By Ian Nurse, D.C.

Tough to pronounce but impossible to ignore, plantar fasciitis is one of the most common foot injuries of both novice and veteran runners. For those who have suffered through it, the symptoms and chronology are unmistakable: insidious at first, then becoming a chronic, sharp and burning sensation on the inside base of the heel with the first few steps in the morning. While the pain seems to get better with activity, it returns with full force by the end of the day. One of the slower healing injuries of the body, it’s not uncommon to hear of people enduring anywhere from months to years.

So what exactly is plantar fasciitis? How does one treat it, or, better yet, avoid it in the first place?

First, let’s start with the anatomy and the role it plays in the proper functioning of the body. The plantar fascia is a fibrous sheath consisting of the connective tissue protein, collagen. This sheath is lined in parallel to the direction of pull over the muscles on the bottom of the foot. This super structure is critical in arch support carrying as much as 25% of the load. As one can imagine, it also plays a significant role in the gate cycle as it acts as a tie beam transferring force from the calf to the forefoot. Running from the inside portion of the heel to the base of the big toe, one can experience symptoms along any portion of the arch; however, the pain typically centralizes where it originates at the base of the heel.

While previous thinking had correlated arch height as a predisposing factor to developing plantar fasciitis, new research refutes this claim. The most accurate kinetic predictor is not the size of your arch but rather the working relationship between the plantar fascia and the intrinsic muscles that lie beneath. As the plantar fascia itself is a passive structure that stores and returns energy, it relies on the intrinsic muscles to create the energy needed to support the arch. If the intrinsic muscles are not firing correctly due to adhesion, scar tissue or muscle imbalance, the plantar fascia has to adopt a more dynamic role that can lead to problems. Tissues tighten up and restrict blood flow to the area, leading to scar tissue formation. This in itself is enough to produce pain, but if untreated can progress into an even more difficult problem: tendon degeneration. In this case, the point on the heel bone where all those muscles and the plantar fascia attach begins to degenerate or die.

How does one avoid ever getting plantar fasciitis?

First and foremost, wearing the proper footwear is crucial. Think of putting a train on the wrong set of tracks. Wearing shoes that are either too supportive, or not supportive enough can be the leading factor to someone developing this condition. The second tool in prevention is strengthening the muscles of the foot. Exercises such as toe scrunches and calf raises a few times a week can help develop a better balanced arch that will rely less on the plantar fascia and more on the muscles.

What can I do if I have been suffering from plantar fasciitis?

As mentioned earlier, plantar fasciitis can be an extremely slow healer. Anatomically, the foot is already in a position of decreased blood flow that also has to work against gravity. As a result, the degenerating tissue is unable to get the nutrients and blood that it needs. It’s important to treat this early so that it does not become a chronic condition. Start with assessing all of your training variables that might have led to it developing in the first place—improper shoes, training surfaces, and intensity. It’s also very important to both help break up the scar tissue that has formed and reduce the inflammation. Rolling your foot over a golf ball can be a helpful form of self massage. Make sure that you then follow that treatment with icing to reduce the swelling. Freezing a Nalgene bottle filled with water makes for a great ice massage tool. As our body heals itself at night, it’s also vital that the foot is held at 90 degree angle to ensure that the fibers heal in a lengthened position. A night splint or the Strassburg sock are useful tools to facilitate this important healing step.

For those cases that are not healing on their own, consulting a professional could be a necessary step. Massage therapists, PT’s, and chiropractors all treat plantar fasciitis on a regular basis and could be the final step needed.

This was originally published in the March/April 2013 issue of Level Renner. Want to get this material as it’s released? Sign up for your free subscription in the box on the right side of the screen. As always, if you have any questions regarding this injury or would like to have your own condition assessed, please do not hesitate to contact Ian: [email protected].