In the coming months, seasoned runners and first time runners will begin their training and preparation for Vancouver’s annual Sun Run. It is this time of year that we see a rise in one of the most debilitating injuries for runners: Plantar Fasciitis.
The Plantar fascia is a frequently injured band of connective tissue that runs from under the heel, fanning out and forwards to the bases of the toes, which provides support for the medial longitudinal arch of the foot. The plantar fascia is stretched and the arch flattens slightly to absorb the impact each time the heel impacts the ground. The fascia is not very flexible and such repetitive stretching from impact can result in small tears in the fascia, and subsequent pain.
The Plantar fascia connects to a long line of muscular slings up the lower extremity. The interconnections of the plantar fascia to the Achilles tendon and calf muscles, the lateral Hamstring, the sacrotuberous ligament in the pelvis, the gluteus Maximus in the buttock and the long extensors in the spine create functional connections where dysfunction anywhere along this line can present itself as plantar fascia pain.
Plantar fasciitis is the syndrome caused by the tearing and inflammation of this tissue, usually at the inside heel attachment, and it is one of the more common problems affecting sports participants and especially people over the age of 40. Given the relationship the plantar fascia has with the surrounding musculature, careful examination is essential for correct diagnosis.
What are the symptoms?
This condition usually occurs on one side at a time. There is typically sharp pain under and along the inside of the heel when weight bearing. It is often worst on first rising in the morning and then with activity which often, but not always, involves running. With severe cases there may be a pain at rest, and walking without a limp may prove impossible. This limping can in turn cause secondary problems elsewhere is the leg or low back.
Some typical factors make this condition more likely to occur:
Muscular imbalance. Tightness of the calf, hamstrings, hip or low back muscles with weakness of the trunk stabilizers and supporting arch musculature of the foot.
Skeletal factors. Stiffness of the big toe and poor arch support both increase the load on the plantar fascia.
Poor footwear for the activity. Improperly fitting or excessively worn shoes that no longer support the heel and arch correctly will lead to overstress of the plantar fascia.
Excessive mileage or too rapid an increase in activity. It is more common in people training over 40 kilometers a week. Overly aggressive progression of sprint or hill work is also a trigger.
Age related. Age produces weakening of connective tissue. This condition occurs more frequently in those aged over 40.
Therapy needs to be prompt and aggressive to avoid a chronic injury which rapidly becomes more difficult to treat. (Runners typically need to temporarily reduce by 25-75%.) Cardiovascular fitness can be maintained with cycling or water running. No sprinting or hill running! Early control of pain and inflammation is achieved with ice and electrotherapy, which includes ultrasound, interferential and current stimulation. If necessary, specific taping to support and protect the fascia will also be used. It is often also necessary to correct any joint restrictions through mobilization or manipulation of the articular structures. As symptoms settle, rehabilitation begins with slow stretches for the calf muscles and fascia. This is progressed to strengthening of the arch support and deep calf muscles. (Applying heat to the muscle between stretches can improve the effect.) You should repeat these exercises at home two to three times daily. Orthotics or generic arch supports to help control foot position are sometimes useful but often an alteration in running style or footwear is more important and may be all that is required. Walk softly! Walking heavy on your feet will increase foot strain. A carefully graduated and monitored return to full activity is essential to prevent a recurrent problem from developing.
REMEMBER: Early recognition and treatment is the best way to avoid ongoing disability. Don’t risk a chronic injury by returning to full activity too quickly!