Is heel pain ruining your stride?
Plantar fasciitis also know as “runner’s heel”, is characterised by a sharp stab or dull ache in the middle of the heel and/or along the arch of the foot. During running our feet absorb 2.5 times our body weight therefore it is not surprising that 10% of runners are diagnosed with plantar fasciitis.
What is the plantar fascia?
The plantar fascia is a thick fibrous band which runs from the heel to the base of the toes. It plays an important role in normal foot biomechanics and dynamic shock absorption. Plantar fasciitis is an overuse condition of the plantar fascia at its attachments.
Who is at risk?
There are a variety of factors that can cause plantar fasciitis in runners including: increasing running mileage too quickly; overtraining; excessive running on hard surfaces; a change in footwear; wearing worn running shoes; and tightness in the calf muscles and Achilles tendon. The main factor however which predisposes runners to developing plantar fasciitis is their foot type. Runners with flat feet (low arches) or high arches are more at risk of developing plantar fasciitis. The flat foot position increases the tension on the plantar fascia due to lowering of the arch thereby overloading the plantar fascia attachment. High arch foot types are at an increased risk due to the lack of shock absorption and therefore increased force which passes through the plantar fascia.
In the acute or early stages it is better to avoid aggravating activity such as running. If there is pain on walking or activity, applying ice afterwards can reduce the inflammatory reaction. If the pain is present for more than three weeks then it is definitely advisable to get physiotherapy treatment to clear it, as the longer you have it for the more difficult it will be to clear.
Physiotherapy treatment for plantar fasciitis should include a thorough assessment, including a biomechanical assessment to find the origin of the cause. Physiotherapy treatment includes: deep soft tissue therapy and stretching of the plantar fascia and calf muscles; a strengthening program to improve the proprioception and stability of the foot and ankle; taping in some cases; orthoses (insoles) if required for flat feet or high arches; a gradual return from low to high impact activities; and advice/education on whether to run and if so, how much running during the rehabilitation process. If the runner already has orthoses, it is important that these are checked as we see some runners in Apex Clinic who have hard orthoses which are in fact, aggravating their symptoms on the sole of the foot. On your return to running it is important to note that the plantar fascia has the greatest stress on it during the propulsive (push off) period of running, therefore you should avoid running on hills until the plantar fascia injury has well and truly resolved.
Have you tried everything with no improvement?
With longstanding cases of “plantar fasciitis” a nerve or spinal component is often overlooked as one of the causes of the pain. At Apex Clinic we specialise in sports injuries and the spine/nerve pain and we see many, many cases of “plantar fasciitis” where the cause of the heel pain or arch pain is actually due to referred pain from the lower back, even when the person has no back pain. Alternatively, the pain could be due to poor movement of a nerve in the foot (the tibial nerve) and this in turn can cause heel pain or arch pain. In both of these cases the pain can nearly always be cleared with the correct physiotherapy treatment along with addressing any of the other causative factors.
There is either an individual cause or a collection of causes of plantar fasciitis. If you are currently suffering from plantar fasciitis make sure that you get the correct diagnosis as to the cause/s of the plantar fasciitis to ensure that you get the correct treatment and return to running painfree.