Daily Tips and Advice
Running and Foot pain
Posted 5 years ago
Plantar Fasciitis-running and rehab
So we're done with January, I hope that doesn't mean that the news years resolutions have gone to rot? Hopefully those of you who set sensible, realistic goals are right on track, and hopefully those of you who are following marathon training regimes are doing well.
Lots of runners seem to have signed up to London of course, but Brighton's marathon looks like it has become very popular in recent years. It sold out some time back but there is still space in the 10Km event on the same day.
I'm not surprised it is so popular, Brighton is a great city, and where I grew up no less!
We have opened up more clinic slots at Straight Back Physiotherapy and are now open from early at least twice a week-ideal for a pre work rehab session!
A fairly common injury seen amongst the running community is that of Plantar Fasciitis which is a medical term used to describe pain in sole of the foot/heel.
Many runners tend to have self diagnosed ‘joggers heel’ this foot pain before coming to clinic. But have you really got the condition? There are many other structures that can mimic the same type of pain, so don't begin inappropriate treatment, get an accurate diagnosis from a healthcare professional.
A quick google search tends to throw up a bunch of well described symptoms that tend to be found in plantar fasciitis. So what are they are? What is plantar fasciitis? and what can be done about this foot pain to allow pain free running?
In an anatomical sense the Plantar Fascia is a thick connective tissue that spans from the inside edge of the heel bone the toes of the foot across the sole of the foot (the Plantar surface!).
For more anatomical info and a 3D diagram check out the following link for a 3D image of the Plantar Fascia Healthline
The Plantar Fascia acts to add support to the long arch on the inside of the foot. It acts in a sling like fashion and bears load as weight is transferred through the foot, in the activities of locomotion. I liken it to a taught hammock that sags when someone lies across it. This happens to the Plantar Fascia in every foot step.
Fascia is a type of connective tissue found throughout the body. Of late there has been great emphasis put on the importance of targeting Physiotherapy treatment at this tissue. You may have heard of Myofascial treatment techniques. Whether or not you can actually target this connective tissue specifically in treatment is another discussion entirely.
The Plantar Fascia is said to have a close relationship with the Achilles Tendon as it has a continuous fascial connection to the structure-this explains why treatment techniques for Plantar Fascia also tend to involve the Achilles (more on specific treatments later).
In our last Blog piece we discussed inflammation or lack of it in an Achilles Tendonitis.
For more information see Achilles Tendonitis.
An 'itis' in the past has denoted an inflammatory condition, and in its initial onset Plantar Fasciitis may well be inflammatory. As with any ‘good acute injury’ there is likely to be inflammatory markers on a cellular level on examination.
However, like a variety of other conditions such as Achilles pain, symptoms may actually develop because of degenerative change in the tissue. In this case we may title the condition a Plantar Fasciosis or Fasiopathy rather than a true fasciitis.
The condition like many other running injuries may ‘set in’ because of a variety of factors including, but not exclusive to-
- Training error such as repetitive loading leading to overloading through- Sudden changes in a training regime, increasing in volume or frequency of sessions or running surface.
(I got a nasty dose of Plantar Fasictiis after romantically running barefoot along a sun kissed beach in Australia. It's what they do in Home and Away isn’t it? But its not what a lad who lives in Cheltenham does with any regularity, so cue severe foot pain, error!)
- Over training, as in ‘catching’ up.
- Or simply towards the end of the five months or so of regular running that most marathon runners will undertake to get around 26.2 miles of one foot in front of the other.
- Inappropriate footwear can cause symptoms, as can recent changes to new running shoes.
- Direct trauma of the Plantar Fascia can also cause injury, a patient recently described being kicked in the foot while playing football.
When degenerative tissue is abused by being overloaded patients will generally report a classic foot dull bruise like pain, often worse in the first few steps of the morning, or in ‘start up’ from resting positions.
Pain may also be described as being worse on commencing running activities, only to settle during activity, but then might be worse after activity. Confusing hey?
So now we know what Plantar Fasciitis is, and what causes it, what can be done to treat it?
Treatment of Planar Fasciitis
If symptoms are related to Mechanical overload-its vital that your therapist establishes the cause of symptoms, leading to an appropriate treatment plan highlighting what needs treating.
Initially it makes sense to help to settle pain right? And to do this some good old fashioned icing or to give it its fancy name, cryotherapy can help. Something as simple as a drinks can kept in the fridge or frozen bottle of water can feel great rolled along the sole of the foot at spells through the day or especially after being on your feet all day, because unless you can walk on your hands all day this is pretty much unavoidable.
Taping provides a great way of supporting and offloading that now damaged hammock. I’ve heard of all kinds of taping regimes, but one that works quite well is to tape daily for three weeks. Put the tape on the foot before even putting the foot to the floor in the morning.
A Podiatrist I have worked with recommends never walking barefoot even around the house, even if you need to get out of bed in the middle of the night to visit the bathroom, or in my case to heat up a bottle of baby milk!
As Physiotherapists we are experts in understanding human movement and anatomy, so assessment must aim to determine sub optimal movement patterns in gait patterns-running and walking.
A good Physiotherapy assessment performed in clinic will determine will a patients efficiency of movement. Are joints of the foot and ankle free and mobile or stiff and immobile? Are muscles of the lower limb flexible or overly tight and inflexible? Is muscle control further up the kinetic chain/lower limb up to the pelvis active and recruited allowing great lower limb control or weak and inactive causing poor pelvic and lower limb control? Is there any nerve involvement in the Plantar Fascia pain? Not all pain is directly related to the Plantar Fascia and it is important to rule out any nerve involvement?
Strength training in Plantar Fasciitis is also important, as with any injury there is an element of muscle atrophy as neuromuscular pathways are slowed.
Temporary orthotics may be considered and in the last resort cases Shockwave therapy may be recommended, as a last option. For further information see the NICE guidelines.
For ongoing foot and ankle problems we have some great consultants in the area, check out the Cotswolds Foot & Ankle Clinic.
So there we have it, an overview of another running injury and some advice on the treatment of plantar fasciitis.
Well I’ve got a new pair of running shoes so I’m off to use them.
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