"Stubborn as an ox" is soooo antiquated. "Stubborn as plantar fasciitis" seems much more applicable, particularly as it is one of the five most common injuries in runners and seems to hang around waayyyy past patience.
Recently, one of our athletes on the DPR running team mentioned pain on the bottom of the foot, near the heel, along with some tell-tell signs of potential plantar irritation. But what is the "plantar fascia"? What does it feel like when irritated? Why does it throw such unreasonable tantrums and what are some non-invasive things to potentially help, as well as prevent symptoms in the first place?
Lets unpack it.
What it is. What it does. Other tissues that play a role.
The plantar fascia is a passive structure structure (can't control it like a muscle) made up of multiple bands of thick, tough tissue with elastic properties. It spans from the heel to base of the toes. Its main purpose is it to support your arch while walking or running. Other major players that aid in maintaining your arch are the posterior tibialis and peroneals, which start at opposite sides of your calf and create a "sling" around your heel. The intrinsic muscles - or tiny muscles located only in your foot - also play a supporting roll. These structures need to work together properly to avoid undo stress on any one in particular. In regards to the plantar: if the arch is not maintained by all tissues it flattens, placing increased strain on the taut bands that passively support it. This can result in changes to the fascia including micro-tearing and a build up of adhesions.
Oh wait! The calf muscle, which is composed of the soleus (deep, endurance muscle) and the gastroc (superficial, strength muscle) refuses to be left out of the party. If your calf is tight, it can limit the ability to pull the foot and toes up toward the shin aka clear your toe while running. Hey there face plant! The calf connects to the Achilles which connects at the heel - very near the plantar fascia. Ideally the entire unit plays nicely together. However, if the calf cannot lengthen as it should the body might try to gain motion from the plantar to avoid the embarrassing face plant. If so, this can cause changes to the fascia. Aka: adhesions, micro tearing, symptoms, not fun.
Just to make this cluster even more complicated, we walk, stand, run, etc. ALL DAY and the area naturally has a lower degree of circulation when compared to say, muscle. Complicated biomechanics, constant use and reduced circulation can all contribute to longer healing times.
WHEW. Lets take a break. Here is a picture of our dog. Dog detox from info overload.
Okay, simply put: the foot and ankle are complicated. When something isn't working like it should, higher stress if placed on surrounding structures - in this case the plantar fascia - which can cause symptoms. 'Nuff said.
Lets get to the good stuff.
Plantar fasciitis is typically a result of increased stress over time causing thickening/adhesions and micro-tearing of the plantar fascia.
Symptoms* most commonly include heel pain, sometimes progressing to mid foot, as well as morning pain or pain when first putting weight on foot after periods of inactivity. Reduced capacity for weight bearing, tenderness, warmth and swelling are also common.
To reduce early symptoms or decrease the risk of plantar fasciitis, non-invasive interventions and exercises have the potential to help. The aim is to improve flexibility, mobility and strength of the ankle-foot complex so that the structures perform their responsibilities more ideally. Here are a few of our personal favorites:
1. Heat and Massage: increase circulation to the area.
Perform: a few minutes a day
*If symptoms are particularly irritable/severe a frozen water bottle can aid in pain reduction. Although it is not advisable to do this prior to performing activities, as cold temporary decreases the structures pliability.
2. Foam rolling calf: to reduced tightness and restrictions in calf. Use a tennis ball to better isolate and release restrictions.
Perform: a few minutes a day
3. Arch Raise: aids in strengthening the musculature supporting the arch of the foot.
Perform: 1-2 sets X 15-20 reps, hold 2-3 sec.
Cue: Do not rotate ankle, only get motion from the arch.
4. Towel crunch: also helps strengthen the muscles of the foot and the ability to naturally maintain the arch.
Perform: 1-2 sets X 15-20 reps.
Cue: Try to pull with toes while lifting arch as in previous exercise.
5. Posterior tibialis and peroneal strengthening: to aid in strengthening the structures that support the arch of the foot.
Perform: 1-2 sets X 12-15 reps.
Cue: Do not allow knee to move/compensate.
6. Calf stretching x 2: remember those two muscles make up the calf complex? Both need to be nice and flexible.
Perform: Hold for 30 sec. minimum. Perform throughout the day.
Cue: Feel stretch mid to high calf with straight knee, low calf with bent knee.
Taping can aid in supporting the arch as well as lessening the responsibility of the plantar fascia. Here is one technique with good anecdotal results, although various techniques and types of tape (i.e. McConnell tape), are utilized as well. Taping has the added benefit of providing insight into how the body might respond to orthotics.***
It is important to note that everyone is different and symptoms are wide ranging. If you are experiencing pain, chat with your coach and seek out a physical therapist to find the most effective options for you.
As for the runner on the DPR team, good communication meant catching symptoms at the very early stages. After a few days of cross training combined with a program similar to the one above, she is back to marathon training!
As always, feel free to shoot questions to firstname.lastname@example.org or leave them in the comments. You'll hear back soon!
Happy running everyone,
Asher Kyger Henry is the running coach for Dasher PR. She is NSCA and NASM certified and finished 5th place at the 2017 US Trail National Championships. She is a lover of her husband and pups, Snapchats with voice changers and a really good high five.
*See mayoclinic.org for additional information (full link in references).
** Reduced mobility of the ankle joint is an additional potential impairment, however a licensed physical therapist should assess this possibility, thus we are not focusing on it here.
***Orthotics have shown to be an option in the treatment of plantar fasciitis. A podiatrist will be able to provide additional information as to if this is a good option for you.
****As always, this blog does not serve as medical advice. Please seek out a medical provider if concerned with your current symptoms. Most states provide direct access to physical therapy and thus, you do not need a referral to obtain PT services.
Photo credits to: Hep2go.com
1. Junior LCH, Carvalho ACA, Costa LOP, et al., The prevalence of musculoskeletal injuries in runners: a systematic review, British Journal of Sports Medicine 2011;45:351-352.
2. Mayo Foundation for Medical Education and Research. Retrieved from: https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/symptoms-causes/syc-20354846