Those runners who have suffered from Planter Fasciitis know how debilitating the condition can be. That nagging pain in your heel and arch with every step you take. Excruciating in the morning. And just when you think its getting better, it flares up again. Worst of all, you cant run!
Fortunately, its not all doom and gloom. The majority of suffers do recover and return to previous levels of activity, painfree. And the good news is that most of the treatment for this stubborn condition can be done in the comfort of your own home.
The Planter Fascia is a fibrous band of tissue or fascia that extends from your heel to your toes. Its main role is to support the arch of the foot and absorb shock during running and walking. Planter Fasciitis is an overload injury. Like most overload injuries, it is caused by doing activities that your body isn’t used to doing. Examples can be deciding to run 10km when your body is only used to running 5km, or hours of barefoot walking on soft sand when you usually walk in supportive shoes. Poor biomechanics may also play a part in the development of Planter Fasciitis which is why it is often one foot that gets injured and not the other despite both feet doing the same amount of activity.
It is important to note that Planter Fasciitis and Heel Spurs are not the same thing. The jury is still out on the relationship between the two. A large amount of people with Planter Fasciitis also have heel spurs, however heel spurs are also seen in those without any pathology or pain. What we do know is that heel spurs seldom cause pain and therefore removing them will not improve pain in most cases.
As always prevention is better than cure and Planter Fasciitis can be avoided by pacing your activities and not making any big changes in running/walking speed or distance over a short space of time. However if you are one of those poor people who didn’t manage to read this article on time, below are 5 top tips to help speed up your recovery
- RELATIVE REST:
This may seem obvious but some form of rest is important with Planter Fasciitis. How much rest depends on levels of pain and irritability of symptoms. My personal clinical practice has shown that pain scales are a good way to judge if you are doing too much. Pain levels should remain less than 3/10 during activity and 24hours after activity to best prevent aggravation of symptoms. So if just walking causes pain of more than a 3/10, running is out of the question. If however, you can run 3km with minimal pain levels (less than 3/10) and your symptoms do not flare up within 24hours after, then you can run 3km and slowly progress using the same scale.
- DECREASE PAIN:
Pain is a complicated phenomenon. Its helpful to think of pain as a learnt experience similar to that of playing the piano. The more you play the piano the better you get at playing because the neural pathways involved with playing tend to strengthen as you practice. It’s the same with pain. The more you aggravate pain, the easier it is to feel pain as the neural pathways allowing you to feel pain, have strengthened. Pain is like a bad habit. Breaking the habit and allowing your body to have respite from pain often helps to resolve pain long term. Massage, acupuncture and pain medication are just some pain relieving modalities.
Recently, an excellent article by Michael Rathleff has shown that that high load strength training of the foot and specifically the planter fascia, is an effective way to treatment this stubborn problem. Michael advocates doing heel raises with a towel underneath the toes every second day for a 3 month period. The exercises are down in a slow manner (3s up, 2s hold, 3 second lowering) to prevent symptom flare up. One should start with 3 sets of 12 repetitions and progress every 2 weeks increasing weight (using a backpack) and decreasing repetitions (see picture below)
Stretching the Planter Fascia- especially in the morning has been shown to enhance recovery in patients with chronic Planter Fasciitis. (see picture below)
- CORRECT BIOMECHANICS:
Both excessive pronation (flat foot) and excessive supination (high arch) have been cited as risk factors for the development of Planter Fasciitis. Excessive pronation can increase the levels of stress in the Planter Fascia by continual elongating or stretching of the fascia during weightbearing. In people with high arches, the foot lacks the mobility needed to absorb shock and therefore there is an increased load on the Planter Fascia.
Focusing just on foot posture when assessing reasons behind why you may have Planter Fasciitis is not enough. Ankle mobility, length of your gastrocnimeus muscle and mobility of your first toe are all elements that if tight can increase stress on the fascia. In addition, problems higher up the kinetic chain like poor pelvic or hip stability may be the reason your foot pronating. In this case, exercises should focus on strengthening higher up the chain and not the foot itself. Correcting Biomechanical faults is essential not only for recovery of Planter Fasciitis but also for prevention of reoccurence
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