Plantar fasciitis can be a debilitating and highly painful condition, which can present a significant barrier to training and competition in athletic populations, particularly runners. The plantar fascia is made up of connective tissues that run from the base of the heel through to the toes on the bottom of the foot. This tissue plays an important role in supporting the arch of the foot and absorbing loads as we walk, and in this instance when running. Most commonly, plantar fasciitis presents as localised pain at the base of the heel but may extend further toward the arch of the foot and into the toes. Its distinct features include increased pain with the first few steps in the morning, or after sitting for long periods. In runners, this pain may be more notable during the beginning stages of a run, with less pain as the run progresses due the tissue becoming ‘warmed up’ and regaining some of its elastic properties. The plantar fascia tissue develops small contractures and tears around the areas of irritation, which with use, stretch these areas, explaining why more pain may be felt after periods of rest and/or non-use, and why pain may improve with more activity. This, however, should not be a reason to overlook such injuries. As this injury progresses, increasing amount of pain may be felt further into running, potentially to the point where pain may overcome running causing one to stop and rest.
Due to plantar fasciitis being an ‘overload’ type injury the plantar fascia tissue can be prone to absorbing excessive loads, which can increase the likelihood of such injuries developing. Like always with overuse injuries, training volume should be considered first, and any sudden increases in training load might be attributable to such injuries. Once this has been adequately addressed athletes and coaches should then consider the following areas for further prevention.
OLD runners: Replenish your shoes every 500-800km’s as old runners are a common cause of Plantar Fasciitis.
Having too much mileage in one pair of running shoes is a common cause of plantar fascia overload. Each pair of shoes has supportive properties, which reduce with each wear. This means that the foot relies on more intrinsic support, which it may not have sufficient capacity to provide. Tracking shoe mileage and replacing running shoes every 500-800 kilometres is a good guide to ensure you’re not at a higher risk of overload.
Running too often on hard surfaces, e.g. the road or footpath, can cause excessive load on the foot and structures in the lower limb. Planning certain running sessions on soft surfaces, such as grass or even a synthetic track can help reduce unnecessary and excessive loads.
Running Biomechanics: Getting assessed for any faults in your running stride will help address the potential signs of Plantar Fasciitis.
Firstly, it is important to have your running biomechanics adequately addressed on an individual basis. A video analysis by a qualified professional can be a great starting point. Commonly, biomechanical faults such as over pronating and over striding can produce high ground reaction forces with each foot strike. This means that structures such as your plantar fascia are exposed to higher loads when running and may require certain training to correct any biomechanical faults.
Often an area of training overlooked by the everyday athlete is the importance of regular strength training. Stronger muscles are often better adapted to absorbing and tolerating higher loads. Having sufficient strength through appropriate strengthening exercises in muscles such as the calves and the muscle in the front of the leg, such as tibialis anterior, can be highly effective in absorbing loads associated with running.
If plantar fasciitis has already developed in runners and all of the above considerations have been adequately addressed, then further treatment of the injury is necessary, in conjunction with all aspects we have previously discussed.
Stretches and appropriate strengthening of both the plantar fascia tissue as well as surrounding musculature can help prevent and/or manage small contractures and thickening that develop with this tissue and assists in timely return to sport.
1. Plantar stretch
Bring your foot into dorsiflexion, that is, pointing your toes toward your shin bone. Once in this position gently tension
your big toe in the same direction until a comfortable stretch is felt.
Hold for 30 seconds
2. Knee to wall
Keeping your foot flat on the ground, lunge forward with your knee towards the wall. Shuffle your foot back until you find the point in which you can only just reach the wall without your heel lifting.
Hold this position for 30seconds.
3. Isometric Holds
Regaining muscle strength is extremely important throughout all phases of plantar fasciitis rehab. In the early and more painful stages of injury, certain exercises may be more irritable than others. Given this, isometric holds can be beneficial for gaining early strength improvements before progressing to more dynamic type rehab exercises. To do this, slowly rise up onto your toes until you are at mid-range, meaning not fully outstretched as to avoid excessive tendon load. Once in this position hold for 45seconds, rest for 30seconds and repeat this 2-3 times.
4. Standing Calf Raises
Progressing to standing calf raises and adding a rolled towel under your toes can be effective in building further strength and allowing greater stretch of the plantar fascia. This is also an effective way of increasing strength input throughout a greater range of motion.
Similarly with the exercise progressions previously discussed, return to running should be done so gradually and in realistic increments. Returning to running following plantar fasciitis injury can be done alongside early rehab and strengthening phases if well managed and if all recovery protocols are adequately addressed.