Ouch! Plantar Fasciitis: It's Not Just Your Foot

One of the most common sources of foot pain is plantar fasciitis.  I have put in a lot of miles of running over the past 7 years and a lot of standing for the past 20.  Plantar fasciitis can affect people of all ages.  It is now affecting me.  Over the years, I have had patients and clients talk about it; hairdressers and teacher friends complain about the debilitating pain of the foot.  The pain, for me, wasn't noticeable during the first hard run after a hiatus from a broken toe and a long winter.  In fact, the run felt so good, towards the end I broke into a full sprint to cross the finish line and beat out an 11 year old competitor. The next morning, I could not weight bare on my foot upon getting out of bed. ("OUCH!").  I was pretty certain I had strained my foot from going up on my toes into that sprint that I mentioned.  I figured it would just go away with further progressive training.  It turns out that it does not go away as quickly as delayed onset muscle soreness. 


Plantar Fasciitis is usually caused by chronic pulling on the plantar fascia, tight Achilles tendon, overpronation, or other factors that overload the fascia.  The connective tissue (fascia) on the underside of the foot becomes irritated and painful resulting from overuse or misuse.  Musculoskeletal issues, going up the kinetic chain, such as lack of dorsiflexion, tight calves and hip flexors may contribute.  Rest, stretching and strengthening are key to recovery and treatment.  Initial ice to alleviate acute pain is recommended.  The idea of rest may seem rather daunting, especially if you are a runner. However, the pain can be excruciating at times and without proper rest from activity that exacerbates the pain, the condition will worsen and become less likely to completely go away.  Maintaining strength training, core training, cycling and swimming as running alternatives will get you through the recovery period.  Retraining the plantar fascia, calves, and hip flexors will help promote dorsiflexion and alleviate plantar fasciitis. 


Stretching and strengthening the foot, posterior calf muscles,  hip flexors and using Self Myofascial Release (SMR) techniques may help rejuvenate and regenerate tissues.  
SMR#1:  Golf Ball Roll- Roll underside of foot for 30-60 sec @ least 1x/day.  Manual foot massage upon awakening, before planting your feet on the floor.
SMR#2:  Calf Massage-  Massage any sore spots on backs of each lower leg for 1-2 min @ least 1x/day.
SMR#3:  Foam roller on hip flexors.  Roll front of hips and top of each leg for 1-2 min @ least 1x/day. 

Progress to appropriate stretching and then to progressive retraining when pain is gone. Simply bring your toes forward towards your body in a flexed position and a combination of flexion and extension.  There are many yoga positions that assist to alleviate foot, ankle, calf and hip flexor tightness and misalignments.  Upward dog/cobra, downward dog, warrior pose to name a few.  Orthotic or arch support may be used to temporarily relieve pain as you heal.  Long term use leads to weakening of the foot muscles.  Use of splinting is controversial and surgery is an option only as a last resort, if true nonsurgical conservative treatment options have been exhausted over a period longer than a year.  


Our mind and body are connected and your whole body works as an integrated system of parts.  The application of effective corrective exercises will enable you to address the underlying causes.  Proper nutrition with an anti-inflammatory diet and daily mindfulness to reduce stress is crucial.   If you are experiencing acute foot pain, consult a licensed medical professional for an accurate diagnosis and treatment.  Physical Therapy is of great benefit especially during intial recovery.  A Certified Personal Trainer can assist with providing stretching and strengthening exercises to address problematic muscle and soft tissue imbalances.


References
American College of Sports Medicine (2010) ACSM's Resources for the Personal Trainer, 3rd edition. Baltimore, Maryland. : ACSM
American Council on Exercise (2010). ACE Personal Trainer Manual, 4th edition. San Diego, Calif.: American Council on Exercise.
Price, J. (2014) Understanding and Alleviating Plantar Fasciitis.  ACEfitness Prosource
Photo source:  http://strengthrunning.com/wp-content/uploads/2011/10/plantar_fasciitis.jpg

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