Plantar Fasciitis by Coach Glenn McDaniel
It’s a cool April morning as you toe the starting line with thousands of your closest friends, wearing your favorite race gear and prepared to battle the famed Boston Marathon. The first few miles go exactly as planned. At the half way point, you are on pace to set a new PR. Your passing people and feeling really good about yourself, then you wake up!!! That first step of the morning reminds you that plantar fasciitis has slowed your training and made walking somewhat painful.
If this is you, and I truly hope it’s not, have no fear. Plantar fasciitis can be treated and overcome. PF, as runners hate to call it, is simply inflammation of the plantar tendon is a thick band of tissue that runs from the heel to the toes. Plantar fasciitis is also the most common cause of heel pain.
The plantar tendon is like a bow string across the bottom of the foot. This bow string, if drawn too tight, will develop small tears and become irritated and swollen. This inflammation creates a lot of pain with those first few steps of the morning. That pain usually goes away after a few steps but can come back when you stand, after a long time in a seated position. This bowstring becomes swollen and tight with the repeated impact it takes while absorbing the load of running, causes our training to become erratic or non existent.
Roughly 80-85% of PF cases start with tightness in the calf and achilles area. In switching to a minimalist shoe, some people don’t allow for proper adaptation. Wear a shoe casually for the first few days will allow the achilles to lengthen and adapt to the new stress. Many Type A runners are quick to go out and test drive the new minimalist shoes, creating an over abundance of stress on the achilles, thus a great strain on the plantar tendon.
It is vitally important to discover the root cause of the PF. If it is simply a lack of arch support, that’s great, but the symptoms can also be caused by other issues that need to be dealt with. In my case, my everyday work shoes were too tight and forced a dropped metatarsal head. This led to an irritated plantar tendon. We worked to treat the PF and not the issue. Once you discover the issue, correct it, and treat the symptoms.
For treatment, you need to find good support in your everyday shoes. There are many ways to get that support. You can find arch supports at local pharmacies and running stores. You can also wear shoes that have more arch support. In battling PF for about a year, I found that stretching the lower leg/achilles offered relief as well. The entire posterior chain is connected from the toes, through the heel and up the back of the leg. A good stretching routine will keep the connective tissue loose, while the foam roller will help remove the lactic acid and junk that builds up throughout the training cycle. The inflammation will also respond to icing and ibuprofen. If the pain is very severe, or lasts too long, you will want to seek medical help.
As a runner, you will want to work on strengthening the foot and lower leg to avoid PF, or to reduce the symptoms of PF. It is not uncommon to see athletes that do their shorter, faster runs in shoes without much arch support, but they will switch to more supportive shoes for longer runs. This approach has helped me tremendously. Standing on my feet all day has slowed my recovery, but the use of arch support in my daily shoes helps. If you have battled PF, and maybe you still are, you want to return to running by reducing your mileage, slowing your pace and staying on flat ground. High mileage and a fast pace greatly increase the stress on the plantar tendon and the achilles area. This leads to more inflammation and will slow down your progress. By keeping your runs to flatter surfaces, you also reduce the flexion in the foot some. Remember, too much flex will lead to irritation.
I battled PF during my training for the Colorado Marathon and used the above to help relieve the symptoms, but the downhill and race pace made things worse. Coming back to better running has been very slow. I started by icing a lot and stretching. The entire month of May was without running. I focused strength, stretching and rehab. When I started back to running it was no more than three days a week at a very leisurely pace. Most of this early running was less than 30 minutes in length and at a very boring pace. By following the tips above, I now find myself running up to 90 minutes at a time and running at paces that are more familiar to me. I’ve never been a fast guy, but finding my speed, and not feeling pain, is priceless.
The truth is, plantar fasciitis is very difficult. It is not something that goes away quietly overnight. It takes time and patience to get rid of. The trouble is that most runners don’t have that time, or the patience. My best advice is to constantly treat your feet. Roll them with a golf ball, tennis ball, or lacrosse ball. Ice them after longer runs. Take care of your feet. So many runners talk about the foam rollers and their IT bands, hamstrings and quads, but most neglect the feet. The feet are your foundation. Would you avoid caring for the foundation of your home? I think not. Treat your feet with care and they will respond.
Be Healthy, Train Smart, Have Fun