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Treating plantar fasciitis

On January 1st, millions of Americans committed or re-committed themselves, to running. For many of them, it was as easy as lacing up a pair of sneakers, bundling up, and heading outdoors. After a long layoff, as many of us take during the holiday season, and especially with the addition of a new activity, it’s no surprise that overuse injuries become more prevalent this time of year. One of the most common injuries that many runners and non-runners alike will face is plantar fasciitis.

Almost all of us have either experienced this condition ourselves, or at least know one person who has suffered from it.  Physiologically, it is a repetitive micro trauma (also known as overuse) injury of the plantar fascia which can lead to pain along the inner aspect of the arch, close to the heel. Pain is usually at its worst first thing in the morning, with the first few steps out of bed.  Generally, the pain improves during the first 15 minutes after arising, but can get worse as the runner is up throughout the day.  Running can become almost impossible, depending on the severity of the inflammation.

Foot anatomy showing the Plantar fasciaThere are many ways to manage plantar fasciitis, from stretching to surgery. For runners, as with almost any lower extremity injury,  discomfort starts at the bottom – with the feet.  It goes without saying that  running shoes need to be replaced every so often, generally between 300 and 500 miles. More specifically, runners need to know their foot type. In most cases, runners with high arches need to find a good shoe with cushion, as their foot becomes rigid during the initial contact and foot flat phases of the running cycle. The cushion helps to dissipate the ground reaction forces the runner can experience during a run. Those with a more flat foot type should look for a stability, or motion control shoe. This helps to limit the amount of pronation, or collapsing of the arch, that the foot goes through during the foot flat phase of the gait cycle. A further option, and one that has helped many runners and non-runners alike, is some type of an orthotic. The purpose of an orthotic is to build the bottom of the shoe up to meet the foot, often in a custom form for that particular foot. However that is best accomplished will most assuredly benefit the runner with aching feet.

For more immediate pain relief, many runners report symptom relief from a simple form of ice massage. It starts with a frozen water bottle, putting a towel on the floor with the water bottle lying on its side on the towel, and rolling the arch over the bottle. Mild discomfort is to be expected – there is inflammation in the arch, and the ice is helping to massage it away.

Calf stretching can also help the patient with plantar fasciitis – by standing with one foot behind the other and putting hands into a wall, keeping the back heel down, the runner can get a good stretch along the gastroc muscle.  Performing this same stretch with the back knee bent and the heel touched down can stretch the soleus, the other muscle in the calf.

Of course, if no treatments work, the runner may have to scale back his/her mileage or stop running altogether, slowly building back up as symptoms permit. If pain does not improve, a trip to a doctor or podiatrist may also be warranted. Medications, injections,and night splints are other treatments which may be employed at this time. With the right shoes, stretching and proper treatment, plantar fasciitis can be just another challenge that runners overcome on the way to their goals.

Written by

Laura Alexander O’Connor, MPT, has been a physical therapist since 2003. A St. Louis native, born and raised, she has worked in outpatient orthopedic clinics with a variety of patients, including many runners. She presented at the 2004 National Athletic Trainers Association National Convention, was published in the Journal of Athletic Training in 2005, and has participated in clinical research at both Washington University and Saint Louis University.

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3 Responses to "Treating plantar fasciitis"

  1. Amy Everpean says:

    Thanks for the info! I recently feared i had this and bought some shoes from http://www.orthaheelusa.com to see if that helps! Can’t wait to try them out!

  2. Do you think it to be wise to stretch the calf in that manner if it is more than likely harboring active trigger points? Going namely by travell and simons text books, that would make the pain worse…

  3. Laura OConnor says:

    I always advocate stretching with the use of a foam roller for trigger point release in the case of recalcitrant calf adaptive shortening. If a foam roller is not enough, one of the “roller sticks” is also good to use.

    Hope that helps. ASTYM is also a great technique that many PTs use to break up adhesions and stimulate healing throughout the kinetic chain.

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