Tough to pronounce but impossible to ignore, plantar fasciitis is one of the most common foot injuries in both novice and veteran runners. For those who have suffered through it, the symptoms and experience are unmistakable: insidious aching at first, then a chronic, sharp, burning sensation inside the base of the heel. You feel it from the moment you take your first steps out of bed in the morning. The pain might get better with activity, but then BANG - it returns full force by the end of the day. Plantar Fasciitis is one of the slowest healing injuries in athletes, it's not uncommon to hear of people managing it for anywhere from months to years.
So what exactly is plantar fasciitis?
First, let's start with the anatomy and the role this strange piece of tissue plays in the proper functioning of the body. The plantar fascia is a fibrous sheath made of the connective protein, collagen, that runs parallel to the musculature on the sole of the foot.
The superstructure is critical for supporting your arch and carries as much as 25% of the load which passes through the foot. As one can imagine, it also plays a significant role in the gate cycle as it a transfers force from the calf to the forefoot. Since this structure runs the inside portion of the heel (in the direction of the toes) to the base of the toes themselves, one can experience symptoms along any portion of the arch. However, the pain is most commonly felt at the base of the heel.
Previously, research showed that those with higher arches were at a higher risk of developing PF, but new research refutes this claim. The most accurate predictor is not the height of your arch but rather the working relationship between the plantar fascia and the intrinsic muscles that lie above it (towards the top of the foot). Since the plantar fascia is a passive structure that stores and returns energy, it relies on the intrinsic muscles to create the energy needed to support the arch. If the intrinsic muscles are not firing correctly due to adhesion, scar tissue, muscle weakness, or muscle imbalance, the plantar fascia has to adopt a more dynamic role that can lead to it becoming irritated. Tissue that becomes upset in this way can tighten up and restrict blood flow to the area which can lead to scar tissue formation. This in itself is enough to produce pain, but if the underlying problem isn’t treated or corrected, it can progress into an even more difficult problem: tendon degeneration. In this case, the point on the heel bone where all those muscles in the plantar fascia attach begins to degenerate or die.
So, how do I avoid ever getting plantar fasciitis?
1st and foremost, wearing the proper footwear is crucial. think of putting a train on the wrong set of tracks. Wearing shoes that are either too supportive, or not supportive enough can be the leading factor in someone developing this condition. The critical tool for prevention is strengthening the muscles of the foot. Exercises such as toe scrunches and calf raises a few times a week can help develop a stronger arch that will rely less on the plantar fascia and more on the muscles. You can check these out in a foot specific strengthening routine in the recover app here
What can I do if I have been suffering from plantar fasciitis?
As I mentioned earlier, plantar fasciitis can be an extremely slow healer. It's important to treat this early so that it does not become a chronic condition.
Start by assessing all of the training variables that might have led to it developing in the first place. Improper shoes, hard training surfaces, and rapid changes in training volume or intensity are often to blame. If there is an obvious culprit, start there.
Then, a program of pain management and strengthening are appropriate. In terms of pain management, rolling your foot over a golf ball can be helpful form of self-massage. Also, try freezing a Nalgene bottle filled with water and rolling your foot over it. This form of ice massage can really help get that pain down. Since our body does a lot of its healing at night, it's vital that the foot is held at a 90-degree angle (like when you are standing upright) to ensure that the fibers heal in a lengthened position. A night splint or Strasburg sock are useful tools to facilitate this step. In terms of strengthening the underlying musculature, it’s important to incorporate exercises that work the muscles of the foot and arch. You know where to go...
For those suborn cases that are not healing on their own, consulting a professional could be a necessary step. Massage therapists, PT’s, and chiropractors all treat plantar fasciitis on a regular basis and could provide the insight to get you over the hump and back to running pain free.
Editor's Note: Dr. Ian Nurse is the founder of Wellness in Motion, a group of runner focused clinics in the Boston area. WIM's staff of acupuncturists, massage therapists, physical therapists, registered dietitians, sports psychologists, and personal trainers are the go to for first timer runners and elite marathoners alike. We’re excited to feature more of Ian’s running health articles on the Recover Athletics blog!