Plantar Fasciitis: HEEL PAIN WHEN RUNNING
Ever stepped out of bed first thing in the morning and felt a shearing pain in your heel? You may have even looked down to confront the sharp toy truck or shard of glass that MUST be on the floor….there is nothing there, it’s an internally generated pain that feels like a cattle prod to the foot every time you plant your foot down.
The very likely diagnosis here is Plantar Fasciitis.
You may hobble around for 10-30 minutes until it frees up and then your symptoms may peak and trough throughout your day depending on the severity of symptoms and your activity levels.
The thing about plantar pain is that often we can warm it up enough to ignore it and run through it, (that is until the next morning when we take the first step out of bed) to a ‘good morning knife stab’ on the sole of your foot.
And so the saga goes on….until we rehab it so you can walk around and run footloose and fancy free.
This condition accounts for about 10% of Runner related injuries! In middle to long distance track runners this statistic may be as high as 22%. It’s a pest of an injury and will continue to bite you until you address the symptoms, the causes and take a preventative take on it’s management. (Spoken from clinical and first hand experience.)
Firstly, let’s take a closer look at what plantar fascia structure actually is:
The plantar fascia is a thick connective tissue which runs form the base of the heel bone (calcaneus) to the base of the toes and supports the arch of the foot. There are three distinct components of the plantar fascia (medial, central and lateral.) It’s a fan shaped ligament which has a key structural role in foot mechanics and often goes unnoticed until it flares.
The most common area of the Plantar Fascia to become inflamed is the medial and central portion which is why symptoms often present on the inside portion of the heel below the main arch of the foot.
The plantar functions both statically and dynamically. While standing still the plantar helps support the arch of the foot. When walking, running or jumping the plantar fascia helps absorb load like a spring to assist in the propulsive phase of gait.
The plantar fascia is also closely connected to the achilles tendon at the back of the heel also as there are continuous fibres which run from the achilles to the origin of the plantar at the base of the heel. This is why tight calves and achilles can contribute to extra tension in the plantar fascia.
What is plantar fasciitis?
’Itis’simply means inflammation so if we team that with fascia (the fibrous connective tissue on the Plantar/underside surface of the foot- we have inflammation of the heel aka “Plantar Fasciitis”. This is often an overuse injury that is primarily due to repetitive strain causing micro-tears of the plantar fascia, but can occur as a result of trauma or other multifactorial causes. The most common area of the Plantar fascia to become inflamed is the medial and central band so symptoms normally arise on the medial (inner) and central parts of the heel.
Factors that contribute to overloading the Plantar Fascia:
*All of these factors may not be causing your personal symptoms but these are some of the most common causes. There may only be 2-3 of the above relating to your personal injury.
When the Plantar fascia becomes overloaded due to these factors outlined, we end up with micro tears in the plantar fascia which causes pain, swelling and stiffness and then we have to work backwards to reduce symptoms and find the causative factors.
Here’s the money question…..How do we fix it?!
Honestly, it will vary from case to case but here are ‘TEN PLANTAR HACKS’that will get you on the road to recovery and back running!
Most of the time Plantar Fasciitis can be fixed using conservative management as below:
NO fancy equipment needed, just some at-home-rehab to get you
1) Rest/De-load:The hardest part, but most important. If you have micro tears in the connective tissue, it means you NEED to de-load. Maybe not completely, but certainly at least moderately. Imagine walking on a fraying tight rope…. Would you feel confident? Probably not. You don’t want those micro tears to widen into full thickness tears. A few weeks off loaded activity, then a slow return to running/walking/dynamic repetitive activity will help manage the inflammation and healing as you re-load back to activity.
2) Ice massage:Freeze a small glass soda water/beer bottle (only half way so it doesn’t explode). Use this several times a day to massage the arch of the foot. 10-15 mins at a time or until the stare melts. You can do this sitting or standing. This will help relieve inflammation and also break down adhesions in the scar tissue formation.
3) Stretch and Foam Roll: Stretching the calves, the achilles and even the plantar itself can help alleviate tension in the plantar. (Only if this is not provocative to your symptoms.) If it feels like a good stretch, go for it, if it aggravates your heel pain to more than 5/10, leave stretching a week or two till the inflammation has settled. This can be done on the edge of a step. A straight leg heel drop, a bent knee heel drop and even a seated toe stretch where you pull your toes back toward you to stretch the arch of the foot. Foam rolling the calves and achilles is a great way to gian mobility through the lower limb. 5mins each side is perfect.
4) STRENGTHEN:The most recent recent research shows great evidence in strengthening the plantar to help support the fascia to remain structurally stable enough to tolerate the load of the foot. If you have acute pain, it is wise to start very easy with double leg calf raise holds. 5x10seconds to help pain modulation. This can be done with a towel under the forefoot to extend the toes. This is progress to 2x12 single leg heel raises on a step with a towel under the toes SLOWLY: 3 seconds heel drop, 2 second hold at the top and 3 second heel lower. It’s tough but can be done 3-4 times a week with rest days between.
5) Footwear:Moderately cushioned shoes with arch support are best for offloading the plantar fascia. Flat shoes and bare feet will case pain and not support the arch or plantar region. Even an additional heel wedge may help offload the plantar as well. It’s best to fond these through a physio.
6) Tape/orthosis:These can be very useful for offloading the painful area of the heel, supporting the arch and giving mechanical assistance to the foot to reduce the plantar from pulling on the site of inflammation and also reduce impact forces on the calcaneus.
7) Dry needling:This can be very helpful in releasing the calves, achilles and plantarfor both pain relief and mechanical release.
8) Night splint:There are many variations of night splints and the main goal is to keep the foot and ankle in dorsi-flexion (foot flexed) during sleeping so the plantar cannot shorten over night to reduce those very first few very painful steps in the morning and keep you mobile. They are not always comfortable but there are many styles to choose from so if the morning is excruciating, it is worth considering.
9) Trunk and Pelvic Stability:What happens ‘up the chain’ can make a massive difference in force impact ‘down the chain’. This means that weaknesses in the hips and trunk- (glutes, core, hips, hamstrings, quads) will mean more load going through the feet, specifically the arches, hence the Plantar Fascia. the stronger the core, hips and upper leg muscles are the less impact trauma for foot contact on the ground. cough cough…. Pilates for Runners is a game changer for injury management and prevention. I can personally hook you up!
10) Gait Mechanics: It is worth getting your walking and running mechanics looked at by a physiotherapist to see if there are some mechanical changes you could make to offload the inflamed area. For example, excessive pronation (rolling in) of the mid foot can overload the Plantar and subsequently lead to more micro tears in the tissue. Fixing this mechanical issue can help restore function.
Plantar fasciitis is debilitating and can impact life, exercise and most definitely running. It unfortunately cannot be ignored, but it CAN be managed. It is often a slow and steady process but the 10 hacks listed above will get you on the straight and narrow in no time. A holistic approach works best, incorporating:
rest, mobility, strength, mechanics, additional external supports and whole body conditioning to make sure you address the source of the problem and PREVENT it from rearing its head.
The goal of course being: Run Fast, Pain Free.
If you need any 1:1 assistance with your heel pain or would like to tryPilates for Runners with me if that is an area you think you could improve on, hit me up via email using the link below!
The mantra “don’t take back pain lying down” (which came into vogue in the late 90’s) could not be more accurate. I approach Pilates to overcome back pain like having your veggies. You need to get your salad (exercises) in before you can have all the dessert (pain free function) you like. It will vary from person to person depending on the nature and causes of their own specific Low Back Pain, but a holistic Pilates program to reduce pain symptoms and gain function would look like this!......
Are we talking a Chris Hemsworth 6 pack or shredded abs of any form? I’d love to say yes… but quite honestly as a runner and a physio, I am definitely more interested in function, posture and form.
We need core strength to simply live and function at a basic level, but for higher level performance (running) and injury prevention, we need optimal evenly distributed strength around the torso and pelvis.
Runners, listen up! Let's get to the core of the matter....
I would like to nominate this particular running injury as being incredible in vogue in 2020. For many reasons, pavement impact has increased, and (just like socks n sandals) shin splint shave made a hard come back. There can be several causes of shin splints, and all of them vary slightly from person to person, but one thing that shin splints are certain of is that they occur from OVERLOAD.
The first thing to note is: GETTING ONTO SHIN SPLINTS EARLY IS KEY IN A QUICK RECOVERY! The longer they linger, the more imbedded the inflammation they can become and mechanical compensatory issues can start to occur. It’s important not to ignore them....
Here is why!