Plantar fasciitis, a very painful and debilitating condition, is commonly experienced by runners in the spring as many runners begin to taper up mileage in preparation for the spring and early summer racing season.

A sudden increase in mileage along with a transition from indoor running (either on a track or treadmill) onto harder surfaces (such as concrete or asphalt) can cause microscopic injury to the plantar fascia.

This results in swelling and pain. Plantar fasciitis is more common in older runners, but it can occur to anyone at any age. It typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, and especially run.

In this post you will discover the risk factors for plantar fasciitis, and learn how to quickly return to your running routine with these self-treatment techniques.

What is Plantar Fasciitis?

Risk factors for developing plantar fasciitis include:

• Sudden increase in running mileage.
• Excessive speed or hill work.
• Sudden change to running on harder surfaces, such as concrete or asphalt.
• Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
• Either excessively high arches or overly flat feet.
• Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
• Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.
• Obesity. Additional force is placed on the plantar fascia while running or walking.
• Poorly fitting shoes or wearing shoes that are worn out.
• Sudden transition from a more built up running shoe into a minimalistic style.

Identifying the Cause of PF

Fortunately, plantar fasciitis can be managed without formal medical treatment. The key is to intervene quickly, and identify the actual cause or causes that led to the inflammation and pain. Consider the following as you begin your rehabilitation:

• Check your shoes. Often, worn out shoes are causing the pain. The inner cushion could be worn out so that the foot is not adequately supported. This could cause over pronation. Shoes typically only last 350-500 miles. If you are nearing those miles, then it may be time to change even if the outer appearance of the shoe still looks good. If you are unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe.
• Add an orthotic. Additional foot control is often needed to normalize gait mechanics. Many running stores sell an over-the-counter orthotic such as Superfeet premium insoles. The blue tends to fit most feet, but a variety of options are available for customization. In my experience, these insoles can last 1,000 to 1,500 miles easily. Custom orthotics may be necessary to correctly support and insure proper foot mechanics.
• Did you progress too quickly into a minimalistic shoe? If you are used to a standard built up shoe, progressing into a minimalistic shoe may be more difficult than you expect and will take more time. Expect a safe transition to take at least three months. I highly recommend waiting until the off season as progressing slowly is always a better choice. Based on your body size, structure, and your foot’s alignment in the shoe, a minimalistic shoe may not be the right choice. It may be better to continue with a traditional shoe or slowly transition from a more supportive and built up shoe to less support over the course of many months.
• Check your running surface. The best and most natural surfaces to run on are dirt, bark or grass. If you are suffering from plantar fasciitis, try to find a softer yet even surface. Otherwise, an asphalt surface is preferable over concrete. For prevention and a cross training strategy, vary your running surface to increase the strength of your feet.
• How is your lower extremity mobility? Mobility issues and myofascial restrictions in your lower legs can be correlated to the development of plantar fasciitis. Try using a foam roller to address any lower leg tightness or restrictions.

7 Tips to Self-Treat Plantar Fasciitis:

1. Begin your rehabilitation. Plantar fasciitis will not go away by ignoring it. The longer you wait to treat it, the harder it will be to feel pain free. Start with these Plantar Fasciitis Rehabilitation Exercises.pdf. Complete with instructions and photos, this guide outlines how to safely self-treat your plantar fasciitis.




2. Mobilize the tissue. Depending on how aggressive you want to be, a tennis ball, lacrosse ball or golf ball can be used to mobilize the tissue. I recommend mobilizing once or twice per day for 2-3 minutes. Then perform additional stretching of the plantar fascia and calves.




3. Use ice. My favorite technique for icing this area is to use a frozen water bottle. Roll your foot over the bottle for 3-4 minutes until your foot starts to feel numb and the pain subsides. It’s possible to frost bite your foot, so be mindful of the length of time you’re icing.




4. Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the plantar fasciitis. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.pdf.




5. Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia. Improving your balance can help to reduce the risk of plantar fasciitis and is an important part of rehabilitation.




6. Start a supplement. I am a supporter of natural supplements and remedies. Many supplements, such as Phenocane Natural Pain Management and Mt. Capra’s CapraFlex, include herbs which are designed to help reduce inflammation. Phenocane Natural Pain Management combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. Mt. Capra’s CapraFlex combines an organic glucosamine and chondroitin supplement along with several other natural herbs designed to reduce inflammation. It can be taken long term or intermittently to help heal from an injury. I recommend trying either supplement for 30 days. (If you are taking blood thinners, please consult with your physician or pharmacist prior to use as the herbs could interact with some medications.)




7. Use a plantar fasciitis night splint. Although a little cumbersome and annoying, night splints can be helpful. While lying, the natural tendency is to flex the foot to point your toes (plantarflex). This position causes the plantar fascia to shorten and tighten, which explains the pain you might experience during the first few steps after sleeping or resting. The night splint helps you to heal by maintaining a neutral position which doesn’t allow the fibers to shorten.

Prior to returning to your normal training activities, insure the following:

• Your involved foot/leg is as flexible as the other (particularly into dorsiflexion, which is flexing your ankle, so that your toes move toward your shin) as well as your calves and Achilles tendon.
• Your involved foot/leg is as strong as the other leg.
• Your ability to balance on one foot is equal in both legs.
• You can jog, run, sprint, and jump without pain. Be careful with a quick toe off or push when attempting to sprint.

With proper treatment, this condition should resolve in 3-4 weeks. Severe cases will take longer. As you taper back into your running program, follow these guidelines:

• Although you will need to progress and train on uneven ground and hills, initially start with level terrain only.
• Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
• Initially start with a slower pace. Don’t immediately progress back into very intense running activities, such as interval or hill training, until you have worked back up to your previous running distances and paces without pain.
• Continue with the rehabilitation protocol until you are performing all of the exercises and running normally without pain.

Plantar fasciitis can be very debilitating and demoralizing, but it can be self-treated if addressed quickly. I recommend following this rehabilitation protocol for 2-3 weeks. If you’re not experiencing relief, please speak with your medical professional. Early management is important for a timely recovery.

For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.