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More Training Info > Plantar Fasciitis
Plantar fasciitis (PF) is the chronic irritation and inflammation of the thick connective tissue that runs the length of the bottom of the foot. It manifests itself as pain close to the bottom of the heel, and can sometimes be relieved by getting more effective foot support, either in replacing an old pair of running shoes, getting orthotics (if warranted) that mold to your feet, or wearing stiff-soled boots with more of the right kind of support.
What is fascia?
A band of tissue called the plantar fascia starts on your five toes, extends backward along the bottom of your foot and attaches on the bottom of your heel. Runners may experience this at some point in their career if they get run too far, too often, too soon. When you run, you land on your heels and then raise yourself on your toes as you shift your weight onto your other foot. At that point, all your weight is on your plantar fascia. When the force on the fascia is greater than its inherent strength, it tears at its weakest point at the heel. Hikers, climbers, and even step aerobics enthusiasts can also suffer from PF. If you step out of bed first thing in the morning, and you feel like the bottoms of your feet are painful, or they feel like they’re starting to “tear,” but it gets better as you spend more time standing or walking on them (only to have trouble the next morning) then you probably are suffering from PF.
Shoes that have stiff soles that do not bend in the right place just behind the ball of your big toe, shoes that are too wide for your feet, running too fast for the present strength of your plantar fascia, or not allowing enough time to recover between speed workouts can all increase the force placed on the fascia and cause tears.
The best way to treat this condition is to stop the activity that causes it to act up, until you can run without feeling pain. Since you pedal with your knees and hips and place little force on your fascia, you can usually ride a bicycle without feeling pain. An elliptical machine might be a good cross-training option, as the foot stays relatively fixed while the rest of the leg muscles can get a great workout. It’s generally thought that shoes with flexible soles are better than those with stiff soles, but you’ll have to see what works for you. In my case I found that the stiffer my boot, the more comfortable my feet felt, especially out on longer hikes and climbs. Wear arch supports that limit the rolling in motion of your feet, and try stretching your calf muscles and see if that helps.
Is this condition the result of a muscle imbalance or weakness?
Generally, it results from overuse, although in stretching your calves and strengthening the fascia, you may be able to prevent development of the problem in the first place and ward off recurrence. To strengthen the fascia, place a towel on the floor with a book, soup can, or weight on the end, and using your toes, drag the weight toward you. Repeat 3-5 times. Stretch your calves on a step by placing the ball of your foot on the edge and dropping one heel down toward the floor. Contract the buttocks at the top, to feel the whole calf lengthen along with the arch of the foot. For best results, warm up thoroughly (5-10 minutes on a bike to break a light sweat) before stretching to end range.
What can I do to reduce the pain?
You can begin by icing area several times a day for 10-15 minutes at a time. (Blue ice or a bag of peas works well, so that it molds to your foot and doesn’t aggravate the tissue further) Ice treatments can be repeated as often as possible, but primarily at the end of the day. Next, try doing calf stretches (above) as often as possible, especially in the morning. You can use a tennis ball to massage the bottom of your foot simply by rolling the ball using your arch. Your workout routine should be altered so that you cross-train with non-impact activity such as biking or swimming. Your doctor might prescribe anti-inflammatory medications and/or orthotic arch supports which should be used according to instructions. Another hint I’ve found to be helpful: before taking your first step out of bed in the morning, spend a minute stroking the fascia on the bottom of the foot in order to warm it up, just like any other muscle in preparation for a workout – if you can get the tissue to feel a little more pliable, that first step won’t feel nearly as painful.
What about massage?
One type of therapy that proved to be especially helpful for me was Active Release Techniques (ART), though any deep tissue massage may work as well. After merely three visits (30-45 minutes each) to an ART practitioner in the Seattle area, as well as several Achilles and calf massages which my husband learned how to do during our visits, I was able to complete back-to-back climbs of Glacier Peak, Olympus and Rainier, no small feat indeed (pun intended!) Steven Tolzmann, in West Seattle, can be contacted at www.painfreesolutions.com for more information on how ART might help with lower extremity injuries including PF.
What activities should I avoid?
If you fear you’re suffering from PF, the best way to recover is to stay off your feet as much as possible, though for hikers, climbers, conditioning coaches, construction workers, teachers, or others who spend a large amount of time on their feet, this just might not be a viable option. It’s best to try to avoid high impact activities such as jogging, basketball, ballistic aerobics classes, etc. Also, try to decrease the amount of time spent walking on hard surfaces and do not walk barefoot unless you can do so in sand or other similar giving surfaces to help stretch and strengthen the fascia at the same time.
How long will the symptoms persist?
This, of course, depends entirely on you. Due to the chronic nature of plantar fasciitis the problem may last just a few weeks (if you comply with instructions) or several long, painful months. When coming back from the injury, running on soft surfaces is far better than harder surfaces – such as sand, gravel or dirt.
How can I prevent recurrence?
Always look to your running shoes as a component of the problem. If your shoes are old and worn, get new ones. If they are new, consider another style or brand. Be willing to spend the necessary dollars on the best footwear you can get. For excellent running shoes in the Seattle area, visit Super Jock 'n' Jill. If your activity is hiking, scrambling, or climbing, visit cobbler Dave Page (also located in Seattle at www.davepagecobbler.com/repairs.html) to see if he can help you get the appropriate fit for your foot and type of climbing.