PLANTAR FASCIITIS
Skip to the bottom of the page if you just want to read what I did for mine.
Today we are going to talk about some of the symptoms of plantar fasciitis and what you might be able to do to eliminate it and continue running. You may have had this in the past and know how annoying it can be to your running. There are plenty of people who continue to run through this issue for quite some time before they seek help. Sometimes you are able to stretch and keep it somewhat under control but there is the risk of tearing the plantar fascia off the heel. If you tear it off the heel it is exceptionally painful. I know because I tore mine. I did not do it running. As a side note, Peyton Manning also tore his which is why he was out so much that last year!!
What is Plantar Fasciitis?
In plain and simple terms it is inflammation to the plantar fascia/ligament along the bottom of the foot usually caused by some microtearing of the fascia due to repetitive strain of the area or surrounding tissues. It can become chronic and move to a more chronic stage such as fasciosis (like tendinosis, the more chronic form of tendinitis) which is most often when I see the patient. We usually do not see the patient until it has become chronic because most people think things will go away so they try to wait them out. When it doesn't go away they seek help. If it becomes chronic it is more difficult to eliminate and also can take longer to get any sort of relief.
What Causes Plantar Fasciitis?
I usually tell my patients that it can be caused by multiple things. It is sometimes hard to say for sure what caused it but there are the obvious things like improper footwear worn for athletic activities, running or walking more than your normal; increase in jumping activities such as in a boot camp class you just started or plyometrics; increasing your running volume too quickly; some diseases or conditions can be a cause such as ankylosing spondylitis or being pregnant. I believe that weaknesses in the glutes and hamstrings can also lead to issues at the ankle and foot such as plantar fasciitis. At a minimum I believe there is a link because I see this so much in my patients-weak glutes with their plantar fasciitis.
Symptoms
The most common symptom of plantar fasciitis is that it is painful the first thing in the morning with your very first step out of bed. It may start out just feeling tight along the bottom of the foot when you first step on it but it progresses to being so tight and painful that you almost can’t put weight on that foot because it hurts so much. Once you get moving and stretch a little you can usually put weight on it and go about your day. You may still feel it while you are walking but nothing like those first few steps in the morning.
Some people get a pain just on the medial aspect of their heel as their first sign. Either way, eventually, it will get so tight and painful with running that you will seek out help due to having to reduce your running. That is when it gets real!
What are the Risks of Getting Plantar Fasciitis?
The American Orthopedic Foot and Ankle Society states the following about possible risks for plantar fasciitis:
being female
being overweight
having to walk or stand for your job
walking or running for exercise
flat feet or feet with high arches
Ok, almost everyone!! Flat feet or high arches…come on! How many people have the perfect height arches? Anyway, if you run a lot, if you increased your running volume too much too soon, or you stand or walk all day for work, you definitely are at risk. If you let this condition progress to being chronic you risk changing your mechanics with running and walking and possibly getting hip, knee, or low back pain.
Review the picture below to get an idea of what the plantar fascia looks like. Many people forget about the lateral band, but you don’t want to forget it when you are working on it. I made a link to a video showing what I did to get my pain to go away in a week and allow me to do my 11-mile run on the weekend without pain.
Image retrieved from: http://theuniquetouchmassage.massagetherapy.com/plantar-fasciitis
What Can You Do if You Think You Have Plantar Fasciitis?
One of the very first things you should do if you begin to feel the symptoms of plantar fasciitis is to stretch your calves. You should do both the bent and straight knee versions. See below:
Image retrieved from: http://goop.com/foot-stretches-to-counteract-high-heels/
Stretches are sometimes enough if you are at the very beginning stages of plantar fasciitis. If you have had it for a while then stretches will not be enough.
You will also want to be sure you do not have weaknesses around your hips/glutes or core as this can also be associated with why you may have gotten plantar fasciitis in the first place. Be sure to test whether your glutes, quads, hamstrings or core are weak, especially on one side. If you find weaknesses you need to do your corrective exercises for these muscle groups at the same time you begin doing your corrective techniques for decreasing/eliminating your symptoms of plantar fasciitis.
There are numerous ideas out there about what you should do for plantar fasciitis. I am not going to dispute them. This is a condition that has always been very difficult to eliminate from a physical therapist's standpoint, especially in runners. It is difficult to eliminate because people who have to stand for their job all day still have to stand all day and runners don't like to stop running!!
What are some other things you can do?
Some people say stretch the fascia, some say not to stretch it. Some say to do Ultrasound or ice it daily or roll a frozen water bottle along the fascia or wear a night splint that holds your foot in a slight calf stretch all night. Any of these things might work for you. I can tell you from years of treating patients with this problem that very few of these treatments completely resolve this condition quickly. They may keep symptoms somewhat at bay but not gone. I have tried everything that has been discussed in the physical therapy world at some time or another with patients and never had great success at resolving it quickly. So, when I got it, I began searching through everything out there and trying every combination of any and everything I found.
When I got it I was furious and had to do something quick!
I got it after an incident involving relieving myself in the woods and seeing a snake causing me to jump and land poorly subsequently causing a partial tear of my Achilles. Because of the Achilles tear I was wearing a slight heel all day at work and I stand all day so that led to my plantar fasciitis.
I was in the middle of training for a marathon and could not afford to take time away from my long runs and did not want to deal with having the pain throughout the run. I also did not want to have to pop Aleve just to get through a run. I finally found a combination that worked and has kept it away for almost a year now. I have tried it with two other people and they had the same, quick resolution of symptoms that I had.
One person I tried it with was a patient that I had seen for knee pain several months prior and she emailed me to say she had plantar fasciitis and wondered what she should do. At the time, I had not come up with this combination of things so I sent her some stretches, ball rolling and foam rolling to see if it would decrease her symptoms until she could get in to see me. About a month later she emailed me back to say it was some better but still there almost every day and she could not walk more than 30 minutes without it coming on again. This time I had my little combo put together. I asked her to come into the clinic for 5 minutes for me to show her and see if it would help. I showed her and a week later she emailed me to tell me her symptoms were gone and she could walk for an hour without pain.
I tried it with one other person who has had symptoms for 2 years. She reported that after the first session she already felt significant pain relief. I counted this as a win because her condition was so chronic. Unfortunately, she did not keep up with it at home as instructed and I have not seen her since she came back about 2 weeks later and told me she hadn’t been doing the things I told her. So, as you can see, this is a very small sample size and I will keep working on it to see if it continues to work for people like it has worked for me. But if you have tried everything else and have not gotten relief, I recommend trying my combo.
Now if I begin to feel any tightness I go through the things again preventatively to be sure it doesn’t come back. Because everyone is different, if you have this issue and what I did for mine does not work for you, try something, anything else so you can get back to running!!
Here is what I did:
Stretched my calves and used the foam roller on my calf daily
Corrected any muscle imbalance weaknesses in other areas of the body, especially the glutes (If you do not know if you have weaknesses try the Evaluate Yourself from Head to Toe testing or see a physical therapist for testing and guidance.)
Used my small, Rubz ball to stretch my plantar fascia
Curled my toes and pointed my foot at the same time until my foot cramped; tried to hold it for as long as I could then rested a few seconds and did it about 10 more times; eventually you will be able to hold longer and longer before the foot cramps until you just stop doing it because it isn’t causing it to cramp anymore
Massage to fascia/connective tissue around heel
**Below is a link to a video to show you some of the above steps. Please have mercy on me for my video skills and for the fact that I do not look my best as I just finished my run and had on no make-up.
I truly hope you never get plantar fasciitis, but if you do, I recommend giving this combo a try!
Kristi