This all too familiar season damaging malady ranges from a gait changing and compensating annoyance to extremely debilitating and disabling. It presents with pain and tenderness of the plantar fascia and/or the inner, underside calcaneus (heel). It can feel like a “tearing” sensation when taking initial steps after sleep and/or prolonged sitting.
This painful repetitive stress injury is an inflammation of the plantar fascia and peri-fascial structures. It typically results from Micro-Tears of the thick fascia.
The following causes are hallmark with Plantar Fasciitis:
- Over-pronation – causes excessive plantar fascia elongation and tension
- Muscular weakness @ Gluteus Medius, Maximus, Posterior Tibialis Muscles
- Gastrocnemius/Soleus (upper, lower calf) and Achilles Tendon tightness
- Under-pronation – inability to dissipate ground reaction forces
- Prolonged shoe wear (rough estimate to change shoes @ 400 miles)
- Excessive mileage or training intensity
- Road Pitch – due to the unevenness of roads, consider this component when planning run routes
- AGE – 40-60 is the highest occurrence and women > men
- Speed work – this can add undue stress to the plantar tissues
Management of Plantar Fasciitis:
- “PRICES” (Protect, Rest, Ice, Compression, Elevation and Support) when acute
- Orthotics – cast for proper biomechanical foot support
- Kinesiotape the foot/ankle to properly support the fascia
- Myofasical and Active Release Therapy – address @ calf, Achilles, foot and hips
- Stretching the lower and upper calf muscles – daily!
- Rolling treatment with cylindrical device and/or tennis ball over plantar fascia
- Adjustment/manipulation of the foot, ankle, knee, hip and lower back for alignment, joint function and proper biomechanics – frequently the developmental cause of the condition
- Ultrasound treatment (2-3X/week)
- Iontophoresis treatment (1-2X/week)
- Dorsi-flexion night splint – wear during sleep for 4-8 weeks
- Anti-inflammatory support – oral (Proteolytic Enzymes), topical (Traumeel) – 30+ days
- Diagnostics: MRI, Diagnostic Ultrasound to determine extent of damage (tears, heel stress fracture, etc.)
- PRP (Platelet Rich Plasma) – for resistant cases consider this progressive technique for injecting enzyme and platelet rich plasma into the injury site
- Avoidance and training modification – pool running, rowing erg, elliptical and/or recumbent bike
- TOPAZ – micro-debridement surgery for resistant cases – this procedure includes numerous “micro” injections into the fascia for a releasing effect
As with all lower extremity injuries, the best medicine is prevention. Train with a sound ramp-up strategy, get fitted for proper shoes and orthotics, maintain structural alignment and stretch lower extremity, hip and lower back muscles and maintain soft tissue compliance with a foam roller routinely. If this malady strikes, get assessed and address with the appropriate therapies sooner than later to shorten the healing window so you can get back to training without pain!!