Runners Guide to Plantar Fasciitis

February 20, 2024

Blog Updated 20th February 2024

Plantar fasciitis

Plantar fasciitis, also known as plantar fascia pain, is a common musculoskeletal disorder affecting the connective tissue on the underside of the foot. As well as providing arch support, the plantar fascia also functions as a shock absorber when weightbearing, and contributes to the normal biomechanics of the foot during walking or running. Research has suggested that repeated strain of the plantar fascia can result in microtears, which when combined with inadequate recovery can lead to inflammation and discomfort. Plantar fasciitis typically presents as intermittent sharp
pain localised to the heel and underside of the foot, which is typically exacerbated by weightbearing and running, and eased by rest. Plantar fasciitis is often painful standing or walking after a period of inactivity, and tends to get better with prolonged movement only to return after further inactivity.

Plantar fasciitis has a lifetime incidence of 10% meaning that 1 in 10 individuals are likely to experience it at some point in their life. It is one of the most common presentations in primary care settings, thought to be the cause of between 3.6 to 7.0 in every 1000 visits to the GP surgery or health clinic.

Common risk factors for plantar fasciitis, include:

• Age – plantar fasciitis is most common in individuals aged between 40-60, likely due to degenerative element of condition in combination with the relativity well maintained levels of physical activity in this age group. Plantar fasciitis can be seen in younger individuals, particularly those that are highly physically active.
• Sex: females are more likely to have plantar fasciitis than males – the mechanism is not completely understood but increased joint laxity and greater midfoot motion is thought to be a contributing factor.
• BMI: Overweight or obese individuals are more likely to develop plantar fascia pain, when compared to those with a lower BMI.
• Foot biomechanics or poor footwear: those with PES planus (flat feet) or PES cavus (high arches) more likely to develop plantar fascia pain.
• Reduced length of calf muscles or Achilles tendon.
• Occupations involving prolonged standing – think bar staff, teachers, landscaper gardeners.
• Sudden increases in training – increases in loading of the plantar fascia such as starting to play a new sport or training for event such as a half marathon.

Management:

Plantar fasciitis is typically self-limiting with 90% of cases of plantar fascia pain resolving within 12 months with conservative care. Treatment for plantar fasciitis may vary depending on risk factors and presentation but typically may consist of:

• Rest – temporary reduction in training load/volume/intensity to allow symptoms a change to settle. As symptoms improve aim to gradually build up physical activity.
• Stretching – stretching of the calf muscles and eccentric loading of the Achilles tendon.
• Rehabilitation exercises – identifying and working on risk factors such as strength, balance and mobility of the ankle and surrounding structures.
• Taping – can provide short term relief of symptoms, used mainly for symptoms management.
• Orthotics – heel gel pads or insoles to provide improved arch support can be useful in reducing pressure on the plantar fascia, particularly for those that have pes planus (flat arches) or cavus (high arches).

Up to 10% of cases of plantar fasciitis can become more persistent in nature, and may benefit from consideration of second-line approaches – such as:

• Shockwave treatment: non-invasive treatment which uses high energy sound waves to stimulate soft tissue healing.
• Injection therapy – use of corticosteroid or platelet rich plasma to reduce inflammation and encourage soft tissue healing.
• Referral to foot and ankle orthopedic specialist for potential surgical management.

If you are suffering from heel pain, that may or may not be plantar fasciitis or any other running or sports-related injury, consider booking in for a physiotherapy assessment. We offer free 10 mins triage calls to discuss if we feel an assessment would be worthwhile to assess your problem.

For bookings and enquiries, contact our reception staff at 0191 285 8701.