Last updated: 30-Aug-17
By Karina Teahan
Chartered Physiotherapist
The tell-tale sign of plantar fasciitis is that first-step pain in the morning, described by some as a “stabbing pain” at the base of the heel, or as similar to walking on broken glass. It usually improves as your foot gets warmed up, only to return again after a long period weight bearing or long periods of not moving your foot at all.
It is a very frustrating injury, not only because it prevents you running and can linger for quite a while, but because it also affects all aspects of your day-to-day life when you need to be on your feet.
The incidence of plantar fasciitis in runners is about 8% but even in the general population it is estimated to range from 3.6-7%.
What is the Plantar Fascia?
The Plantar Fascia is a thick band of fibres that runs from the base of the calcaneus (heel bone) to the metatarsal heads (toes). The root cause of plantar fasciitis is not fully understood but there are many factors that may predispose us to it.
Predisposing / risk factors
The plantar fascia absorbs a significant load as it supports our body weight but this load can be increased even more by the following factors:
- Wearing hard, flat or unsupportive footwear
- Going barefoot
- Tight calf muscles / reduced ankle range of motion especially if you find it hard to bring your foot towards your shinbone. In a way the plantar fascia is a continuation of the Achilles tendon. Like a cable that angles around a corner, tight calf muscles could put excessive tension on the plantar fascia, increasing the risk of injury. For those of you those are keen to learn more on this, look up the Windlass mechanism!
- Obesity – this may not necessarily be relevant to runners but increased body weight as well as the inflammatory nature of fat may add to your risk of developing plantar fasciitis
- Long hours on your feet, perhaps due to your job
How do I manage my Plantar Fasciitis?
The term “itis” is a bit misleading as we now know it is not purely inflammatory but more closely related to a tendon injury. Initially it is very important to manage the pain and control the loading on it so as to avoid making it a more chronic injury.
- Footwear: consider wearing cushioned supportive shoes at all times, even in the house. Avoid barefoot, high heels or flip flops. If you find it difficult to wear runners throughout the summer, something similar to a Birkenstock shoe would offer some support, but do try to stick with the advised footwear
- Golf/tennis ball rolling under your arch – ice the area afterwards
- Ice-massage: oil the underside of your foot and massage with ice for 3 minutes x 3 times/day
- Stretching the calf muscles: knee bent & knee straight. Do this as many times a day as you can but a minimum of 3 x 30 second holds x 3 times/day
- Specific plantar fascia stretches: cross the affected foot over your other knee and stretch up all your toes. Hold 10 seconds x 10 reps x 3 times/day
- Massage – massage deep into the foot muscles with an oil/cream to help really get into those tight spots. Ice afterwards.
- Build up your foot and toe muscles to strengthen your arches through simple exercises such as picking up marbles or a pencil with your feet.
- Taping: your Physiotherapist may show you how to apply tape to lift up the arch and support it in the acute phase.
- Orthotics: these will offer good foot support and many off-the-shelf options are quite good, if you cannot afford a custom made device. In the early stages a burrito type orthotic is quite good, though many find them too rigid (and you would not be able to run on them). Another good option is Vasyli Mcpoil. Do not use the soft, gel-type arch supports as these are likely to make your foot feel worse. Again your Physiotherapist will guide you on the most appropriate type for your individual foot profile.
- Deep dry needling of your calf muscles or quadratus plantar muscle (tiny muscle above your arch) by your physiotherapist can give great relief.
Rehab Phase
High load strengthening has been shown to be very effective due to the similarities between plantar fasciitis & tendon injuries.
Continue this after the acute phase and you can still do the above in conjunction with this next phase.
- Alternate days for 3 months
- Unilateral heel raise with towel inserted under all your toes so they are maximally stretched towards your shin at the top of the heel rise
- Every heel rise (concentric) takes 3 seconds, pause at the top (isometric) for 2 seconds, and 3 seconds coming down (eccentric). You might want to put a thin layer of padding under the balls of your feet if this starts to feel sore as you push up.
- Weeks 1 & 2: 12 reps x 3 sets
- Weeks 3 & 4: increase the load by adding a back pack with some weights. 10 reps x 4 sets
- Week 5 plus: further increase the load in the back pack. 8 reps x 5 sets
- (You will need to figure out the load you take by identifying your RM and work from there to achieve the desired reps & sets). Make sure to hold on as you are doing it as it’s a strength exercise not a balance one.
- Ice after your session
*** The above rehab phase is a guideline only. You may find that your calf muscles are not strong enough to allow you to do 12 reps x 3 sets, you may have to start on 10 reps only and progress over a longer period of time.
Miscellaneous
- Extracorporeal shockwave therapy has shown very good results for conditions that are not responding to the above management.
- Corticosteroid injections are used in some cases but approach with caution as there is a risk of complete rupture of your plantar fascia with this as it is a significant weight bearing structure. It is more of a risk than injecting the tendon in the shoulder or elbow.
- PRP (Platelet rich Plasma) injections are used by some orthopaedic consultants to promote healing of injured tendons, ligaments & muscles.
Conclusion
If you follow all of the above you reduce the risk significantly of this becoming a lingering frustrating injury. Do not underestimate the benefit of proper footwear even around the house and the necessity of stretching & icing. Do not attempt to go back to running until you can walk without pain and have no pain the following morning.
As with the return to running after any injury, make sure your return is gradual and stick with the exercises to keep your foot healthy & happy.
Karina Teahan (BSc, MMT, MISCP)
Chartered Physiotherapist
All images Karina Teahan.
About the author: Karina Teahan (BSc, MMT, MISCP) is a chartered Physiotherapist and elite runner who graduated from University College Dublin in 2002. She did a Masters at the University of Western Australia and worked in Dublin, Manchester and New Zealand. Karina is now based in a Primary Care Centre in Cork, Ireland.
