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Plantar Fasciitis – Prevention, Causes, and Treatment


 

By Zachary Kernan

John had been training for the St. George Marathon for the past 10 weeks and as life will have it, work and family obligations took their toll on his training schedule.   Expense reports had come due and the kids had been sick for the previous 4 days, preventing him from running for the past 3 weeks.  This was going to be John’s second marathon and he’s loosely followed a training program that he found online.  The training guide indicated that his mileage should have been at 38 miles for the week with a tapering schedule anticipated over the next 2 weeks. 

 John was quite nervous about the marathon and was concerned that his training program had not been adequate enough for him to finish the 26.2 mile course.  In an effort to catch up and prove to himself that he’d be able to complete the marathon, John skipped ahead on his training program and completed the current week’s prescribed 38 miles. 

 John was on his long run of 20 miles and at mile 16, began to feel an achiness through the arch of his right foot.  The ache was initially dull and John was able to push through the run as it did not affect his pace.  The next morning, John threw back the covers, stepped onto the ground and experienced a sharp pain through the bottom of the heel and the arch of the foot.  The discomfort slowly dissipated by the time he was walking out the door on his way to work.  After being on his feet for most of the day at work, John felt that aching foot come back to haunt him. 

John is experiencing plantar fasciitis, the most common cause of foot pain in adults and one of the most commonly cited injuries among long distance and marathon runners.   Pain is typically experienced through the arch of the foot or through the bottom of the heel.  Symptoms of plantar fasciitis are typically at their worst with the first few steps in the morning and/or with prolonged standing and walking.

The plantar fascia is a thick piece of tissue connecting the heel to the 5 toes.  Its purpose is to provide stability through the arch of the foot.  There’s a higher incidence of plantar fasciitis in the running population compared to the general population due to the repetitive impact, or microtrauma, of the plantar fascia.  The bones and ligaments of the foot must withstand forces that are equal to 3-4x your normal body weight with running.  This repetitive microtrauma can overload the plantar fascia with faulty biomechanics or with overtraining.

There are several factors that increase the risk of developing plantar fasciitis in runners:

  1. Excessive training
  2. Sudden increase in the weekly mileage
  3. Sudden increase in the long run mileage
  4. Flat feet or excessively high arched feet
  5. Faulty running biomechanics
  6. Tight calf muscles
  7. Limited ankle ROM (range of motion)
  8. Limited big toe ROM

Prevention of plantar fasciitis can be best achieved with proper training, regular stretching of the calf muscles, stretching of the plantar fascia, and replacing your running shoes every 300-500 miles.  Proper training that ensures that lowest risk of running related injuries is the 10% rule.  Neither your total mileage for the week nor your long run for the week should exceed a 10% increase of the previous week’s mileage.

The first line of treatment for plantar fasciitis can be done at home and includes:

  1. RICE (Rest, Ice, Compression, Elevation)
  2. Stretching the calf muscles (Figures 2 and 3)
  3. Stretching the plantar fascia (Figure 1)
  4. Wearing supported shoes (avoid barefoot walking)

figure 1 - plantar fascia stretchfigure 2 - Soleus Stretchfigure 3 - gastrocnemious stretch

Figure 1 Plantar Fasica Stretch     Figure 2 Soleus Stretch     Figure 3 Gastrocnemius Stretch

The second line of treatment for plantar fasciitis typically involves a medical provider and becomes more individually tailored to your current condition.  Sports medicine physicians, podiatrists, family physicians, and physical therapists all have vast experience treating plantar fasciitis.  Depending upon the cause of each case of plantar fasciitis, treatment may include medication, night splints, orthotics, arch taping, injections, or a prescription for physical therapy.  In rare cases, where all conservative measures have been exhausted, a surgical release of the plantar fascia may be indicated.

Physical therapy of plantar fasciitis in the running population typically includes a review of the training program, shoe assessment, postural analysis, running mechanics evaluation, manual therapy (ASTYM, joint mobilizations), and prescriptive exercises.

The great news is that plantar fasciitis typically has very positive outcomes.  In most instances, when caught early enough, the recovery time can be as short as a few weeks.  In severe and chronic cases, plantar fasciitis can linger for several months with most episodes being resolved in 1 year with proper treatment.

References:

A retrospective case-control analysis of 2002 running injuries. Taunton et al. Br J Sports Med. 2002;36(2):95.

 Predicting plantar fasciitis in runners. Warren BL, Jones CJ. Med Sci Sports Exerc. 1987;19(1):71.

 Anthropometric and biomechanical risk factors in the development of plantar heel pain – a review of the literature. Rome K. Phys Ther Rev. 1997; 2:123

zach pic

Zachary Kernan, PT, DPT is a licensed Physical Therapist who works for Mountain Land Physical Therapy and Rehabilitation as the Clinic Director in the West Point office. Zach is an active runner and enjoys working with runners of all ages and ability levels. Mountain Land Physical Therapy has offices located throughout Utah and each office is equipped with high speed running video analysis equipment and trained staff ready to keep you at your best. For more information about the running video analysis or to seek treatment, go to www.mlrehab.com/run

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This entry was posted on Friday, December 6th, 2013 at 1:09 am and is filed under Common Running Injuries, Injury Prevention. You can follow any responses to this entry through the RSS 2.0 feed.

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