There seems to be an epidemic of this at the clinic at the moment, so I thought a bit of extra info would not go a miss.
First off, what is it? Well, the plantar fascia (PF) is a strip of thick fibrous tissue that extends from the heel bone to the toes on the sole of the foot, connecting to the musculature on the sole of the foot. Think of it like an elastic band that stretches as you flatten your foot on the ground and then tightens as you go onto your toes. Therefore when we run the PF undergoes a significant amount of load, seasoned runners will generally have very strong ones!
With weight bearing activity the PF normally breaks down then remodels and adapts in response to the load put through it, i.e. it gets stronger and stays stronger. Sometimes the fibrous tissue in the PF can break down due to repetitive overload and micro trauma in the PF tissue occurs, this leads to pain and weakness. This degenerative process is not as inflammatory as once thought and current treatment approaches are focused on stimulating the PF to repair and get stronger.
PF can be caused by internal factors like how flat footed you are, how much you pronate and if there are any weaknesses elsewhere in the foot or lower limb. Or, it can be caused by external factors such as changes in footwear, or changes in training that can lead to repetitive overload and break down of the PF. When this occurs, the typical symptoms are pain on the heel or around the instep on the foot. This is often worse first thing in the morning when walking, and often eases the more you walk on it. When PF gets more severe, the pain can be very debilitating and can prevent running.
This condition strikes fear into the most seasoned of runners as it can cause long lay off’s in running. However, common sense and early intervention can help to prevent and treat PF very successfully.
Top tips for prevention
- Keep your training load uniform in it’s progression. Don’t increase milage too sharply. I see PF most commonly in clinic when training load has been increased too much after a long lay off period.
- Use sensible footwear that is correct FOR YOU! Not everyone can use minimalist shoes all the time, if you are unsure get you gait checked by a physio/ podiatrist.
- Poor biomechanics can cause PF. Excessive pronation or leg length discrepancies can lead to overload, if you are unsure get this checked with Physio/ Podiatry
- Drills and speed work that focus on forefoot contact are very beneficial in strengthening the plantar fascia and surrounding musculature.
- Keeping the Calf and hamstrings well stretched post runs can be useful too.
Treatment
If you do have PF, don’t worry, it can be fixed! If the pain is mild, and there are no other compounding factors I often encourage athletes to continue running at a level that does not provoke much pain, this helps to maintain loading through the PF and helps it to heal. If the PF is more problematic then other treatments are available.
Orthotics that correct bespoke biomechanical deficiencies can be very helpful. Steroid injections are popular, though they often only give short term relief and there is a risk of plantar fascial rupture with this treatment, I very rarely use this in practice. Stimulating a healing process with other types of needle therapy and injections is becoming popular and more researched. Extra corporeal shockwave therapy can be quite effective, this treatment involves using a shockwave transmitted into the PF in order to stimulate a healing response. I always encourage graded exercises that steadily expose the PF to more load in a pain free manner, this is essential in the rehab process. In addition to this, taping techniques and deep soft tissue and fascial release techniques can be very effective in rehabilitation for PF.
For more information on Plantar fasciitis treatments, shockwave or injection therapy, get in touch.
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