Plantar fasciitis is inflammation of the plantar fascia, a dense connective tissue structure that runs along the bottom of the foot from the heel to the area around the ball of the foot. Though referred to as one unit it is actually comprised of many thin layers that have to work together and glide over each other in order for it to work together.
When that area gets inflamed the layers do not properly glide and as a result cause pain in the bottom of the foot. The severity ranges, a relatively mild case can be isolated to one area of the foot, where a severe case can be felt from the heel to the ball of the foot and make walking painful.
Experts estimate that it affects nearly two million Americans per year and will affect almost 10% of the American population in their lifetime. The numbers go up exponentially in the running population.
The foot is foundation of the body, and as a result, it is the foundation for proper biomechanics of a runner’s stride. Altering heel strike or stride in anyway will alter the way one bears weight through the foot which will alter the distribution of force up the kinetic chain of the leg. One can compensate without knowing they are doing so due to their foot pain, and, as a result can create issues in the knee, hip and back. The onset of plantar fasciitis can affect training and performance goals.
Robert Brown knows all too well how painful the condition can be, while training for the Penn State University cross country team, “I did a hill work out and the next thing I knew I had to take a month off from running.” As the Assistant Track Coach at Penncrest High School in Media , Pa, he uses his experience to help prevent injury in the members of his team.
Prevention is as close as one can get to “the silver bullet” in the running world. Doing things such as rotating you footwear, monitoring your running surface and gradually changing your training regimen, be it distance or terrain, all call help prevent the onset of this painful condition. Still it is not a failsafe plan.
Mike Peditto watched how it affected his teammates while running both track and cross country at The University of Florida and Arizona State University. "Plantar fasciitis was probably the number one injury guys would come down with; I've never seen so much attention to preventing a type of injury.”
He continued, “guys would be in the training room everyday taking preventative steps and even that did not always work. The guys who did get it felt helpless, they felt there was really nothing they could do but rest.
Surgical success varies and can result in damage to the nerve, onset of infection and complete rupture of the plantar fascia. Conservative treatment should be considered prior to surgery even in chronic situations.
With a conservative approach, the goal of treatment is to decrease the initial inflammation associated with acute injuries by resting and icing the structure.
Going forward, the goal needs to be to continue to address the residual inflammation in the area as well as improve the range of motion. Electric stimulation, ultrasound, iontophoresis or phonophoresis with 0.4% dexamethasone are indicated.
Use of the FDA approved ML 830 laser (830Laser.com)
Proper stretching of the “calf muscle” which is made up of the gastrocnemius and soleus is also required. The soleus is often very tight and is one of the most neglected muscles by running athletes. Additionally, deep friction massage and the proper fitting of an orthotic may be required.
With training runs and on race days, proper warm up and stretching are crucial, additionally, taping can provide some additional support.
When looking for ways to address this issue, be wary of treatment programs that are either completely passive or only address the plantar fascia alone, typically though it is the specific diagnosis and chief complaint, it is a symptom of a biomechanical issue elsewhere.
As it was previously stated the way your foot hits the ground can affect your back, hip and knee. Conversely, your back, hip, knee and ankle all affect the way your foot hits the ground and how you bear you weight through the foot. An imbalanced load on to the plantar fascia will have a similar effect to shifting the load in your car and how it affects the wear of your tires when not distributed equally.
In most situations, plantar fasciitis is caused and is therefore a symptom of biomechanical issues elsewhere in the body. Tightness and strength deficits of the hip, knee and ankle can contribute to this problem and therefore need to be addressed in order to provide a long term resolution and decrease the possibility of reoccurrence.
Christopher Stulginsky, PT is a 2003 graduate of the physical therapy program at the Rangos School of health Sciences at Duquesne University in Pittsburgh, PA. He is a certified member of the Prehab Network and a Certified Premium Provider in use of the ML 830 Laser. He has worked at The Johns Hopkins Hospital in Baltimore, MD and in various Sports Medicine clinics around the country. Currently, he is the managing partner or Ayrsley town Rehabilitation, a physical therapy clinic in Charlotte, NC.
For more information please visit: www.ayrsleyrehab.com
