Get Back To Running: Treating Plantar Fasciitis

What is Plantar Fasciitis?

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Plantar fasciitis is an overuse injury that results from the degeneration or thickening of the collagen fibers in the plantar fascia. The plantar fascia is a band of fibrous connective tissue that runs from your heel bone (calcaneus) to the bases of your toes (metatarsals). It plays a vital role in stabilizing your foot's arch while standing, walking, and running.

The repetitive stress placed on the plantar fascia during running can lead to degeneration and breakdown of the tissue, resulting in pain and discomfort. Although the term "plantar fasciitis" implies inflammation, the condition is more about the degeneration of the tissue rather than inflammation.

Causes of Plantar Fasciitis in Runners

Plantar Fasciitis makes up 5-18% of injuries caused by running [1]. As a runner, it's crucial to recognize the factors that can contribute to the development of plantar fasciitis.

Some common risk factors include [2]:

  1. Weakness in the foot/ankle muscles

  2. Wearing worn-out or improper running shoes

  3. Increasing running volume too quickly

  4. Increasing running mileage

  5. Tight calves and Achilles' tendons

  6. Spending excessive time on your feet (e.g., due to a standing job)

  7. Having excessively high or flat arches

  8. Limited ankle dorsiflexion (pointing ankle upwards)

Symptoms of Plantar Fasciitis

If you're experiencing plantar fasciitis, you may notice some common symptoms, such as [3]:

Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82. PMID: 21916393.

  1. Pain along the arch and sole of the foot, particularly on the inside edge of the heel

  2. Morning pain that's worse when taking the first steps out of bed but gradually fades as you move around

  3. Pain when pressing along the sole of the foot or stretching the fascia

  4. Development of heel spurs in some cases

Foot and Ankle Pain After Running

Different Causes of Heel or Ankle Pain After Running [1]:

  1. Plantar Fasciitis: As previously mentioned, plantar fasciitis is a common cause of heel pain in runners. The degeneration of the plantar fascia tissue can contribute to pain in the heel area.

  2. Achilles Tedonopathy: Achilles tendinopathy presents as aching posterior heel pain. This is caused by irritation of the Achilles tendon, which connects your calf muscles to your heel bone. Most patients with this condition have pain, swelling, and tenderness on the Achilles tendon 2 to 6 cm above its insertion into the calcaneus. 

  3. Ankle Sprain: Lateral ankle sprains are more common in runners. Pain is usually on the outside of the ankle and can be caused by the ankle rolling inwards during an initial foot strike.

Addressing Heel Pain After Running:

  1. Identify the Cause: The first step in addressing heel pain after running is to identify the root cause by having a comprehensive running assessment to evaluate your running technique, gait, and foot mechanics. This assessment may include video analysis to identify any factors contributing to plantar fasciitis, such as overpronation, excessive foot strike force, or inefficient running form. A functional tests may also be performed to assess your lower limb strength, flexibility, and mobility.

  2. Modify Your Running Routine: Reducing your running volume, incorporating rest days, and adjusting your running form can help alleviate heel pain. Additionally, consider incorporating low-impact cross-training activities like swimming or cycling to maintain your aerobic capacity while giving your heel a break.

  3. Choose Proper Footwear: Wearing the right running shoes for your feet can help reduce the impact on your heel and alleviate pain.

  4. Perform Proper Warm-Up and Cool-Down: Implementing a thorough warm-up and cool-down routine that includes dynamic stretches, muscle activations, and mobility drills can help prep your body for running and minimize the risk of heel pain.

  5. Strengthen and Stretch: Incorporate specific exercises and stretches for your feet, calves, and Achilles tendon into your routine. This can help improve your overall foot and lower leg strength, flexibility, and mobility, reducing the risk of injury.

Here are some examples of foot strength and stretches you can add into your training:

Consistency and patience are key when it comes to treating plantar fasciitis. At Resilience Physical Therapy, we can help you develop a individualized treatment plan that addresses the underlying causes of your plantar fasciitis, such as muscle imbalances, bio-mechanical issues, running form etc. so you can increase your chances of getting back to your regular running routine.

References:

  1. Arnold MJ, Moody AL. Common Running Injuries: Evaluation and Management. Am Fam Physician. 2018 Apr 15;97(8):510-516. PMID: 29671490.

  2. Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019 Jun 15;99(12):744-750. PMID: 31194492.

  3. Goff JD, Crawford R. Diagnosis and treatment of plantar fasciitis. Am Fam Physician. 2011 Sep 15;84(6):676-82. PMID: 21916393.