Tuesday, May 19, 2015

The Dreaded Plantar Fasciitis

Plantar fasciitis - that ugly monster that rares it's head and makes your foot miserable. I can't tell you the number of people who come into Sportspectrum (running specialty store) where I work complaining about their foot pain.

"Plantar fasciitis (also known as plantar fasciopathy or jogger's heel) is a common painful disorder affecting the heel and underside of the foot. It is a disorder of the insertion site of ligament on the bone and is characterized by scarring, inflammation, or structural breakdown of the foot's plantar fascia. It is often caused by overuse injury of the plantar fascia, increases in exercise, weight, or age." - Wikipeida 

The thing that amazes me is just how long most of them have been suffering with PF and it's pain. "I've had this for 2 years, it's chronic". Some of them tell me that they have a custom orthotic from their podiatrist. Beyond that there are only a very few who are doing any thing else to recover from this injury. I don't know how they do it... living with that kind of pain for so long.

"If your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss), an overuse injury that affects the sole of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes."

"You're more likely to develop the condition if you're female, overweight or have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches also are more prone to plantar fasciitis." - American Orthopaedic Foot & Ankle Society

I've had bouts of plantar fasciitis over the years. The quicker you do something about it the sooner you can get through it. The Internet is filled with great information and videos on self treatment of PF, "New Techniques for Treating Plantar Fasciitis" is just one of many good ones that I have found. It frustrates me that most of them have not taken the time to find out anything about what they can personally do to treat the pain, and most of them can't even pronounce it properly. I sit with them and explain that in order to recover from this they have to be pro-active. Wearing a "custom orthotic" is rarely going to fix the problem. Pretty much without fail after giving them a list of things to do and "not do" I get the wide eyed response of "I had no idea.......". Now, how many go home and actually put anything I've told them into action is another thing altogether. Sometimes it's easier to just complain about something than rather do something about it.

So just what do I tell them to do? Well here is a list:
  1. NEVER walk barefoot. You must keep support of the fascia all the time. This even means when you get out of bed in the middle of the night to go to the bathroom you must put on some kind of supportive shoe or sandal. (This always gets me the look of are you kidding me?). 
  2. Stretch your calf muscle before taking one step out of bed. Put a hand towel by the side of your bed and stretch your gastrocnemius and soleus muscles prior to standing up. The gastrocnemius is stretched by pulling your toes back with the towel wrapped around the forefoot with your knee straight. The soleus is stretched with the knee slightly bent. Here is a great blog post that I found: "A Little Soleus Stretch Goes a Long Way!" by Allyson Sunderman, DPT.
  3. Body work on your lower leg. This may be by using a foam roller, or actually putting your hands on you leg and doing some deep tissue massage. Concentrate on the soleus muscle more than the gastrocnemius. The soleus is exposed below the gastroc, use cross fiber work on it to spread out the muscle and allow for increased blood flow into the muscle. You can also get to the belly of the soleus, you'll have to brace your fingers together, and work in between the heads of the gastrocnemius. In this picture I have weight on my foot (I had to prop up the camera), you will want to work on your leg with it non-weight bearing. Dig around and you will find a very tender spot, the trigger point, work on this in a cross fiber direction for 6-8 strokes in about a 1 inch size, then leave it alone and go back several times during the day and repeat. You will find that each time you go back and work on it there will be less tenderness. 
  4. Body work on your foot. Don't forget to do some work on the bottom of your foot itself. A simple way to do this is with a little hard rubber ball on the floor under your desk. Some people recommend a golf ball, but you want something with a little flex in it. 
  5. Taping. This is what I personally do immediately when I feel any hints of PF. I use Rock Tape H2O, I've tried several other brands but this one stays adhered much better and lasts longer. Taping you arch will hold the fascia up and allow it to heal and not get re-stretched with every step. Here is a Rock Tape video with instructions on taping for Plantar Fasciitis.
  6. Arch sleeves. There are products on the market that are compression arch sleeves, I know that Feetures makes one. I've used these before and had moderate success, you can't wear them in the shower, and I've found that it really doesn't do as good a job as the taping.
Catching this early and doing some self treatment will help you tremendously in your recovery of PF and not allow it to become a chronic problem. Waiting until you've been hobbling around for weeks "hoping" that with just a little rest and time off of training will make it go away is not going to work.

I hope this sheds some light on this common problem with runners and non-runners. Good luck and keep training! See you at the races!!