Monday, September 19, 2016

Marathon Training Tip #11: Treat Plantar Fasciitis


What is Plantar Fasciitis?


The plantar fascia is described as a thick fibrous bands of connective tissue that originates from the medial aspect of the heel through the sole of the foot and inserts at the base of each toe. It is a shock absorbing bowstring supporting the arch of the foot.  For runners the plantar fascia can be a source of major discomfort causing stabbing pain at the base of the heel and aching throughout the arch of the foot. It affects the push off mechanism of the foot and produces pain during push off phase while running.  It can also cause stabbing pain in the morning during the first few steps getting out of bed.

Plantar fasciitis was originally thought to be an inflammatory condition but recent research has found it is non-inflammatory breakdown of tissue as a result of repetitive microtrauma and the name of the condition may eventually be renamed to plantar fasciosis.  There are also studies discussing the tension on the flexor digitorum brevis and its resultant forces on the plantar fascia contributing to plantar fasciitis pain.

Diagnosis of plantar fasciitis would be tenderness to touch along the medial aspect of the calcaneus (heel bone) on the soul of the foot. Tenderness can also be present along the medial arch when palpating the edge of the fascia. The condition is also accompanied with tightness in the calf or Achilles causing a decrease in Dorsi flexion. Strength of the flexor digitorum brevis can also be a factor. In one third of all plantar fasciitis patients, the condition is bilateral.

While plantar fasciitis is thought to be caused by being flat footed, and flat footed runners have higher occurrence rates, it is not clinically proven that fallen arches are predisposing factor. Runners of all arch height can be affected by this condition.

Treatment


Treatment of plantar fasciitis can come in many forms. There is strong evidence supporting manual therapy including self-mobilization of the ankle joint and toes as well as self-soft tissue mobilization of the plantar fascia itself.

Stretching of the gastroc as well as Soleus components of the lower extremity also have strong supporting evidence of improving plantar fashion conditions. Stretching of the sole of the foot by pulling the great toe back is another treatment technique that is supported by strong evidence.

For those runners with significant morning pain, night splints have also proven to be successful in reducing plantar fasciitis pain. Foot orthoses with a supportive arch are also clinically proven and have strong evidence of improving this condition.

Other external treatment alternatives which have good supporting evidence are anti-pronation taping of the plantar aspect of the foot as well as kinesiotaping of the arch of the foot.  RockTape shows an example below:


Strengthening of the flexor digitorum brevis will also help in the treatment of plantar fasciitis conditions. Different ways to perform strengthening exercises for the flexor digitorum brevis include a simple exercise such as picking up rocks or marbles with your toes or trying to scrunch a towel or pick up a hand towel with your toes.

Prevention


While treatment of plantar fasciitis is a good thing to know, knowing how to prevent it in runners is probably more important. Changes to increase mileage to quickly as well as increase in hill training are common flaws that can lead to plantar fasciitis conditions. Making sure you have good ankle joint flexibility to perform Dorsi flexion as well as well stretched lower extremities and a strong flexor digitorum brevis will also help prevent this annoying condition.

Watch the video for some self-help treatment techniques...



Blog post by T.C. Cleary.

About T.C. Cleary PT DPT SCS

T.C. is a member of the Cape Cod Rehab Running Team not because she enjoys running herself, but because she is one of the select few PTs in Massachusetts to be Bard Certified in Sports Physical Therapy. An ice hockey player and coach, T.C. particularly enjoys working with high school and college athletes. She believes in treating everyone the way you would want your child or mother treated and employs many different interventions to obtain maximum recovery. T.C. also has special interest in Anterior Cruciate Ligament (ACL) Injury Prevention & Treatment along with Concussion Management.

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