Runners Guide to Plantar Fasciitis
August 16, 2018
With the Great North Run on the horizon, a lot of runners will now be dusting of their shoes and putting in the miles in preparation for a new PB!
One condition that commonly affects runners throughout their running career is a symptom called Plantar Fasciitis. Runners are particularly prone to develop Plantar Fasciitis due to long periods of running and exercise. The stress and tension that can come from these activities can cause the fascia to become inflamed and strained, in turn this can lead to the muscles and tendons of the foot and lower leg to also become aggravated. The classic sign of Plantar Fasciitis is first step pain, which is a sharp pain at the base of the heel immediately when getting out of bed in the morning. Some runners can continue running with a mild case of Plantar Fasciitis without treating the underlying cause of the problem. On the other hand, for some runners continuing to run can cause additional damage to the Plantar Fascia ligaments and worsen the condition, which can lead to debilitating pain that makes walking difficult, and running pretty much impossible.
Many people believe that only long distant runners develop Plantar Fasciitis, but this is false. It is caused by the constant stress that is put through the heel of the foot, meaning anyone who takes part in a high impact sport is at risk. The problem with running is that people tend to over pronate (foot rolls inward) when they run to ease pain, but this creates further tension on the ligament.
What causes Plantar Fasciitis?
Plantar Fasciitis in runners is usually caused by:
- sharp increase in mileage
- big increase in speed work
- weak feet or arches
- improper shoes for your strike and foot (pronation)
- tight calf muscles (lack of stretching)
- tight achilles tendon
Symptoms of Plantar Fasciitis:
- sharp stabbing or aching pain in the heel
- sharp stabbing or aching pain in the arch (location depends on cause)
- trouble walking after getting out of bed in the morning
- same issue after sitting for long periods, but pain dissipates with movement
Plantar Fasciitis in experienced runners
If you’re an experienced runner and suffer a bout of Plantar Fasciitis, it’s best to take a few days off to allow your foot to heal. During your time off focus on stretching both of your feet several times a day and use a foam roller for your legs and calves. Make sure to take a look at your running shoes and consider replacing them if they appear to be worn out. Once your symptoms begin to improve, slowly return to your running routine at a reduced level and slowly build up to your regular routine.
Plantar Fasciitis for the beginner
If you’ve just started running and suffer a mild or moderate bout of Plantar Fasciitis, you can continue to incorporate running into your fitness routine. However, start slowly by walking followed by intervals of jogging and walking. Make sure to rest for a few days in between each run to allow your feet time to recover and slowly increase the duration and intensity of your walking and jogging intervals up until the point where you are jogging more than walking. If your Plantar Fasciitis worsens at any point, you should refrain from running until symptoms resolve.
What treatment aids with Plantar Fasciitis?
Treatment initially involves offloading the plantar fascia and here at physiotherapy matters our experienced therapists will give treatment advice and assess the needs of your symptoms and whatever stage they are at.
Below is a list of treatment techniques used to treat Plantar Fasciitis.
- Taping – this can work very well to alleviate pain, and can be almost immediate. It isn’t a long-term solution, but can relieve symptoms in the beginning.
- Using a night splint to stretch the calf, so that less load is placed on the Plantar Fascia (if tightness in the calf is a factor).
- Using a gel heel cup – this can act to increase shock absorption, and by raising the heel there is also less stretch on the calf. So, temporarily, this may relieve pain in someone who has a tight calf.
- Massage – but this depends if the Plantar Fascia is actually tight or just painful. If it is tight, then massage can temporarily relieve the pain, but if it is irritated then taping and corrective footwear is preferable.
The causes need to be identified, as correcting them will form part of the treatment, so there is not a recipe that will fit everybody. But these are the areas that need to be assessed:
- Lower limb biomechanics – the angulation of the leg in relation to the pelvis as you move, as well as the knee position, can affect how the foot is loaded. Frequently patients with Plantar Fascia pain will need to correct issues higher up in their kinetic chain.
- Foot type – someone with a very flat foot may need to see a podiatrist. Podiatrists specialise in custom-made orthotics that reduce the load though the plantar fascia.
Sometimes the initial offloading and correction of biomechanical and training issues does not alleviate symptoms, and then other treatments may be considered:
- Acupuncture – definitely not a first-line treatment, but is very useful in conjunction with other treatment modalities to help to alleviate pain.
- Extracorporeal shockwave therapy – Good evidence base now to show it has a positive effect on the painful symptoms.
- Corticosteroid injection – this may be useful in the short-term, but must be combined with other treatments as above.