Plantar Fasciitis in Runners

In each stride, the force is transferred from the ground to the body through the plantar fascia. As a result, the plantar fascia must be able to absorb a substantial amount of force for a long period of time. Overloading of the plantar fascia can lead to irritation on the bottom of the foot, commonly known as plantar fasciitis. 

Cause of plantar fasciitis 

Plantar fasciitis is an overload syndrome, meaning that the loads placed on the fascia has exceeded what it is able to absorb. This leads to irritation along the inside arch with pain localized on the inside portion of the heel (where the plantar fascia inserts onto the calcaneus). Plantar fasciitis is usually worse with the first few steps in the mornings. Standing, walking, running, and jumping will typically aggravate the plantar fascia while inactivity and rest usually relieve the pain. 

It should be noted that while plantar fascia pain is commonly called fasciiits, the primary driver of pain is not actually inflammation. Therefore, treatments that aim at controlling inflammation are generally not advised. 

A common scenario that leads to plantar fasciitis in runners is when there is a change in programming. Changing the route to include more hill running can lead to a spike in load on the plantar fascia. Another common change is increasing weekly mileage too quickly, whether running for longer distances or running more frequently. In both cases, the sudden increase in load on the plantar fascia can lead to irritation and pain. 

Running shoes and plantar fasciitis

An important consideration for runners is shoe wear. As every foot is different, the brand and type of running shoe to use is specific to the runner. However, it is important to replace your running shoes every 300-500 miles. The materials in the shoe break down and lose their ability to absorb some of the impact of running, causing your body to absorb more of the impact. Obviously this is a concern with plantar fasciitis suffers, since this would increase the force on the plantar fascia. 

Treatment of Plantar Fasciitis 

A conservative treatment approach is recommended for plantar fasciitis. 

The first time in treatment is to manage the load that is placed on the plantar fascia. Generally this means modifying the amount of running temporarily to allow the plantar fascia to calm down. Some running may be tolerated but reducing a combination of the frequency, intensity, and duration of running may be needed. Using the elliptical or stationary bike during treatment can be a temporary solution to still have a cardio workout during treatment. 

Joint manipulations to the foot and manual therapy to the tissues around the foot can help reduce the pain of plantar fasciitis. At home, using a golf ball to roll on the bottom of the foot can be a helpful way of doing self massage on the plantar fascia. This can be performed after periods of inactivity (getting out of bed or getting up after sitting) to reduce the pain with the first few steps. 

In the clinic, Graston technique or manual release therapy can be performed to help reduce plantar fascial pain. Research on manual therapy for plantar fasciitis has shown that it is effective in reducing plantar fascia pain and improving function. 

Before returning to running, it is important that the treatment of plantar fasciitis includes a rehab program to increase the strength of the plantar fascia. Since running is one plyometric hop to the other, the plantar fascia needs to be able to absorb a lot of force quickly. This will help to reduce any potential flare ups when returning to running and also reduce the risk of future plantar fasciitis episodes. The rehab program should gradually progress from heavy slow loading of the plantar fascia to quick plyometric exercises.