Running Training and Technique   How to Treat Plantar Fasciitis

How to Treat Plantar Fasciitis

 March 01, 2013 10
How to Treat Plantar Fasciitis

Heel pain in runners can be a tough one to treat… The symptoms of this injury can vary from mild to severe, constant or transient. Some runners feel pain along the arch, some directly under the heel bone, but the diagnosis is typically the same dreaded two words: plantar fasciitis.

Modern medicine tends to treat only the symptoms of this condition, overlooking the underlying causes. Medical treatment modalities such as cortisone, night splinting, boots, and steroidal anti-inflammatory medication may help bring relief… for a month.

In runners, since we put constant pressure on our feet, long-term recovery from PF comes from delving into what I consider the two chief causes of this disorder. You may have one or both of these functional problems, but below I have outlined how to treat each to finally heal your heel.

I have had PF in my left foot off and on for three years, but finally got it over the hump using a combination of these therapeutic courses. Now it only gets aggravated during periods of intense speed training on the track, and I can resort to my trusty rehab plan to nip it in the bud.

Cause 1- Trapped Soleus

The soleus is a forked muscle that sits along both sides of the larger calf muscle, the gastrocnemius, and works as a prime mover for propelling the runner forward with each stride. In my opinion, tightness in this muscle is the number one cause of PF in runners.

The first exercise to correct any impingement or tightness here is to use an Active-Isolated Stretch on the soleus directly. Sit on the floor with legs out in front of you. Slide the injured foot up until it is parallel with opposite knee. Take hold of your forefoot with both hands, clasping fingers lightly. Keeping your heel on the ground, use hands to gently raise the forefoot off the ground as far back as you can comfortably go. Repeat 10-12 times for two seconds each. Perform on the opposite soleus as well for muscle symmetry.

First thing in the morning, our PF muscles are tight and shortened from a night of immobility. This is why PF hurts worse in the morning. Before your feet hit the floor, sit up on the edge of your bed with feet dangling if possible. Relax toes and ankles completely. Gently press the inside edges of your feet together, inner arches touching. Roll ankles with feet pressed together 40-50 times both clockwise and counter-clockwise. This activates the soleus alone and allows it to pump fresh blood to the feet and lower legs. This can be done several times per day, and will greatly accelerate healing.

Cause 2- Scar Tissue Over the PF

plantar fasciitis in runnersIf you have had PF for a while as many runners often do, then you may have a build-up of scar tissue along the arch and PF attachments. In bare feet, feel around for any tight spots, “crunchy” bits of tissue, or small muscle knots.

Without going straight into the direct point of pain (mine was the inner corner of my heel near a bursa sac), massage in a progressively harder way along the arch, under the metatarsals, and along the heel. Roll the ankle and dorsiflex your foot as you massage up, down, right, and left along the bottom of the foot. Use your knuckles, thumb, palm, and even finger nails to rake across the heel’s fat pad, eliminating any scar tissue you find in the area. Do this for 20min every other day to bring about positive change.

Other Helpful Tips

After 7 days from the onset of symptoms, stop icing the heel and taking NSAID medication; these modalities only decrease blood flow to the area and impede healing. Take acetaminophen when pain is present if you must (after consulting with your doctor, of course). Heat before runs for one month as needed.

Do not stretch the arch/PF directly, as this may only create a cycle of “tear and repair”. Instead, spread toes widely with fingers to relax foot muscles, perform the active soleus stretch above, and keep the calves, hamstrings, and hips loose as well. Finally, WEAR MINIMAL SHOES for running. Strengthening the feet is critical for PF sufferers, and you will never develop such strength in heavily cushioned trainers with thick heels.

Best of luck in your recovery from plantar fasciitis! This is an injury that takes patience and diligent work to overcome, but it can be done by following the above protocol, training intelligently, and modifying your gait/shoe choice to aid in the healing of your heel.

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COMMENTS (10)

  • Night splints, rest, isolated stretching, and I’ll add this: strengthening of the lower calf muscle by doing simple ‘toe raises’. Stand up with feet a natural distance apart, and simply raise up on your toes for however many repetitions you can. Do as many sets as you can work in during the day.

  • What helped me the most was ditching all of my shoes (casual and athletic) with a hard, raised heel.

  • This is the first article that I have read that nailed it for me. I worked with a health professional that performed Active Release Technique to break up scar tissue in my feet and my PF went away. After years of using bandaids like night splints, orthotics it always was there in some extent. The ART technique is very painful but after a couple of treatments I was cured. I now run with Skora Forms minimalist shoes and life is great again.

    • Hi Matt –

      I know you posted on this forum in the fall, so you might not see this. Who did you go to to have the the Active Release Techniques performed (e.g. what kind of therapist?) I have also suffered from PF for a couple years and have tried the traditional means of recovery (custom orths, physical therapy, stretching, icing, etc). But the physical therapy did not include massage/ART. Also, I’m in NC so if you know of anyone specific here, that would be especially helpful. Obviously, you may not. I’m going to email Peyton Hoyal, too, since he’s in NC.

      Thanks,
      Kristin

  • Thanks Peyton, great article, would you give the references for the benefits of not stretching the plantar fascia. This is difficult to comprehend, thanks, Mark

  • Mark,
    This holds most true when one is in the early stages of PF. The fascia has to mend itself back together, and constantly tugging on the arch doesn’t aid in this process. My sources from this come from personal experience, my chiropractor (Dr Daniel Bachelor), sockdoc.com, and a myriad of other experts. I don’t believe much of what I read in the medical field, but I do believe what actually works; in this case, not stretching the PF directly helped cure my personal bout with this injury. However, I think active isolated stretching of the feet is pivotal to preventing PF in the first place, as a strong, supple arch is less likely to be injured.

    Peyton Hoyal

  • One must also remember that nature did not intend man to run extended distances on concrete and other hard flat surfaces. These “unnatural” planed surfaces have a higher impact rating and force up the kinetic chain. That is probably the root cause of PF. Also the author does nothing to address that a runner with inefficient foot biomechanics is probably just pronating themselves into a tibial tendon issue by wearing minimalist shoes. Those are not a safe recommendation for all runners, although its safe to say that anybody that reads running blogs is probably not an over pronator and there for not much of an issue.

  • I liked this article, however, I disagree as far as the minimalist shoes are concerned. I was specifically told by my podiatrist that flat shoes caused the PF in the first place. He told me to stop walking around the house barefoot, avoid wearing flat flip flops, and to run in a shoe that has a lot of padding in the heel so that the heel is raised in relation to the toes. After following his instructions, my PF went away. I will occasionally wear flip flops too long in the summer and I can feel it coming back so I go back to wearing tennis shoes during the day and I immediately see improvement.

  • Sure, but you told on yourself- the PF returns every time you ditch said shoes. The reason for this is that the “big heel” is serving as a veritable crutch for your achilles, PF, and soleus; they are still weak and tight from the raised platform, and this kind of shoe is only masking the underlying causes. In your case, I would wear the cushioned shoes for non-running activities, but perhaps invest in a lower-profile shoe to test while running (gradually increasing your volume in the lighter shoe). This way, you stimulate the muscles/tendons connected to the PF while running, then let them recover in the cushioned shoe during the day. The podiatrist’s suggestion was to help you become pain-free; just like medication would do. My goal is to help you stay that way, even if it feels unorthodox at first.

  • What do you consider “minimalist shoes”?

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