Plantar fasciitis | Running’s arch enemy

Plantar fasciitis is one of the most common running injuries, and also the most nagging. Here's how to tackle it

Updated8 Jul 2013
Hard surfaces and inappropriate footwear aggravate the condition<br />
Hard surfaces and inappropriate footwear aggravate the condition

Last year, one of the runners I coach came to me with a challenging problem. He wanted to run and train hard but each time he stepped out to run, he was beset with pain in the soles of his feet, making it an agonizing experience. It was not hard to diagnose the problem—I too had suffered from it in the past. He had plantar fasciitis.

If you are a runner or have friends who are runners, it is more than likely that you have already heard of the term, and just how disastrous those two words can be when it comes to running.

Plantar fasciitis is among the most common running injuries alongside shin splints, runner’s knee and Achilles tendinopathy. If you wake up in the morning with a pain spread over the heel and sole of your foot, several days in a row, you would do well to consult a doctor, preferably one with a specialization in sports medicine. Plantar fasciitis is an inflammation of the connective tissue called the plantar fascia that links your heel to your toes, forming the arch of your foot. It occurs due to chronic overuse and excessive and repetitive strain of this tissue. While its occurrence in sportspersons is widely known, it happens just as easily to amateur runners. It is characterized by pain ranging from dull to sharp in the arch section, or just in the heel, or radiating from the heel to the arch.

The pain is usually more intense when one starts the activity (be it running or walking) and usually decreases once one has warmed up after a few minutes.

In sportspersons, especially runners, it occurs when sudden and large changes are made in the intensity of training, or due to overtraining, even if the change in intensity has been gradual.

The running surface, footwear and biomechanics, all play a role. Hard surfaces such as asphalt and concrete aggravate the condition. Inappropriate footwear (hard-soled footwear is one potential culprit) as well as incorrect biomechanics contribute too.

Fixing it

There are two facets to address in plantar fasciitis, the inflammation, and the underlying causes. The inflammation can be addressed by lowering the intensity of your running (most experts agree that you don’t need to stop running completely, except in severe cases), taking non-steroidal anti-inflammatory drugs (NSAIDs) prescribed by a doctor, as well as some topical applications and physical therapy.

The occurrence of plantar fasciitis in sportspersons is widely known, but it happens just as easily to amateur runners.

But he recommends extreme caution in the use of this option as overuse of steroids can lead to rupture of the plantar fascia itself, which is extremely painful and complicates the injury. The rule, he says, is to never have more than two steroid injections at one spot and ensure a minimum gap of six weeks between those two.

He also refers to the advent of a new option— the PRP (platelet-rich plasma) injection, which is used to heal the patient biologically, since it uses the patient’s own cells. This is resorted to in cases when the patient has not responded well to conventional methods. Platelets are extracted from the patient’s own blood using a centrifuge and injected back into the affected area to aid rapid healing.

Further, as a last resort, surgery may be recommended to release the plantar fascia.

Even though Dr Kalyan sees over 150 patients a year with plantar fasciitis, he says he operates in barely one-two cases.

Matters of the sole

Addressing the pain is only a temporary measure—the long-term solution lies in stretching and strengthening the plantar fascia.

As is the case with most running-related injuries, addressing the kinetic chain, which links the calf muscles, the Achilles tendon and finally the foot itself, can alleviate the problem.

“The issue itself is not a strength issue but a flexibility issue,” says Gladson Johnson, founder-director of Attitude Prime, a physiotherapy clinic in Bangalore. “Hence, the flexibility of plantar fascia and the accessory muscles has to be dealt with. Strengthening the calf or other muscles is not the solution.”

If you have tight calf muscles or a tight Achilles tendon, you increase the chances of plantar fasciitis, as those stiff muscles then pull on the plantar fascia to compensate for their lack of flexibility, thus increasing the pressure on it, and not allowing it to relax or maintain the arch.

There are several calf-stretching exercises which you can do after consulting your doctor or physiotherapist. One such exercise involves sitting on the ground, with your legs stretched in front of you, then turning your toes on one leg towards you. If you are flexible enough, you can gently grip the toes with your hands and increase the stretch in the calf. Hold for about 15-30 seconds and then release the toes. Repeat on the other leg. Do this twice at one go. As with most stretching, attempt this after 15 minutes of warming up by walking or jogging.

The tightness in the foot itself can be relieved by two exercises. One involves sitting in a chair with the feet on the ground. You can begin by scrunching your toes for about 2 seconds and then releasing them. Do this 10-15 times.

You can also pick up objects like balls, pens or rolled-up towels, using just your toes. Do this for 1-2 minutes each, two-three times a day.

You can also gently roll a golf ball (even a tennis ball will do) underneath the arch of your foot for about 5-10 minutes depending on your doctor’s recommendation. This will help loosen the arch portion of your foot.

Dharmendra is a running coach and amateur long-distance runner based in Bangalore.

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