The Evil, Never-leaving Plantar Fasciitis
By Marie-Catherine Bruno, BScPT, Cped(C).
The idea of writing about plantar fasciitis came to me when I went to the Pacific North West Orienteering Festival (PNWOF) last June. I was sitting in the finish area and overheard these two men complain about how they had not been able to train for the longest time due to injuries. That’s when the nasty plantar fasciitis came up…
What is the Plantar Fascia?
The plantar fascia is located under your foot, and runs from the heel (calcaneus bone) to the base of your toes (the ball of the foot). It is sandwiched between your skin and your muscles and tendons. Its purpose is to support the longitudinal arch of the foot and also to keep the tendons down when you bend your toes (otherwise they would pop out of the foot!). The Latin ending itis means that we are dealing with some inflammation. So a plantar fasciitis is an inflammation of the plantar fascia, usually due to a constant or repetitive stress on the fascia.
What causes Plantar Fasciitis?
There are many possible causes. The key to healing such an injury is to first of all find out what caused it; only then can you receive the appropriate treatment. I will focus on the most common causes, but keep in mind that you can always develop a plantar fasciitis from a strain during a race even if none of the following problems apply to you.
- Pronated foot (mistakenly called flat foot): this is definitely the most common cause. Refer to If only I knew how to avoid shin splints, ONA Vol. 17, N. 4 to do the little test that will tell you whether you have pronated feet or not. If you do, what happens when you put your weight on your foot, is that it flattens out and this stretches the fascia. Over time, it creates microtears in the tissue and this leads to a somewhat chronic inflammation (and weakness of the tissue, which makes you even more prone to injuries – watch out the vicious circle!). When you are running, the pounding just accelerates this tearing process.
- High arch: some of you, although it should be a minority, have what we call a high rising arch. If you are the kind of person that always has a problem finding shoes that are high enough for your foot to slip in, you probably have a very high arch. The problem is that most shoes will not provide you with a high enough arch support, therefore when your foot gets tired, your arch will flatten out and you will end up with a similar problem to the pronated foot above.
- Working/training on hard surfaces and/or being overweight : the harder the surface, the most impact your body has to absorb when you are simply standing or walking. So you need to wear good shoes to work if you work on concrete floors (a thick absorbing sole will do it) and absolutely avoid running on harder surfaces than normal pavement (sidewalks are usually made out of concrete, so therefore a lot harder. Bricks are also harder, so stick to the street pavement if a trail run is not possible) You work or train on a hard surface and you are overweight? You are asking for disaster! The extra weight will force your foot to flatten out, and therefore create microtears in your plantar fascia. Think about it…
- Wearing high heel shoes : high heels are very pretty, but definitely not the best footwear on the market! Besides changing your posture, affecting your centre of gravity and shortening your calf muscles, they also put an enormous stress on the plantar fascia. Remember, the fascia is attached to the base of the toes. When you wear high heels, most of your weight goes forward, right on the ball of your foot, exactly where the fascia attaches. It then stretches it and eventually strains it.
- Worn out training shoes : worn out shoes do not absorb the shocks as well as new ones. The springy material of the sole eventually dies and then you get a flat! When that happens, it is the arch of your foot that starts absorbing the impact by elongating and then returning to normal position, just like a bungee cord. You now know that leads you to what! Also, worn out sole usually means worn out upper as well, meaning that the arch support is probably also gone. Running shoes are expensive, but so are doctors, physical therapists and medications!
- Old surgery or deep laceration : the plantar fascia we said, runs front the heel to the ball of the foot. But it is also attached to the body fascia, which is a very strong tissue (similar to ligaments and capsules, but in a much stronger version), that contains a multitude of sensory nerves. The fascia lies just beneath the skin, and wraps around most muscles and joints. It is only one big piece in your entire body (unlike bones, per say, that come together in joints to form the entire skeleton), so anything that affects it somewhere can refer pain anywhere else along it. So if you have had a surgery, a deep cut or even a contusion (deep bruise), your fascia may be restricted and causing a stress on your plantar fascia.
Note: Leg lesions are more prone to have an effect on the plantar fascia, but keep in mind that it is possible that any lesion anywhere in your body (including your brain) might affect the plantar fascia. The fascia itself will be the subject of a future article.
- Bad running pattern: When you walk, you should first hit the ground with your heel; this part of the stance is called the heel strike. When you run, you should follow that same pattern, but only land a little further, meaning that you will spend less time on your heel. Be careful though: many runners try to make their running look lighter and easier by avoiding completely the heel strike and landing directly on the front of the foot. Bad idea! The ball of the foot is not designed to absorb such an impact – you still must let your rear and mid-foot absorb the shock.
What to do
The most important part of the treatment is to eliminate the cause. So you have to figure out what caused the plantar fasciitis in the first time (orienteering itself cannot be blamed!). If you cannot find anything in the above list, see a specialist.
You now have to work on getting rid of the cause: So for pronated feet or high arches, get orthotics made for you. The cost ranges from $300 to about $500, and they will last 2 to 5 years, depending on the materials used. Make sure you don’t train in worn out shoes, watch your running pattern, lose weight if you think you are carrying some extra pounds and try to run on softer surfaces like trails. If you think your problem comes from the fascia further up in your body, consult a specialist (Registered Massage Therapist, Physical Therapist or Chiropractor) that can use Myofascial Release techniques. Also, avoid running hills for a while; they force you to land your stride on the front of the foot, which increases the stress on the fascia.
For any of the above, it should take about 3 weeks of complete foot rest (some sports that do not load the foot, like swimming, are allowed) to let the fascia completely heal and regenerate. That and getting rid of the cause will take care of most of the problem, but you will still need some anti-inflammatory treatment, gentle stretching and massage to speed up the healing process in the meantime (physical therapy).
It is a myth that a plantar fasciitis will last for months – if yours does, read this article over again because you certainly have missed something somewhere!