Plantar fasciitis: We have muscles, bones, ligaments, tendons, and ‘stuff’ in our bodies. Fascia runs all throughout our bodies. It one piece. One continuous tissue from the tips of our toes to the ends of our fingers. Think of it as a ‘onesie’ for our body. We pound on that onesie a gazillion times and finally it talks back to us.
History: Most of the time there is no trauma. The pain is worst when you wake in the morning or get up from sitting a long time. It gradually gets better within a few steps after moving. Then, just when you get warmed-up and running well, it comes back with a vengeance. It can occur in runners with either flat feet or very high arches. Look at your recent history. Two of the most common causes are a change in footwear or a runner trying to change their running pattern. They have been running 20 years as a heavy heel striker and they read Born to Run or their new running coach wants them to change to a midfoot striker.
Self-Exam: Here are some things you can look for in yourself.
1. Your foot hurts when your first wake up in the morning and, after walking around a lot the pain decreases
2. Ditto if you have been sitting for a long time.
3. If you try to do a deep squat, you raise up on the balls of your feet and your heels come off the floor. VID
4. Poke yourself on the bottom of your foot, just in front of the heel bone. This may hurt VID
5. Your pain may vary a lot depending on which pair of shoes you are wearing.
Treatment:
1) Manage the pain:
a. To relieve that horrible morning pain, I recommend a night splint. There are a lot of fancy splints and boots out there. But, in this case I recommend this simple night splint.
b. NSAIDS will help.
c. Kinesiology taping your plantar fascia an relieve some of the stress on the muscle and increase blood flow. LIN
d. Rolling the bottom of your foot on a coke bottle or lacrosse ball may help.
e. Ice or heat can relieve your pain.
i. Ice right after you get done running
ii. Heat on non-running days
f. Continue running but avoid aggressive speed work and hill repeats, especially downhill running.
2) Restore full motion:
a. A lot of patients with plantar fasciitis have tight heel cords.
i. Sequential short-term running will address these muscles. VID
b. Stretching does not have to be part of your warm-up or cool-down. But it HAS to be part of your training program. LIN
3) Begin non-weightbearing exercises to restore strength without all the pressure on the joints
a. Exercises to increase your foot mobility.
i. Begin with forefoot strengthening. Alphabets, maybe ‘short foot’ exercises, towel scrunch, marbles VID
b. You will not be at this level very long; we just need to increase your strength while minimizing stress on your foot.
4) Begin body weight exercises.
a. Apply the kinesiology tape to your foot before you start your weight-bearing exercises.
b. Double leg heel raises?, eccentric heel raises, heel raises. Be careful these may make your foot more sore. Static lunges, dynamic lunges, LIN
c. Standing hip abduction, heel raises (double progressing to single), dynamic lunges
d. Click here for video to know if you are ready to progress to more aggressive exercises.
5) Correct running mechanics.
a. Gradually return to your previous running. Start on relatively flat ground or even on a treadmill. The best part of returning to running with a treadmill is that you can actually hear your footsteps. Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move. If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running. Listen and ‘feel’ how you run. Is one leg hitting the ground harder than the other? Does one arm swing differently than the other? Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.
b. As soon as you can run without pain and without a limp you can return to your normal running routine.
6) Return to running speedwork and hills. After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.
7) My favorite step, get back to full running! Have fun. Eventually you will bust something else and be back to the website to fix that.
8) If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do. We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.