What do runners and couch potatoes have in common? They can both get pain in the heel and arch of the foot from problems with ligaments there. These ligaments are called the Plantar Fascia and the problem is known as Plantar Fasciitis and it can cause sharp pain in the heel, arch and foot especially in the morning.
What is Plantar Fasciitis?
Your Plantar Fascia is a tight band of connective tissue that runs from the heel of your foot and fans out into five bands to the base of your toes. Plantar Fasciitis (PF) is the most commonly reported cause of heel pain (1). It is characterized by pain at the calcaneal origin (heel bone) of the plantar fascia and increased thickness of the plantar fascia (2).
Although this stubborn condition is prevalent in people who sit a lot it is also extremely common in the active people too and is the third most common injury amongst runners (3). Like most runners I’ve had a few battles with PF pain myself, so here’s some useful information and a few handy tips on how you can avoid, manage and treat this stubborn condition.
What causes Plantar Fasciitis?
The condition itself is thought to be caused by overload of the long arch underneath the foot. In active people this is often caused by a rapid increase in exercise for example, an increase in hill running or the classic too much too soon. In the sedentary people PF pain is often caused by joints and muscle not working correctly, that is, poor biomechanics or weight gain. The exact cause of this condition is still poorly understood and recent findings suggest that the name Plantar Fasciitis may be misleading as it doesn’t usually involve an inflammatory phase (-itis means inflammation). The term Plantar Heel Pain, Plantar fasciopathy or fasciosis is probably more accurate. Below is a list of some of the common causes of PF pain that I see in clinic.
- Pes Cavus (high foot arch) and Pes Planus (flat feet) deformities
- Inappropriate footwear
- Overweight – high BMI
- Diabetes
- Poor ankle range of movement
- Increase in weight bearing activity e.g. hill running, speed training, high intensity work out classes
- Excessive dynamic foot pronation
- Poor balance and lower limb control
What are the signs and symptoms of Plantar Fasciitis?
A common presentation for a patient with PF symptoms is pain and tension on the sole of the foot, pain is often worse with the first steps in the morning but eases with time and movement. Runners will often say that the pain is present before their warm up or at the start of the run but eases once activity increases, however the pain comes back with vengeance after activity or the next morning.
How can a physiotherapist help?
A physiotherapist will be able to diagnose your symptoms by taking a taking a careful history of your complaint. During the assessment stage we will look at your biomechanics, functional ability and carry out various tests to diagnose Plantar Fascia pain and rule out any other conditions which may be causing your symptoms. From here we can formulate a treatment plan which may consist of soft tissue release, joint mobilization, taping techniques, electrotherapy and an exercise rehab programme. We can also provide you with advice on orthotics, appropriate footwear and help gradually get you back to full pain free activity in the shortest possible time.
How can I avoid plantar fascia pain when running or training?
Here at Sundial we work with several of the local running club in Brighton and Hove and we provide support for the Brighton Half Marathon. This is the programme we recommend:
- Have a gait analysis with us here at Sundial
- Purchase appropriate footwear
- Grade yourself into running slowly, have a training plan and avoid the dreaded too much too soon
- Don’t just run, mix up your training with other forms of exercise for example, swimming, cycling, strength training
- Give your feet a break, have a rest day, try some foam rolling or low impact exercise such as yoga or Pilates
- Remember, if in doubt, get it checked out and don’t let a niggle become a pain.
Sundial, at our two clinics here in Brighton, offers a free 20 minute physiotherapy assessment to anyone who would like advice about an injury, this session is a great way to get some useful tips on how best to manage your injury and to see if physiotherapy is right for you. Why not call the clinic today to arrange a free informal consultation and stop that niggle turning into a pain!
James
Sundial physiotherapist, Brighton and Hove
References
- Singh et al, 1997 and Buchbinder, 2004
- Buchbinder, 2004
- Ribeiro, 2011