Plantar fasciitis – pain in the heel and foot

 

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

  1. Singh et al, 1997 and Buchbinder, 2004
  2. Buchbinder, 2004
  3. Ribeiro, 2011

 

Brighton Marathon Top Tips

Jewel runs Brighton Marathon

Brighton Marathon training is in full swing now and we have prepared some top tips to avoid injury whilst training and to make sure you complete the course.

Don’t let a niggle become a pain

Other than normal post training muscle soreness don’t ignore niggles as at this stage of training you can’t afford them to become an injury. Get them checked out by someone. At Sundial Clinics we are offering “Free Runners MOT’s” with our physio Quentin during March and April where we can do some checks and give advice so that problems don’t worsen, become painful, and stop you completing your marathon. We also use RockTape which can help prevent problems.

Run Long

The long run is the most important component of your marathon training and will get you to the finish line as painlessly as possible! It should, by now, make up about 80% of your entire training program.

Use the Right Equipment

Which type of shoes work best for you? What is the mileage on the pair you are wearing? Will they make it through both the training and the marathon? Running shoes lose up to 50% of their shock absorbing ability after about 250 miles of use. You have 2-3 times your body weight going through your foot at every foot strike. That’s about 100 tonnes per mile. If you have foot pain let us check it out.

Consider your clothes. Chafing is a major concern especially during long runs and the marathon so make sure your clothes are tried and tested. Vaseline is a necessity for many
runners to reduce chafing. Also consider how much and what type of clothing you need,depending on the different temperatures and conditions that could occur on a spring day in
Brighton.

Socks are another area to consider. Which type work best for you (i.e. thin, thick, two layers, etc.)? Try out some and find out which suit you before marathon day. Race day is not a time to be trying new equipment! Merino wool based socks are great for temperature regulation and moisture wicking.

Don’t forget to hydrate.

The current advice about running and hydration is very simple — try to drink to thirst. And during long runs and your marathon, you’re going to get thirsty. Also, make sure you’re
rehydrating after your runs — you’ll know you’re hydrated if your urine is a light yellow colour.

Recover and Rejuvinate

As soon as the race is over:

  • Get something to drink.
  • Eat! Carbohydrates replenish depleted energy stores. Fruits, vegetables and salty foods replace essential minerals. Protein enhances muscle repair.
  • Determine if you need any medical attention (aches, pains, blisters, etc.)
  • Gently stretch within 20 minutes of completing the race and twice daily for the week after the race.
  • Keep walking. Sudden stopping or lying down will cause a drop in blood pressure and perhaps fainting, leg cramps, and/or nausea.
  • Get a post-race massage. Also, get a massage or two in the week after the race to help you recover.
  • Get a few laser sessions here at Sundial. It has been shown to improve muscle recovery and tissue healing

Avoid long soaks in hot water which may cause swelling and exacerbate muscle soreness. In the early stages of recovery you are better off to cool your legs by soaking them in cold water which will reduce inflammation.

During the first week of recovery, it is best to avoid running altogether. Instead try walking or swimming each day to loosen your body and promote healing.

Finally, good luck from me with the rest of your training and race day!

More Marathon Trainig Tips

Runners Knee: 2 Most Common Causes

Orthotics and Runners Knee pain

Foot, Knee or Hip pain – A Simple Solution

If you ever get foot knee or hip pain on standing or walking for a while, then you’ll know the misery that this can cause.

Fortunately, there is a simple solution.

Here at Sundial we use Superfeet orthotics to help ease the discomfort. In this short video Brighton chiropractor Matthew Bennett talks about the causes of foot knee and hip pain associated with over-pronation. If you want to know more about this click here:–

If you would like to know if you would benefit from wearing Superfeet orthotics then pop in for a free check with one of our physios or chiropractors here in Brighton.