Ask a group of runners about their most common running injuries, and chances are you’ll hear a chorus of complaints about frustrating foot pain.
Plantar fasciitis – or PF – is the most common cause of runners’ heel pain, resulting in more than 1 million doctor visits every year in the U.S. alone, according to the National Institutes of Health. Other common predisposing conditions include low thyroid conditions, diabetes, smoking and autoimmune arthritis.
Plantar Fasciitis Pain
Dr. Kevin Sherman, a sports chiropractic physician and Active Release Therapy (ART) practitioner in Scottsdale, Arizona, says PF is the most common condition he sees in his patients. “I see seven to nine cases a day, and it’s not just the athletes who get it.
“It’s an epidemic here in Arizona due to hard flooring surfaces and the fact that people wear flip-flops year-round. Flip-flops are probably the biggest contributor.”
Flip-flops, he notes, force the toes to grip the shoe at a strategic point in the gait cycle. That motion affects two muscles above the fascia. “The truth is most of the cases I see are not true plantar fasciitis. Rather, the problem is with those muscles above the fascia, which have been traumatized for so long from hard surfaces and walking in flip-flops, which causes repeated micro-trauma.”
Signs & Symptoms
Dr. Sherman says prior to the onset of PF, a person may first experience significant calf tightness. “It comes on insidiously slowly,” he notes.
The condition can also be aggravated by running in minimalist shoes, which provide little to no support, and forefoot running. “As far as athletes go, plantar fasciitis can share some of the same root cause as shin splints. The pain usually dissipates after walking around for a few minutes.”
“The most common symptom is pain with the first few steps out of bed in the morning,” says Dr. Sherman. “The pain will present in the arch, primarily, and the heel area. The pain usually dissipates after walking around a few minutes.”
What’s a Runner to Do?
Fortunately, there are a number of effective home treatments if plantar fasciitis is detected early.
Foam rolling. Sherman recommends rolling through the calf and the bottom of the foot several times a day.
- Cold packs. Dr. Sherman recommends keeping an ice pack in the refrigerator to guard against frostbite, adding that a pack cooled to 55 degrees will provide full therapeutic benefits. He warns not to apply ice directly to the foot. “You can inadvertently freeze the nerves and the skin.”
- Stretching. Toe stretches against a wall, or a seated stretch holding the toe up for 2 seconds and releasing. Repeat these stretches 10 times.
- OTC Medication. Over-the-counter anti-inflammatory medications can also help relieve inflammation.
Don’t Do This
- Don’t roll the foot on a golf ball or tennis ball. Sherman warns balls can inadvertently roll across the muscles and tendons of the foot and cause further damage.
- Don’t apply solid, frozen ice to the foot. The chances of frostbite and nerve damage are high because the skin on the foot is so thin.
- Don’t use heat. Heat actually opens up blood vessels and invites in more swelling.
When to See a Doctor
As soon as self-care measures are no longer working, seek out the help of a doctor. A physician trained in Active Release Therapy will generally begin with treatments designed to break up thick myofascial adhesions. The number of treatments will vary depending on the patient, but usually six to 10 visits will remedy plantar fasciitis.
Dr. Sherman will sometimes accompany ART with Graston Technique therapy and dry needling if improvement stalls at any time during the treatment phase.
If left untreated, plantar fasciitis can become a chronic condition. “There can be a significant amount of disability, and it becomes very difficult to treat because the area becomes so sensitive,” Dr. Sherman says. Rarely does the condition warrant surgery.
The good news is there are some preventative exercises that can be done to help avoid plantar fasciitis altogether.
The most effective of these are hip stabilizing moves that will support the gluteal muscles and knees. “Any motion that allows for the drift of the knee inward during cycling or running puts a tremendous stress on the plantar fascia and the IT (illiotibial) band,” says Dr. Sherman.
Three exercises to incorporate into your workouts are:
- Forward Lunges. Stepping forward with one leg and lunging with the knee at a 90-degree angle above the foot. Watch yourself in a mirror so the knee does not wobble from side to side. Go only as low as you can with the knee remaining stable.
- Monster Walks (or Gorilla Walks). Use a stretch band around the ankles and walk slowly forward and backward.
- Toe Raises. Raise up on the balls of both feet. Lift one foot slightly off the floor in front of you. Return slowly to the ground on the other foot. The release is ECCENTRIC, meaning the work is done on the downward motion. Reverse and do the other side. This exercise is also helpful for building Achilles strength.