What is it?
The plantar fascia is a tough band of fibrous tissue that connects your calf muscle to your foot. It extends from your calcaneus (heel bone) to the metatarsals (ball of foot). It works to allow your foot “spring” during running and walking.
Plantar fasciitis is an irritation of this tissue due to excessive tightening or shortening of the fascia. It is commonly felt as pain in the heel that is worse when getting out of bed or after sitting for an extended period of time. It is also aggravated by walking and running.
How did I get it?
There are two anatomical factors that contribute to the development of plantar fasciitis. Flat, hypermobile feet cause excessive stretching and pulling of the plantar fascia causing microtears near where it connects to the heel bone. High arched, rigid feet do not flex well and do not dissipate shock. This causes contusions to the fascia resulting in bruising, tearing and pain.
How is it treated?
There are many ways that plantar fasciitis can be treated. Some are more risky and less effective than others.
Custom Orthotics: A proper foot orthotic can go a long way in taking the stress off of your plantar fascia. The right custom-made, biomechanical orthotic can address the underlying cause of your foot pain. Abnormal joint position, overpronation or foot rigidity can be addressed and the biomechanics normalized. The orthotics must be custom molded to your foot and designed with your specific body weight and activity in mind. The restoration of correct mechanical function takes the abnormal stress off the plantar fascia and allows it to heal.
Stretching: Often we are told by runners that they have been stretching in an attempt to help plantar fasciitis. The stretching exercise is directed at lengthening the plantar fascia. The problem is they are not following a scientific, research based stretching program or using a medical device that can help such as The Strassburg Sock. In order for stretching to be a successful part of the healing process the plantar fascia must be lengthened and for that to happen the tissue will have to be stretched for a specific amount of time and for a specific amount of repetitions. The Strassburg sock allows the tissue to be stretched all night as you sleep thus promoting lengthening.
Rest: For many rest is not a realistic option, the race you are training for is looming. Our bodies are wonderful “machines”, if you rest it long enough it will heal itself. How long? This is uncertain. Some patients report that they rested for two years and even now can not walk without pain. Some undergo painful surgery and the pain still persists.
Drugs/Anti-inflammatories: Drugs such as Ibuprofen are anti-inflammatory agents not Healing agents. They actually impair the healing process and many times allow the runner to injure themselves further by promoting running on the still injured plantar fascia. Studies have shown that these medications are harmful to your body, can cause ulcers and strain your liver.
Ice: Ice is often recommended and is another example of a non-healing modality. A runner often reports that they have been icing their foot after running so that the pain will subside and allow for another run the next day. If you banged your head against a wall and did not plan on doing it again then it would make sense to possibly place ice on your injured head. However, if your intent was to continually bang your head every day then icing it would be of no use. Instead you might try to place padding between your head and the wall. With running it is the same. If you ice your foot so that you may run on it again thus re-opening the wound that makes no sense. Addressing the underlying biomechanical cause does.
Steroid Injections: Steroid injections are extremely painful and most doctors are reluctant to inject the plantar fascia anyway. Recent research has shown, that in the majority of patients with plantar fasciitis, the tissue is not inflamed but scarred. During the initial injury inflammation was present but inflammation only last up to seventy two hours, then scarring takes place. Steroid injections have also been shown to increase the chance of rupture of the plantar fascia.
How long will it take to heal?
This depends on how long you have been suffering from Plantar fasciitis. By correcting the cause of the injury with orthotics and following the treatment regimen provided by a knowledgeable doctor you can expect 50-75% relief usually within two weeks. As with all injuries, the sooner you seek professional advice, the sooner you will be back running PAIN FREE!
Written By Dr. Victor J Runco, DC. Dr. Runco is the Clinical Director for the San Diego Running Institute, 15 time marathoner and two time 50 mile ULTRA-MARATHONER. He also specializes in the treatment of running and tri-athlete injuries.
