Plantarfasciitis: Injury in focus

12th December 2013

By Peter Colagiuri

As a runner, if you haven’t had plantarfasciitis, you’ve at least heard about it or know someone who’s suffered from it. So why is it so common, so frustrating to fix and so debilitating?

Firstly, we need to look at the anatomy and function of the plantarfascia. It’s a moderately springy band of tissue under the foot that absorbs force as the arch collapses, helps to lift the arch as you’re preparing to push off and gives the foot some rigidity when you’re pushing off. Very handy thing to have and very busy little structure. It gets it’s versatility from the design, connecting on to the toes so that it can stretch out when you first hit the ground (and the toes are flat) and tighten up late in the stride (as the toes bend back). But with complex design comes complex dynamics and the potential for abnormal loading.

And this is where plantarfasciitis comes onto the radar. Technically it’s not an “itis” (suffix used for inflammatory conditions) as there’s no direct source of inflammation. It arises when the structure undergoes abnormal or excessive load. The irritation usually commences at the base of the fascia, where it connects on to the calcaneus (heel bone). From there, it can cause an associated bone reaction and/or it can spread further forward along the fascia.

The key identifying features of a classic case of plantarfasciitis are:

  1. Excruciating pain on putting weight through your feet first thing in the morning (and occasionally after a long period of sitting)
  2. Easing pain as it “loosens up” in the morning and on runs
  3. Worse in unsupportive footwear or barefoot walking

These features aren’t exclusive to plantarfasciitis but should raise the degree of suspicion if they are occurring, and slowly getting worse.

Then there’s the long list of underlying causes of plantarfasciitis: bad shoes, weak or fatigued muscles, poor stride mechanics and rapidly increasing training loads, just to name a few. But the easiest way to understand the causes is to look at the common link behind every cause: plantarfascia loading.

When you run further than usual, your stabilising muscles begin to fatigue mid-run and your arch collapses with greater speed, leading to increased loading. The same dynamic is behind causes such as old shoes (worn cushioning can accelerate pronation), increased body weight (leads to earlier fatigue) and plantarfasciitis soon after returning from another injury (weaker muscles fatigue earlier).

Poor stride mechanics can increase plantarfascia loads as longer strides make it difficult for stabilisers to function, making them less effective at supporting the foot and placing more demand on the fascia.

Treatments for plantarfascia fall into two main categories: those that minimise the pain to keep you running and those that fix the problem. Although the first type of treatment can keep you moving in the short term, you will need to fix the underlying cause to actually be free of the problem.

Pain-relieving treatments include: ice, stretching and self-massage (rolling a frozen bottle of water under the foot). There’s even a special sock to maintain the tension on the fascia overnight so you minimise that early morning pain. But each of these methods only relieve the pain to some extent; they won’t fix the problem. In addition to the DIY treatments, physio can offer a very effective taping to support the foot and take away most of the pain.

The fixes for the underlying issue can be: strength/stability programs, joint mobility work, running technique corrections, new footwear or training modifications; the trick here is that it needs to target your particular problem otherwise it won’t be successful. These approaches are often used in conjunction with the pain-relieving treatments to keep you running, partly to maintain your sanity, partly to minimise the risks associated with time off running.

The best advice I could give to anyone suffering from plantarfasciitis is to get running-specific help. The function of the fascia and causes of the problem are quite complex and aren’t likely to be fixed without a thorough understanding of what’s going on. Timely good advice saves you frustration, lost running time and frustration. Yep, it’s that frustrating.

See more at: http://sydneyrunning.com.au/injuries/injury-in-depth-plantarfasciitis/#sthash.l5oj0oAf.dpuf

Top tips for treatment:

  1. Adding a higher heel can help ease the stretch and the pain. It can be done with a heel left inside your runners or by selecting a medium height heel for ladies dress shoes (1-2” heel should be sufficient)
  2. Roll the foot over a frozen bottle of water. Just pop a 600mL bottle of water upright in the freezer with 500ml of water in it (to allow for expansion)
  3. Old-school toe crunching exercises don’t work as they encourage abnormal muscle function around the foot
  4. Low-Dye taping is very effective at relieving pain and taking the stress off the area. It can be part of the solution for short episodes of plantarfasciitis but it’ll need to be applied by a physio, podiatrist or chiro
  5. Stick with your treatment approach long enough to evaluate its effectiveness and adjust it if needed
  6. Be patient! Plantarfasciitis takes weeks or months to build up; don’t expect it to disappear overnight
  7. Anti-inflammatories (eg. Nurofen, Voltaren) don’t fix the problem and can often complicate the treatment by temporarily masking the pain feedback to abnormal loading of the  fascia
  8. Stretching may relieve some of the pain but forceful stretching can make it worse
  9. Stopping exercise for a prolonged period isn’t a solution. It may give short term relief but it can lead to weakness and add to existing causes of the problem

Peter Colagiuri is a Sports Physiotherapist, specialising in running injuries. He practices in Miranda and Manly in addition to researching at the University of Sydney. For more information see bioathletic.com.au, manly@bioathletic.com.au or book an appointment (02) 9977 1580.

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