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.