As a Sports Therapist I am used to seeing a variety of different injuries and ailments. In this new feature I will be giving the low-down on the most common sports injuries I see, how to treat them, and most importantly how to prevent them. First up in the series: the increasingly common and very painful Plantar Fasciitis.
Plantar fasciitis makes up around 10% of the sports injuries I see; most often in runners. It is, essentially, inflammation of the plantar fascia; the connective tissue that runs from the heel to the base of the toes. Here I will describe how to tell if you have plantar fasciitis, what to do to treat it, and how to prevent it recurring.
The plantar fascia is a thick, fibrous tissue that supports the arch of the foot and aids in the “take-off” phase of running gait. It stems from the calcaneus, or heel bone, and extends down the length of the foot to the heads of the metatarsals (toe bones), splitting into five branches as it does so. Because of its tendon-like structure it is not very responsive to stretching, but a large stretch-demand can be placed on it during running activities, making inflammation common.
Patients suffering with plantar fasciitis describe a pulling or tearing sensation along the sole of their foot, usually worst first thing in the morning. This is often likened to the pain experienced when stepping on a plug and can be very sharp.
The pain usually gradually eases with exercise, as the fascia warms up. Aching can also be experienced at rest or late at night.
The causes of plantar fasciitis are uncertain, but likely factors in runners are:
- Increased age
- Increase in weight
- Tight Achilles tendon and/or calf muscles
- Change in footwear
- Sudden increase in training/mileage
- Overpronation of the foot
The good news is that around 80% of patients find that symptoms settle within 12 months with conservative treatment. A treatment plan is best provided by your Sports Therapist or Physio, but can often include:
- Rest; whether this is rest from running (using cross training activities such as cycling or swimming), or just a reduction in training, depends on the severity of your injury
- Sports massage for the feet, calves, and Achilles.
- Stretching of the calves
- Self-massage; I recommend patients roll a frozen bottle of water underfoot whilst sitting, but a tennis ball will suffice
- NSAIDS (non-steroid anti-inflammatory drugs) including Ibuprofen. These can be taken orally, or applied topically as a gel. Some people can suffer stomach problems with Ibuprofen tablets, in which case gel is preferable.
- Night splint; using an orthopaedic boot to hold the foot in dorsiflexion (calf stretched, ankle at 90 degrees or less)
- Footwear modification; moving to a more supported shoe may help prevent overpronation if this is a cause (it is always best to get your gait analysed before changing footwear)
Ice and heat alternating treatment can also be used to help reduce inflammation.
Once symptoms have eased it is time to start a strengthening program to help prevent recurring injury. These exercises are best performed barefoot at home.
This exercise will strengthen the muscles in your feet as you move whilst balancing on your toes, in a similar way to the action performed whilst running.
Start by standing on both feet. Raise yourself up on to your toes and take slow, small steps forward with each foot in turn, staying up on your toes. As you bring your foot forward to take each step, dorsiflex your foot by bringing your toes up towards you (bringing your foot to just past 90o at the ankle); you should feel a slight stretch in your calf muscles as you do this.
This exercise will strengthen the muscles in the sole of your foot and your toes.
Sitting on a chair, place a small hand towel on the floor in front of you. Place one foot at the near end of the towel, with the length of the towel running out from in front of your foot. Using your toes, gather up the towel until you reach the end, passing the scrunched up sections of the towel underneath your foot.
As well as the strengthening exercises above, keeping the calves nice and loose is always a good start for preventing plantar fasciitis from occurring. The calves attach to the heel bone via the Achilles tendon, and as already mentioned the plantar fascia stems from the heel bone in the opposite direction. If the calves are tight, then a pulling force is applied to the heel, which can cause excessive stretching of the plantar fascia, causing it to work harder in the running gait cycle.
As plantar fasciitis is an overuse injury, it is always less likely to occur in people who increase their training gradually. This applies not just to mileage increases, but also to changes in footwear or terrain. Whenever a change is made to your running, you should always ease into it gradually to lessen the likelihood of injury.
If you have been wearing the same style of running trainers for a while now with no problems, then I would not suggest you change, but if you do tend to be more susceptible to injuries with no obvious other cause (increased training, sudden changes in terrain or impact injuries) then it may be worth visiting a gait analysis specialist.
A.A. Narvani, P. Thomas, B. Lynn. Key Topics in Sports Medicine. Routledge, 2006.
CC Image “Hot Foot” courtesy of istolethetv on Flickr.
CC Image “Foot Massage” courtesy of Bali Mandira Beach Resort & Spa on Flickr.