Running: Plantar Fasciitis

Running is one of the most participated sports throughout the world; this is probably partially due to the fact that you can just go out and run at any time. Also, running is taught to us from an incredibly young age; the next phase of movement from walking is running.


However, when running is taken up seriously as a sport there are some common injuries that come along with that. This series of blogs is going to talk through those common injuries and ways that they can be prevented.


Starting at the Feet

Starting at the feet; one of the most common running injuries is plantar fasciitis. This is an inflammation of the fascia that covers the bottom of the foot. The plantar fascia originates in the calcaneus (heel bone) and inserts into each toe individually, it also helps to support the arch of the foot. Plantar fasciitis is the most common cause of heel pain and feels like a sharp pain the heel or arch of the foot. The pain gradually gets worse with time and tends to be worse in the morning or after periods of inactivity, then as the plantar fascia warms up the pain decreases. As the condition advances you may experience pain during activity as well.



Predisposing factors to plantar fasciitis are tight calves/ Achilles as well as high arches. Other risk factors include overtraining, increased hill work, footwear with poor cushioning, worn footwear, increased distance or intensity and a change of running surface. It is also associated to repetitive stress which is where running comes in. The repetitive impact on the plantar fascia can cause the inflammation.




So, what can we do to prevent it?

If you are planning on increasing your training load, then make sure to do it gradually so that the plantar fascia can adapt to the distance and strengthen as you go along instead of getting inflamed. Another important prevention tip is to make sure that if you are someone with tight calves to regularly stretch/foam roll/ get a massage to loosen them off as this can cause an alteration in foot positioning if left tight for too long. Correct footwear is also important so if you’re running regularly then getting your gait analysed is important as the correct footwear can then be recommended to you with the correct cushioning and support.



If plantar fasciitis is something you’re suffering with then there are a few things you can do at home to help with this. One of the first things is activity modification, and no this does not mean sit down with a glass of wine and put your feet up! So, if running is causing the pain to get worse then a break from running might be beneficial. With the addition of taking up activities like swimming or cycling that don’t have that repetitive force being impacted on the plantar fascia. Then, as the pain subsides, a graduated return to running pain free would be the best course of action. A return to running program can be sourced from a Sports Therapist. As previously stated above massage/ foam rolling to the calves, Achilles and underside of feet would help. Also, if you freeze a water bottle full of water then you can roll the bottom of your feet on the water bottle which will ice the area and massage it at the same time. Strengthening exercises for the tibialis posterior, hip abductors and external rotators will help to maintain the correct foot position and keep the plantar fascia from becoming over stressed. Again, strengthening programs can also be sourced from a Sports Therapist.


Treatments

More invasive interventions include dry needling to the surrounding musculature and plantar fascia itself (ouch!) which will help to release the tightness that has built up. This is also an option for more of quick fix but is likely to be painful and rehabbing will have to be completed after treatment.


Another treatment for advanced plantar fasciitis is shockwave therapy which aims to breakdown any adhesions/ scar tissue in the area. However, shockwave therapy tends to need a few sessions to be effective and can be quite painful in places but as a new treatment it has some promising results.

In very severe cases surgery is considered however there is not evidence that this intervention actually works. Also, it could potentially be a long recovery for a treatment that may leave you worse than when you started.


If you think that you have plantar fasciitis then seeing a Sports Therapist to get an initial consultation would be a good place to start. They can then offer you a specific treatment program tailored to you as well as give you any help and advice that you may need.



Another interesting point to look at when running is wether you run in shoes or barefoot. There are many studies that suggest that wearing shoes pushes your feet into a different position than their natural one. In fact, Altman and Davies (2016) found that there were less injuries not only in the feet but in the whole lower limb (hip down) in the barefoot running group of participants than in the shod running group (trainers). There are also barefoot running shoes that just aim to give the foot protection whilst running and don’t add in any extra support. I would say if your foot positioning is causing you pain throughout running then trainers with extra support where you need it would be best for you. However, if you are a neutral runner or have no need for extra support then barefoot running may be beneficial if you can stand your feet looking like this?


In Summary

As you can see there are lots of ways to prevent and treat plantar fasciitis, both things you can do to help yourself or specific treatment for you prescribed by a Sports Therapist...so don’t worry you got this!


If you have any questions about any sports injuries do not hesitate to contact me by emailing totaltherapy26@gmail.com.


Beth Roberts BSc (Hons)

Sports therapist


References

  1. Brukner and Khan’s clinical sports medicine (2017).

  2. Pelletier- Galarneau et al. (2015) ‘A review of running injuries in the foot and ankle.’

  3. Taunton et al. (2002) ‘ A retrospective case control analysis of 2002 running injuries’

  4. Altman and Davies (2016) ‘Prospective comparison of running injuries between shod and barefoot runners.’

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