Plantar Fasciitis Tutorial

Plantar Fasciitis Tutorial

There and back again (almost)

I’m probably going to run tonight.  It will be my 3^rd run of my comeback since being cleared by the doctor.  I have been working with Plantar Fasciitis for over 6 months.  I will give this topic a more specifc treatment with all the details in future posts but for now I wanted to pass along my major learning from this episode.

The first thing I want you to understand is that this injury has stages over time and each stage has appropriate and inappropriate treatments.  This is important for two reasons; first because when you go looking for treatment you are going to find a big mixed bag of treatments that people recommend without the specificity of the phase of the injury appropriate to that treatment.  Second, and more importantly, some treatments will make the injury worse if applied in to the wrong phase.

I would define the physical phases of the injury as follows:

1. Injury
2. Recovery
3. Maintenance

The injury phase:

The injury phase is when you first realize you are injured.  There is significant pain in the heel or bottom of the foot.  The pain is worst in the morning when you get out of bed.

It starts as a pain in your heel that feels like a slight muscle pull or bruise.  As you ignore it, it turns into an ever worsening ache.

If you are smart and catch it early the injury phase can be treated quickly.  If you’re an idiot like me and most endurance athletes you will run on it until you can’t stand it anymore and build up scar tissue.  This is where the injury becomes chronic.

Picture the tissue as a bundle of chords.  In normal tissue the chords all run together in the same direction in a bundle.  When you tear the plantar fascia it tries to fix itself by healing.  When you keep running on the plantar fascia  it continues to heal a little then get re-torn.  After a few weeks or months of this you build up a bunch of scar tissue in the plantar fascia .  It is almost like a tumor.

This scar tissue now looks like a fibrous knot where the fibers are hard and bunched and twisted together in all random directions and they are inflexible.  They can’t heal back into the normal smooth bundle of chords. Every time you put stress on this little knotted bundle, it tears and gets sore again because it just isn’t designed for the repetitive stress.

During the injury phase you will notice pain and swelling and the injured area will feel hot.  There is no treatment for this except to let it heal and try to knock down the inflammation.

The “Let it heal” part covers all the treatments like:

–        Rest

–        Supportive shoes, sandals, inserts

–        Change your work shoes

–        Night splint

–        Walking cast or immobilization.

–        Light stretching

–        Taping

The “Knock down the inflammation” part covers treatments like:

–        Ice

–        Anti-inflammatories and anti-inflammatory foods

–        Analgesic cream or other topical anti-inflammatory

–        Cortisone shots

The Recovery Phase:

The next phase, the recovery phase, begins when, and only when the swelling has come down.  The problem with this type of injury is that you can’t just let it heal.  If you do nothing it will still have that fragile knot of scar tissue that is a time bomb waiting for you to do some exercise.  You have to engage in treatments that straighten out that knot and help it heal as healthy tissue.

Treatment during the recovery phase involves various manipulations of the fascia to break up, straighten out and promote blood flow to the injured area.

These treatments include:

–        Massage of the area to break up the scar tissue

• Graston technique
• Self massage
• Rolling on a golf ball or ice bottle

–        Deep, strong, repetitive stretching of the entire chain especially the plantar fascia

–        Non impact exercise to promote blood flow

–        Various professional physical therapy treatments

–        In extreme cases sonic treatment and/or surgery

Note: during the recovery phase you still maintain the ‘let it rest’ techniques to keep from reinjuring it and you apply the “reduce swelling” treatments of ice and anti-inflammatory especially after recovery treatment.

These treatments during recovery are not quick fixes. They are long term repetitive treatments that you have to stick with over a period of time to get the efficacy of the treatment.

The Maintenance phase:

After what can be months of stretching and massaging and recovery you may have the injury under control to the point where you can start running again.  You are still not out of the woods.  What got you into this situation can still rear its ugly head if you don’t continue to treat as you regain your running.

You will continue to use the appropriate treatments from “let it heal” (i.e. night splint, good shoes) and the treatments from recovery (i.e. massage and stretching and ice) as you ease back into running.

There are additional treatments that you can work in to build up the strength of the foot to prevent the injury from reoccurring.

Maintenance treatments:

–        Barefoot running – even if you’re not a barefoot runner working in some barefoot running to strengthen the foot

–        Foot exercises like picking up marbles with your toes or scrunching up a newspaper with your toes

–        Strength exercises and cross training

That’s it folks.  That’s the summary of treating plantar fasciitis.  It can be overcome but it may take time.  The worst thing to do is to rush things.  Take your time and understand which phase you are in before treatment.  A scattershot treatment approach will drag out your recovery.