Why you keep getting injured: A complete guide to Plantar Fasciitis
Plantar Fascitis is one of the most common running injuries, and the most common cause of reported heel pain. If my house is anything to go by, I’m guessing Lego related injuries are a close second. Around 1 in 10 people (not just runners) are diagnosed with Plantar Fascitis, with it being more common in 40-60 year olds, and women 6 times as likely to suffer.
What does it feel like?
Most people first experience Plantar Fasciitis (PF) as pain in the heel. My personal experience with PF has been pain in the arch of the foot that felt like a tormented three year old was attempting to break the surface of the skin with a marble. Whilst my pain was only noticeable with activity, many of my clients have reported increased pain upon waking or sitting, anywhere from the heel to the arch, and I’ve seen people unable to walk as a result of PF. The saying pain in the arse gets too much street cred. Those who have suffered with PF will know that a pain in the foot can control everything about your day, and mood, when it hits its peak.
What causes it?
My PF first came about when my foot and Vibram five fingers first become acquainted, not that long after they first appeared on the market. I’m sure I am by no means the first person to have suffered PF upon their first affair with these shoes, carrying it almost like a STD from that girl or guy you probably shouldn't have messed around with. But if my body wanted to let me know that these fairly unattractive shoes weren't for me, it made it known during my newfound zest for beach sprinting free of worrying about sticks and wheels that often frequented my local. And I’m sure I’m not the first person to fall prey to PF as a result of the barefoot running movement. To be fair, I had been running barefoot for many years, but it was the confidence I gained through not having to worry about anything damaging my foot on the beach, that saw me dramatically increase my sprint volume. (And between you and I, it wasn’t the last time I made that fashion statement, which for a while, I was secretly quite fond of).
The plantar fascia is tissue that supports the arch of your foot from the calcaneus (heel) to the toes. It’s role in running is particularly apparent from foot contact to toe off-so essentially it’s pretty important the whole time your foot on the ground. Downward force on the arch of the foot stretches the fascia beyond its strength, and can be one of the many causes of PF. The massive increase in PF injuries with people transitioning to barefoot running makes sense, as many mistakenly keep the heel loaded away from the ground, keeping the plantar fascia on stretch with repetitive downward force. Indeed, any activity or position that places stress on the arch of the foot, weather directly or as a result of misalignment in surround muscles, could be seen to be involved in PF. Most cases are the result of small tears or irritation in this area, but some may see a complete tear, or even a tear of the tissue away from the heel. Traditionally, it has been said that shoes with poor arch support is a cause of PF, but in a healthy arch this shouldn't be a problem. More likely contributors outside of the ugly shoe transition are tightness at the Achilles and poor running and walking gait.
Causes-going deeper
As mentioned anything that places extra stress on the Plantar Fascia is likely to be involved in development of of PF. An often overlooked aspect is the role of a fancy sounding muscle called Posterior Tibialis. This is a deep muscle sits underneath the “calf” muscles, and plays a role in eversion of the foot (part of the process of pronation). The essential information here, is that, alongside the Soleus (line of your calf muscles), Posterior Tibialis serves to support the arch of the foot. Weakness of the Posterior Tibialis could see extra stress on the Plantar Fascia, (as well as Soleus as resulting Achilles issues). Causes aren’t limited too what I’ve mentioned here. Poor range of motion of the ankle, either through poor articulation of the joint, or calf tightness, and structural and biomechanical issues relating to poor foot mechanics may also be involved.
What to do about it.
Support
Firstly, given that downward pressure on the arch is likely to exacerbate the injury, supporting the arch in the early stages is a good call. Either an arch support, or taping the arch makes sense.
Rolling
Rolling the foot doesn't make sense to me in the early stages whilst the tissue is healing, though you may roll the area away from the injury site to help deload tension, or use your hands to do so, which is preferable. Either way, and despite doing this myself to keep the arches of my foot feeling good, there’s no real evidence in the literature on this just yet. For me personally it’s the best way to use a golf ball (my golfing skills are terrible). Keep in mind, that the need to release in this manner depends on what is contributing to tightness in this area.
Releasing
Keeping the ankle joint mobile is also important to keep the Plantar fascia happy during movement. You could do this through placing a band around the front of the foot, with it anchored behind you, and bringing the knees forward over the toes to improve articulation at the joint.
Stretching
Stretching the calf has been one of the main treatments for this injury for sometime, but ensure that you aren’t just stretching one part of your calf. Perform bent knee and straight legged calf stretches, as well as stretches that involve bending the toes back. (Triceps surae)
Strengthening
It’s important to ensure that muscles like the Posterior Tibialis are strong to help support the arch. Calf raises are good, but you need to ensure that you are working the right muscles. In my experience, most people when performing a calf raise, are doing little to help the Posterior Tibialis, and may actually be creating some muscles imbalance through the lower leg. Check out how to do this properly here.
But can I run?
It depends (doesn’t it always?). If your pain is excarabated by running then obviously not. If you are able to reload the arch, with a support or tape, and running gait isn't an underlying cause of your pain, then yes. If you are reading
this and the injury has just happened, and you are scrambling to find someone who will tell you that, yes, you can run, then chill out for a couple of days. If at that stage you can do a light run with some support on the arch, and everything pulls up ok. Then keep running, but avoid hills and sprints for a little while- you’ll know when.
Ongoing Running Technique
Hills and sprints would be a no-no for a little whole. Decreasing your stride can be a good thing for taking some stress of the foot (and everything else).
Wearing shoes with some arch support may also be helpful, though if this freaks you out, initially phase it out through cycling your shoes every 2 or 3 runs, back into your more neutral shoe. Ensuring that foot loading is optimal during running via a gait analysis would b every useful, and ensuring over pronation isn't a factor.
If your a forefoot striker, return to running pain free may be slower, and preceded by more strength work, Alternatively, short bursts of running, followed by a strategy to deload the calf and plantar fascia could work for you.
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How to prevent it
Toe scrunching exercise
Scrunching a towel on the floor with the feet is a good way to keep the muscles
in the base of the foot string and active, and maintain a healthy arch. For added
difficulty, pick the towel up with the toes and pass it to the other foot without
touching it with your hands.
Arch support
If you are reading this and think you may be at risk of PF, then running with a
good arch support may be the trick to allowing you to run pain free whilst you
take the time to work on some of your weaknesses.
Optimal running gait (click here if you want me to check out your running gait as part of both my online and face to face services)
Running patterns that allow for a healthy distribution of load through the foot
and subsequent joints is the key to avoiding any injury. In this case, particularly
being on the look out for over-pronation, or in the case of forefoot or midfoot
strikers, making the mistake of keeping the heel raised and calf loaded, which
not only limits force transfer but places a huge amount of stress on the calf and
plantar fascia.
Click here to take my quick interactive free assessment now.