- If you've had it, you'll know about it.
Plantar fasciitis is one of the more painful of injuries
as well as equally frustrating
due to its typically slow healing time.
Well, avoiding it in the first place
is obviously the best scenario
but if you have been unfortunate
enough to pick up this injury,
you'll most certainly want to solve it as soon as possible.
So, today, I'm going to be talking about
how to cure but even more importantly
how to prevent this pain in your foot
that is plantar fasciitis.
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If you've not had this injury
you might be wondering what all the fuss is about.
Well, it's a pain underneath your foot
just in front of your heel bone
where the fascia attaches to your calcaneum, your heel bone,
and sometimes you can also feel discomfort
down the center of the arch along the foot.
When your plantar fascia becomes inflamed or overstressed,
it leads to discomfort,
more often in the morning and after rest,
and it's important not to confuse
it with bursitis of the heel pad.
This is very much in front of your heel
as opposed to the main ground
contact point of your heel bone.
Fascia is a flat band of connective tissue
that connects tendons, ligaments, and bones,
and basically acts like a web that holds the body together.
Now, if you look at the foot,
that's made up of 26 different bones.
So, imagine if one of those joints
isn't quite moving properly,
it's going to affect the whole of the foot's biomechanics
while the plantar fascia itself
actually holds together the heel bone, the calcaneus,
and then runs under the foot and attaches
to the base of the five toes.
As a result, it plays a crucial role
in the movement of the foot during heel strike,
mid stance and toe-off,
controlling the pronation of the arch,
and therefore it helps with shock absorption
during the ground contact phase,
but also with energy return
when it comes to the toe-off phase.
It can start as quite a subtle pain
that just comes on gradually and some people
even describe it as though they've stood on a pebble,
but this dull ache can end up leading on
to an acute pain and is especially tender
and sore if you pupate the area.
Now, it can be confused with
a few other problems in the foot
such as a bruised fat pad on the heel pad or even bursitis,
but there are a couple of distinct signs that set it apart.
The most obvious symptom that differentiates this injury
is pain in the morning when you get up
or after a long time of sitting
or not moving your foot and ankle,
and it will gradually decrease as the fascia
gets stretched naturally from walking,
but it can also increase the pain
if you're spending a long time standing,
doing a lot of walking or also during running.
Now, the acute pain can sometimes initially die down,
but if you don't actually address the injury properly,
then it can lead to chronic pain
due to micro tears in the fascia.
So, it is and most certainly worth sorting it out early on
because you'll end up being out from running
for a very long time.
Now, plantar fasciitis is less likely
to be found in forefoot runners,
but it can happen in either foot
and sometimes even both, but that's pretty rare.
There are multiple causes to plantar fasciitis,
but the most common being a sudden increase
in training intensity and or volume
which is going to put a lot of strain
on the connective tissue and the muscles
that surround the foot and the lower leg.
Also, a lot of sprinting or plyometric exercises
when your body's not fully prepared or warmed up
can also lead to micro tears in the fascia.
Tight calves go hand in hand with an increase
in training volume and that in turn puts more pressure
on the structure of the foot.
So, you could see it as a lack of stretching
being the problem or maybe an increase
in training too quickly,
or maybe a combination of the both.
Now, also doing too much walking
or running barefoot can lead to plantar fasciitis
as the foot has less support than it might be used to,
but also due to the impact on the heel.
Now, the heel structure and the heel pad
is obviously a separate structure,
but damage to this area can actually
aggravate the plantar fascia.
If your job does involve a lot of standing
and you've got poor posture,
or your foot isn't adequately supported,
it can actually lead to straining the plantar fascia
just as the same as if you're an over pronator
when you're walking or running,
you're going to be constantly over working the fascia.
Now, limited dorsiflexion can actually increase
the pain in your plantar fascia,
but it's a bit of a flipped circle
because it's also a symptom for this.
So, as we know fascia is very notorious
for having such a limited blood supply.
With that in mind, you're going to have to be very patient,
but obviously prevention is better than cure.
Any signs of plantar fasciitis need
to ideally be addressed as soon as possible,
as it can become a rather persistent injury.
Now, my first bit of advice is to go and speak
to a professional and get a treatment plan to follow.
However, today I'm going to be covering
the more common treatments that have been
proven to work for this injury.
For this one, you want to find
a small say 500 mil water bottle,
pop it in the freezer and then you can
use it as a massage tool.
So, you want to role your arch of your foot
over the top of the bottle for around 10 minutes a day,
you can do this three or four times a day,
and this will work as a massage,
but also help with the inflammation as it's ice.
Tight achilles and calves can lead
to irritation of the plantar fascia.
So, you need to make sure
that you stretch the back of your calf,
and this should be something you include
in your everyday training program
and it's a good idea to work out
what stretch is best for you.
So, one of the options is standing facing a wall
with your feet sort of a stride width apart,
and then your back leg behind you,
and you want to push your weight down
through your heel until you start to feel
the stretch in the back of your calf.
Repeat it on the other leg,
then go back to the first leg and repeat it
with a bent knee and you'll feel the stretch
move further down your calf,
and then an option which I personally prefer,
is finding a step, something to hold on to as well,
so you don't have all of your weight
going through the balls and your toes.
So, stand on the balls of your feet on the edge
of the step and gently lower your weight into your heels,
and you'll feel that stretch again at the back of your calf,
and also repeat it with a bent knee.
You can take some of the pressure off the area
by making sure that you've got an everyday shoe
and a running shoe that has a heel higher than the toe.
Now, I don't mean high heels in this case,
but it's probably best to avoid barefoot shoes
that have a completely flat surface
and then when it comes to your everyday shoe,
especially if have you have a job
that means you spend a lot of time on your feet,
look for something that's supportive
that's just going to take that pressure off a bit more.
Gentle massage along the length of the fascia
will increase blood flow as well as improve
the malleability of the area,
and you can do this either sitting down
with your fingers and your thumbs
and just massage it yourself,
or use a golf ball and gently
roll your foot around on top of it.
Some therapists prescribe this sock to wear at night,
it's a calf length sock that has a strap
from the toes to the front of the calf.
So, it acts to gently pull the toes in that direction,
putting on a constant stretch
on your plantar fascia overnight,
and this will then relieve the soreness
of those first few steps in the morning.
Some therapists opt to use a cortisone injection,
but there have been cases where that's actually
caused some of the heel pad to dissolve
and can obviously lead to other problems.
There's Botox, which can help relax the muscles
and structures around the fascia.
Shockwave therapy is also a favourite with some others,
but obviously all of these need to be delivered
by a medical expert and only after
the less intrusive options
have been fully exhausted, and as we know,
the fascia has a pretty non-existent blood supply
and therefore is notorious for its slow healing.
So, patience really is key,
but optimally prevention is better than cure.
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Before increasing your running mileage,
you need to make sure that your foot
and lower leg are prepared for the extra loading.
Now, prevention is basically addressing
the causes before they happen,
and one of the most common causes of plantar fasciitis
is increasing your running mileage too quickly.
So, to prevent that,
you basically need to increase it gradually,
and a good guide for this is the 10% rule.
So, don't increase your mileage by more than 10% each week.
Strengthening your foot and calf muscles
will help make you ready to absorb the impact
and the stresses when you do start to increase your running.
So, for this, simply you need to find a step,
standing on the edge of that
and you're going to do heel raises.
Start off with both heels together.
So, you're taking less of the load.
Lower your heel down and then raise up
on to your tip toes and back down again,
and when you've done this for a week or so,
you can progress to single leg calf raises,
and those assisted, so holding on to something,
and then once you've got more strength and balance,
you can actually progress
to unassisted single leg calf raises,
and this will proprioception,
but also really turning on those
intrinsic muscles around your foot.
Well, along the same lines but with more focus on your foot,
you can work to turn on those intrinsic muscles
which help control and make a nice smooth movement
from the heel strike, right the way through to toe-off,
and you can start by just doing some exercises
sat at your desk with extending your toes
and then crunching your toes back up
and you can do that throughout the day,
and then a slightly more specific exercise
you can do later on with a towel
or some fabric on the ground.
Use your toes to scrunch that fabric towards your heels.
Even before you have any symptoms,
it's a good idea to do some self massaging your foot
and also the medial border down the inside of your calf
as some of the muscles that actually attach on this part
will then run and come into tendons
that go underneath your foot
and amalgamate with that plantar fascia.
So, by just loosening that it will help
make the tendon sheaths and the fascia
be able to move more effectively.
We've already included the calf stretches
in the cure section but hopefully
if you put them into your daily routine,
they can become part of prehab and stay there,
but there is one other stretch which
you can add to make it a little more specific
to the actual underside of your foot.
So again, come up to the wall but this time,
put your toes so they extend now actually touching
the wall and your foot is flat on the floor
and then gradually bend your knee towards the wall
and you'll the stretch in your calf
but also underneath the bottom of your foot.
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The main take home is look
after your body and train smart.
If you use the 10% rule and make sure
you listen to any niggles,
you should hopefully be able to avoid
the onset of plantar fasciitis.
Now I seriously hope that all of you guys
watching haven't experienced this injury,
but if you have I'd love to know
what treatment worked for you.
So, please share with us in the comment section below.
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If you want to find some injury prevention secrets
from top pro Sebastian Kienle,
that is down here and there's a video on knee pain
and it's prevention that Mark made,
and you can find that one just over here.