascia and arch. Roll the underside of your foot to break up any muscle adhesions, scar tissue, or trigger points. Massage will also increase healing blood flow to the area without adding extra stress.

6. Do exercises to strengthen your feet and don't forget your hips, too. Many injuries can occur from weaknesses in the hips, including plantar fasciitis. Since the hips stabilize each leg during the stance phase of the running gait, strength in that area is particularly vital.

7. Do a test run once you are experiencing no pain during normal activities. The goal of this run is to simply see if you can run without pain – it is not to gain any fitness.

I find this the trickiest time during my recovery, because it is easy to over do. First requirement, of course, is that there be no pain during the run. But more important is to evaluate how the foot feels an hour or two after a run. If there are signs that you are aggravating the condition even if it doesn't hurt to run, stop running (again) . Sometimes a balance can be managed by keeping the runs very short.
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  Member Comments About This Blog Post:

KBEHNKE81 2/22/2014 7:36PM

    This makes so much sense out of my PF experience. Key point: wear shoes during non-exercise times that support healing as well. If you take care of your foot during a 30-minute run but squash it into shoes that compromise the foot the whole rest of the day you're not doing yourself any favors. My PF is gone, but not I've got wrist pain. Got any advice about wrists?

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VISUALLYRICS 2/21/2014 5:39PM

    I feel like I just hit the jackpot! This was such a good read.

What an emoticon blog, Catherine! What a wealth of info - emoticon
I've bookmarked your blog and am so hopeful as I begin the process of healing...using several of your tips. Those Orthaheel sandals look so comfy. I will look for them. . .

On top of your fav pair of running shoes and these sandals, what other athletic shoes do you wear?

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NATPLUMMER 2/20/2014 4:45PM

    Good info.

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CAROLCRC 2/5/2014 9:00AM

    Lots of good ideas here - what works for one case may not work for another. Night boot simply aggravated mine, and caused pain in outer part of the foot. 9 weeks and counting.... still in a lot of pain and not running.

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BLUENOSE63 2/5/2014 7:15AM

  My other advice would be NOT to get cortisone injections in your foot for PF! It is extremely painful and does not work as per my running group members who had it done!

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SMITTY4RL 2/4/2014 8:01PM

    Thanks for the info--I was having some twinges in my right heel and ankle, but do to it being injured and operated on in the past, I attributed the issue to that--hm, maybe it's not. But thanks again--great stuff here.

Are you injured?

Comment edited on: 2/4/2014 8:01:45 PM

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BLUENOSE63 2/4/2014 7:55PM

  I would highly recommend ART....Active Release Therapy as it has worked for a number of my running friends!

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BOILHAM 2/4/2014 7:51PM

    Sorry to read how very complicated this is to resolve. I hope soon you are fully repaired that you are running as much as you'd like.


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LIVE2RUN4LIFE 2/3/2014 8:00PM

    The boot can help the tissues to heal. It doesn't address root causes, however, which in my cases seems to involve scar tissue / adhesions that irritate the surrounding tissues when I land on it while running.

Last Thursday when I reinjured myself during my run, I was totally pain free prior to the run. Can't wear the boot while running.
emoticon

Comment edited on: 2/4/2014 8:53:06 PM

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JUNEPA 2/3/2014 7:13PM

   
I had a friend with plantar fasciitis ( why in the world is there a double i after the c in fasciitis ) and she found something that worked for her, which she shared with another friend and it also worked for her. I was going to post it on the Galloway thread when Trill said she was having some trouble. This is what my friend shared.

I suffered too long with plantar fasciitis and tried just about everything. Then the orthopedic surgeon I saw told me to get a "night splint" for my foot. I bought it at a medical supply store in Chilliwack, but I'm sure you could get one at any medical supply store. It comes in small/medium/ or large, depending on the size of your foot.

It is sooooo simple. All you do is wear this splint at night. It's easy to get used to. What it does, is it holds your foot in the position it would be in, like being in a downhill ski boot. I had a bad case of plantar fasciitis. It only took about 3 nights of wearing the splint to virtually have the problem gone!!! I still get it back, but not as severely, only after a long hike or if I'm standing for a long time. Then I wear the splint that night and the pain is instantly gone by the next day.

I spent a bunch of money on special inserts for my shoes/runners. The orthopedic specialist said it was a complete waste of money. The only thing that works for plantar fasciitis is to wear this splint. I guess it stretches the fascia and ligaments back into the correct position.The splint cost just under $100.00 My GP told me that her doctor colleague just wore a ski boot to bed at night, and it works the same, but I think that would be harder to sleep with on!!!! hahaha

Anyways, I hope it helps your friend because I know how painful it is.





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RUN4FOOD 2/3/2014 5:43PM

    thanks for sharing this information. Hope your PF is continuing to improve.
Had it about 4 years and never want it again.
I've heard it can take 9 to 12 months for a full recovery. I thought the Strassburg sock I slept in helped quite a bit.

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SHOAPIE 2/3/2014 4:38PM

    emoticon

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PLMITCH 2/3/2014 3:08PM

    Thanks for sharing - very informative.

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THETURTLEBEAR 2/3/2014 2:50PM

    I had a bout about fifteen years ago and a fellow hiker who was a PT suggested standing with my toes on a step, and slowly lowering my heels, then holding that position for two minutes - doing this several times daily. Stretching the calves and splaying/working the toes is part of this which makes sense in what you said. It went away within a week. I've used this several times since then and never had prolonged problems. The one time I had issues which didn't resolve immediately was in 2011, in the Spring after I joined SP. I was determined not to stop exercising to let things resolve, and stretching, rolling, icing, etc. wasn't enough without also letting some healing take place. I just put up with it for months and kept doing what I was doing. Then I got an awful case of poison ivy, got put on a steroid pack, and it was gone within a week. I guess that case WAS inflammatory!

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JUSGETTENBY42 2/3/2014 2:18PM

    emoticon

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