What is Plantar Fasciitis?
I have been lucky to remain largely injury-free during my running career, except for a bout of Plantar Fasciitis which lasted for about 3 years. It is a painful injury that for me got so bad at one point, that I was considering packing the sport in for good. Over that period, I tried all of the remedies available, to no avail. It is an injury that can affect runners of all abilities, as well as people who are more sedate in nature.
The Plantar Fascia is a tough, fibrous band of tissue that runs along the sole of the foot with attachments to the heel bone (calcaneus) and to the base of the toes. It provides support to the arch of the foot and has an important role in normal foot mechanics during walking. Tension or stress in the plantar fascia increases when one places weight on the foot when standing, or as one pushes off on the ball of the foot and toes — motions which occur during normal walking or running.
There is a lot of debate and conflicting information as to the root cause of the injury, and it is massively misunderstood by the medical community.
What are the symptoms of Plantar Fasciitis?
The pain associated with plantar fasciitis is typically gradual in onset and is usually located over the inner or medial aspect of the heel. Occasionally, the pain will be sudden in onset, occurring after missing a step or after jumping from a height for example. The pain is commonly most severe upon arising from bed in the morning, or after periods of inactivity during the day.
The degree of discomfort can sometimes lessen with activity during the course of the day or after “warming-up”, but can become worse if prolonged or vigorous activity is undertaken. The pain is also often noted to be more severe in bare feet or in shoes with minimal or no padding at the sole. The most common symptom is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn.
In my particular case, the pain was there one day, and not the next. The discomfort I experienced was usually first thing in the morning, although sometimes present after a hard effort like a 5 km time trial. I tried to get around the injury by running in the afternoon when the pain had mostly subsided. I had the injury in my left heel only (thank goodness), although I know of club mates who experienced pain in both heels simultaneously.
So what can be done to cure Plantar Fasciitis?
Plantar Fasciitis is a common and often persistent injury affecting runners, walkers, hikers, and nearly anyone who stands a lot for a living.
Most people recover from Plantar Fasciitis with a little rest, arch support, and stretching, but not everyone. Severe cases can stop you in your tracks, undermine your fitness and general health, and drag on for years. It can be a very stubborn affliction indeed.
What are the current recommended cures for Plantar Fasciitis – my personal experience
Usually, the pain will ease in time. ‘Fascia’ tissue, like ‘ligament’ tissue, heals quite slowly. It may take several months or more to go. Below are some of the most common treatments recommended by medical professionals, which for me, provided mixed results:
Footwear – Getting it wrong
When I was experiencing Plantar Fasciitis at its worst, I was advised by a medical professional to switch to shoes with cushioned heels and good arch support. This may be sound advice to treat the affliction initially, but it does not get to the root cause of the problem.
Around the same time, I happened to read “Born to Run” by Christopher McDougal, as well as Dr. Phil Maffetone’s “The Big Book of Endurance Training and Racing”. In both of these, the case is made for minimalist shoes, and puts forward the argument that human feet are perfectly designed to take the body’s weight. Could it be that shoes with too much support are weakening the arches in most people, leading to Plantar Fasciitis and other conditions, yet they are constantly being recommended? In architecture, the arch is used to support great loads and is one of the strongest designs possible. Surely, our arches exist for the same purpose?
This for me was the light bulb moment. I started to slowly switch to minimalist shoes over a period of weeks. At the same time I came across a fantastic course which taught me the supplementary exercises and information which I needed to banish the injury forever.Click here to find out more about this.
A physical therapist would usually stretch the plantar fascia and Achilles tendon, and assist in strengthening lower leg muscles, which would lead to a more stable ankle. A therapist may also teach you to apply athletic taping to support the bottom of the foot. If money is no object, it can be a good option.
The physical therapist or doctor may recommend wearing a splint that stretches the calf and the arch of the foot whilst sleeping. This holds the plantar fascia and Achilles tendon in a lengthened position overnight and facilitates stretching.
I had expensive orthotics made, which were recommended by one of South Africa’s top podiatrists. Unfortunately, they did not help in my case, and the result was no different to wearing motion-controlled shoes as mentioned above. Wearing orthotics may provide some relief initially, but they will not solve the problem permanently.
I tried these after the orthotics failed, which only provided temporary relief. It is a process which involves painfully injecting a type of steroid medication into the tender area. Multiple injections aren’t recommended as they can weaken the plantar fascia and possibly cause it to rupture.
Extracorporeal shock wave therapy:
In this procedure, sound waves are directed at the area of heel pain to stimulate healing. It’s usually used for chronic cases that have not responded to more conservative treatments. This procedure may cause bruises, swelling, pain, numbness or tingling and has not been shown to be consistently effective.
This is a surgical procedure whereby the plantar fascia is detached from the heel bone. It’s generally an option in severe cases where all else has failed. Side effects include a weakening of the arch in the foot. I was contemplating this as a last resort, before I decided to try a combination of exercises and minimalist shoes. I am glad that I did as surgery would possibly have ended my running career for a long period of time.
There are a choice of many costly treatments that are supposed to assist in curing plantar fasciitis. However, I tried most of them and they only provided temporary relief at best. Before trying any of the above, I would recommend a series of strengthening exercises, like those found on Jeremy Roberts’ course, combined will a slow progression to minimalist shoes. This is the best way to banish this painful injury for good.
Click here to find out more.