Plantar fasciitis and running

Plantar fasciitis can affect all types of runners from new to experienced runners. It doesn't discriminate between being relatively "fit" to overweight and can become the bane of your life if you are not careful. Plantar fasciitis is also known as a heel spur or runners heel but as far as most people are concerned its a throbbing heel and arch pain. Put simply plantar fasciitis is inflammation of the plantar fascia. The plantar fascia is a broad, thick, fibrous band that extends from the base of the calcaneus (heel bone) to the base of the toes. The fascia is composed of a close-knit network of organised collagen fibers, which gives the fascia the strength necessary to support the immense force placed through the arch when walking . One of the first tell-tale signs will be increased discomfort in the arch while your running and this will progress to a really sharp and uncomfortable pain in the arch and heel so much so that you will start to reduce your mileage and eventually just stop running. You will be happy to know that you are not the only person suffering from this, approximately 10-15% of runners get plantar fasciitis including professional athletes and Olympians. Dathan Ritzenhein, a pre-race favourite dropped out of the New York City Marathon. We learned he had a 20 to 50 percent tear of his plantar fascia as well as Olympic marathoner Ryan Hall who was forced to drop out of a Marathon due to plantar fasciitis.

Other Conditions that resemble plantar fasciitis

Before we start to talk in detail about plantar fasciitis its important to talk about the other conditions that can also mimic plantar fasciitis type pain.

A stress fracture of the calcaneus which is the heel bone is common in runners and is often confused with plantar fasciitis, there will be pain present when the heel is squeezed from the sides especially on the outer aspect.

Plantar fascia rupture, if you have this then you can't really miss it! The fascia which is the fibrous structure that runs from the heels to the toes will be swollen, very painful and could also be warm to touch.

Baxter neuritis which is a fancy term to a squeezed nerve in the heel called the baxters nerve. You would get pins and needles along the nerve and sometime the runner will feel a burning sensation.

Arthritic conditions such as rheumatoid arthritis and ankylosing spondylitis.

Causes

Now back to plantar fasciitis, we need to define this as opposed to Plantar Fasciosis which is when  the plantar fascia has actually started to deteriorate. Plantar Fasciosis is sometimes called chronic plantar fasciitis and if you have regularly occurring instances of heel pain, that do not go away within a few weeks, you may have Plantar Fasciosis. Plantar fasciitis is inflammation of the fascia at the insertion point of the heel. If the arch of your foot is like a bow, think of the plantar fascia as the bow’s string. The plantar fascia, along with several muscles both in the foot and in the leg, supports the arch and makes it malleable. Too malleable, and the foot flattens out, overstretching the plantar fascia. Not malleable enough, and the plantar fascia absorbs too much weight too quickly.

The reason why you get plantar fasciitis if you're a runner is quite complex and could involve a number of causative factors. One of the most common causative factors we have found in clinic is tight calve muscles i.e. the gastrocnemius and the soleus. If your calf muscles are tight this will in turn put a greater strain on the plantar fascia.

One of the other main culprits is a condition called over pronation which is essentially when your foot rolls in too much. As the foot rolls in too much the arch of the foot collapses which puts a greater strain on the plantar fascia. However the converse which is over supination which commonly occurs in high arched feet can also lead to inflammation of the fascia.

Inappropriate running shoes or running shoes that are really passed their best days can also aggravate the fascia and lead to this condition.

A sudden increase in mileage or intensity can lead to plantar fasciitis or changes in your running technique such as change your foot strike.

Treatment

There are various treatment options for runners with plantar fasciitis from cortisone shots to extra-corporeal shock wave therapy however one of the first interventions you can do to treat plant fasciitis is good old fashioned rest. Staying away from running for a few weeks will allow the inflammation to reduce. However other treatment options include sports orthotics such as the dr foot sports insoles which have been used to treat runners with plantar fasciitis for over 15 years.

Other treatments include changing your running shoes, taping the arch and heel to take pressure off the plantar fascia and stretching exercises. I cannot stress the importance of stretching the calves too much, we have found in clinic that the dr foot sports insoles along with stretching the calves tends to resolve this condition.

Stand with the leg to be stretched at the back and hands on a wall at shoulder height. Bend the front knee and lean forwards, keeping the back knee straight and pushing the heel down into the floor. Hold this for 20 seconds and repeat 3 times on both legs 2-3 times a day. Other treatments include steroid injections, acupuncture, prolotherapy injections, night splints.