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Alex "Iron Doc" McDonald - Plantar Fasciitis: Overview, Prevention and Treatment
By Alex M. McDonald, MD
11/4/2008 |
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Plantar fasciitis is an irritation of the tissues surrounding the muscles and tendons in the bottom of the foot. Often caused by repeated activity with inefficient rest or increasing activity too quickly. Traditionally this occurs in runners who’s arches collapse during foot strike and/or over pronate as well as lack of flexibility in the muscle of the lower leg. This repetitive flattening of the arch leads to inflammation and irritation. Runners are most often affected but, not the only athletes who can be plagued by this injury. Plantar fasciitis is a very frustrating injury for anyone, especially a runner, due to limited symptoms at times and the perception of being healed, only to be easily re-aggravated by activity. As a result caution is strongly advised on returning to weight bearing activity, particularly running.
Duration of plantar fasciitis and presence or absence of pain, can be important indications of when it is appropriate to return to weight bearing activities, in particular running. If you are still experiencing pain at rest running is ill advised. Trying to run while acute inflammation is present can significantly further aggravate the condition and prolong your recovery. Rest, ice and stretching are the mainstays of treatment. Trigger Point technology massage balls is an additional modality which is very effective for both treatment and prevention of plantar fasciitis. Patience now, with plantar fasciitis will pay dividends later. Often NSAIDS, such as ibuprophen, are recommended, however, there is little conclusive evidence that suggests NSAIDS offer any benefit for soft tissue injuries, such as plantar fasciitis.
Once an athlete is no longer experiencing pain at rest it is safe to gradually return to activity. Initially with gentle foot exercises that strengthen the muscles in the arch of the foot, such as gentle toe curls, marble pick ups, tapping the big toe while holding the remaining four off the ground and continuing the regimen with TP massage balls . Begin with just a few of each exercise and gradually increase the repetitions. Also, while returning to activity it is important to continue the routine of stretching and ice.
When pain is no longer present, running can be re-incorporated with a few modifications. If you have not already done so, make sure your running shoes provide appropriate arch support as well as cushioning. A specialty running store can be very helpful if you are unsure. Commercial insoles or custom orthotics from companies such as Spenco are good options to provide necessary support. Be careful when returning to activity, re-injury can easily occur and a gradual increase in time and distance is strongly advised. It is imperative not to over reach your limits, as pain can diminish with warm up and activity but then can be amplified afterward. A good rule of thumb when returning to activity is not more than 50% of your previous uninsured training volume or distance. If plantar pain persists or reoccurs, physical therapy or seeing your doctor is recommended.
The prevent return of symptoms many of the previous mentioned treatment stradegies should be incorporated daily or weekly into your training routine. A pair of running shoes that are appropriate for your foot and body type, stretching and regular use of TP massage balls will all help you to stay injury free. A third and most important component to athletic success without injury is a well organized and progressive training program that pushes your limits, but does not break them.
Plantar faciitis resolves entirely in the majority of patients within a few months. In the mean time non-weight bearing exercise, such as biking and swimming, are appropriate. The key to a healthy return to running is initial rest, with gradual return to activity along with a good dose of patience.
Alex M. McDonald, MD, is a professional triathlete, coach and a member of the Timex Multisport Team. His interests lie in coaching endurance athletes, sports medicine and exercise physiology. He obtained his MD degree from the University of Vermont. Prior to medical school, Alex graduated from Connecticut College in 2003 with an emphasis on both the biological and social sciences. He currently lives and trains in Durham, NC.
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