I’m a little nervous to say this...but I think Spring is here!
If you are like me then you are itching to get back on the road or back on the trails and resume running. If your running days are over or you prefer walking, then this article is for you too. Today I would like to talk about Plantar fasciitis, how to treat it and what you can do to minimize your risks of developing it.
The plantar fascia is a thick band of tissue that runs along the arch of the foot from the heel to the base of the big toe. The plantar fascia is a continuation of the calf muscle along the achilles tendon into the heel and bottom of the foot.
Plantar fasciitis accounts for around 8% of all running injuries and is common among runners of all ability levels. It is the most common cause of pain on the bottom of the heel and approximately 2 million people are treated each year for this condition. Plantar fasciitis is often diagnosed as an “inflammation” of the plantar fascia, but it may in fact be a degenerative process without inflammation.
The most common risk factors are:
1. Excess Body Mass (i.e. obesity)
2. Prolonged Standing (occupational)
3. Increased running (walking)
4. Lack of ankle dorsiflexion motion (related to excessive heels on sneakers/shoes)
5. Lack of great toe (i.e. big toe) extension motion
There are a variety of treatment options recommended but unfortunately there is no clear choice for everyone. Every case is unique. This is a point I would like to make sure is emphasized because unfortunately we make assumptions that the treatment that works best is one that works for everyone. Sure there are similarities, but identifying your specific issue is often the difference of a reasonable outcome with a prolonged agonizing outcome.
Physical therapy is one of the most effective (consistently effective) for those suffering from plantar fasciitis. There are other common treatments, but when I did research and reviewed the actual scientific studies there were only a few consistently effective solutions.
1. Inserts (i.e. orthotics) for 2-12 months (Inserts should be a TEMPORARY SOLUTION...not a long term plan) This can be off the shelf OR custom orthotics.
2. Heavy loading/strength training (foot/calf)
3. Manual therapy (specifically trigger point release techniques)
4. Stretching has only a mild effectiveness at best.
For those of you that know me or have heard me talk, you will know that I advocate for strengthening the foot. This is especially important for plantar fascia health. I prefer to avoid long-term use of inserts because joints that don’t move leads to the muscles that cross them to get weaker. Recent studies have shown that shoes that limit or prevent motion lead to weakness in the muscles of the foot. The same authors have also found that people that use “barefoot” style shoes (no support at all) will see improvement in strength of the foot in a matter of weeks.
Inserts are incredibly helpful at times and similar to how we use splints and casts to protect our bones and joints when they are injured, inserts can serve a similar function. But when we are in a cast for weeks allowing the bone to heal, our muscles atrophy and our joints stiffen. For some people, wearing inserts can have the same effect.
The bottom line:
STIFF FEET= WEAK FEET
On the other end of the spectrum you will see a lot of runners wearing shoes with extra cushion. The idea is that more cushion will absorb forces and “protect” us somehow. Unfortunately this is not the case.
The Orthopaedic Journal of Sports Medicine published a study that concluded, “runners experienced a higher impact peak and increased loading rate with the “maximal” shoes.” They calculated that the “Vertical force impact peak (VFIP) was significantly longer in the soft shoe,” resulting in MORE IMPACT, not less!!
These discoveries may explain why shoes with more cushioning do not protect against impact-related running injuries.
Modern shoes try to manipulate the “natural foot” movements by one of two ways:
1. Controlling motion (i.e. inserts)
2. Controlling shock absorption (i.e. more cushion)
Trying to control your feet or use them in an unnatural way may be part of the problem. What we do know is that in the last 50 plus years of trying to manipulate our shoes, there is no evidence of these technologies actually reducing injuries.
Let me direct you back to the main risk factors that are associated with plantar fasciitis that can be addressed with exercise, specifically strengthening of the foot and calf muscles. Physical therapy can help by providing you with exercises to strengthen the muscles that are unique to you and can ensure you progress safely.
If you are experiencing pain at this moment, my therapists and I recommend a full body assessment to ensure you are addressing where you are weak, or where you may have mobility “cheats” that are contributing to your issues. At Goodemote PT, we also perform manual therapy to improve blood flow and reduce pain and allow for a safe progression back to activity.
There are a variety of treatment options but unfortunately there is no clear choice for everyone, find a guide because every case is unique!