PLANTAR FASCITIS (HEEL PAIN) - CAUSES AND TREATMENT

written by: Nem​
​Plantar fasciitis can be one of the most frustrating injuries you can encounter during your running career. It usually appears out of nowhere and is characterized by a deep ache or sharp pain under your heel and along the arch of the foot.

​​It can take many months or even years for the involved tissues to heal. If you have been diagnosed with this condition, conventional wisdom is to stop training and rest until the pain goes away. However, is this really the best way to treat plantar fasciitis? Can you continue training and still get rid of heel pain?

WHAT IS PLANTAR FASCITIS AND WHAT CAUSES THIS CONDITION

Plantar fasciitis is a repetitive strain injury that involves inflammation and degeneration of a plantar fascia – a thick band of connective tissue that runs across the bottom side of your foot and connects heel bone (calcaneus) to your toes.

​Runners are at higher risk for developing this condition, especially if you are overweight and have to stand for a living (e.g. cashiers). Most runners who develop heel pain are usually the ones who start increasing mileage and intensity abruptly.

​In addition, any of the following factors can contribute and increase the risk of plantar fasciitis:

• Flat feet and feet with high arches;
• Excessive foot pronation when running;
• Poor shock absorption with ground contact;
• Beginning speed work and hill training;
• Running on hard, flat surfaces (asphalt, concrete);
• Wearing high heels;
• Tight calves.

​HEEL PAIN FIX

Contrary to mainstream recommendations, you may be able to continue running while treating your plantar fasciitis. Most recent evidence shows that stress from exercise is required to stimulate the healing response of the plantar fascia.

However, this does not mean that you can continue running at the current intensity and mileage. We need to decrease either intensity or volume or both at the same time depending on the severity of your symptoms.

Too much running intensity and/or volume and you can cause further damage to the plantar fascia. However, not running with enough intensity and/or volume and structures in the foot start to weaken and become more susceptible to further injury.

In addition to running, we need to worry about incorporating specific foot and ankle strengthening exercises. These exercises will help to strenthen the foot and trigger the healing response in th plantar fascia. 

This food strengthening exercises need to be part of a general strenthening program that works your other muscle like glutes, quads, calves and core. This ensures that there are no imbalances and weaknesses somewhere else in the body that might be contributing to foot issues.

However, similar to running, we need to select the right type of strengthening exercises for your anatomy and goals and be careful not to do too much or too little. 

So how do we go about finding this optimal level of running intensity/mileage and what kind of exercise should we be doing to strengthen the foot?

HOW TO CONTINUE RUNNING WITH FOOT PAIN

Best way to go about finding your optimal level of exercise is to listen to your body and rate the pain/discomfort on a 1-10 point scale, with 10 being the most excruciating pain you have ever experienced. Use the following guidelines:

• 7-10 zone – you feel sharp pain with every step you take. If this is your current situation, you should not be forcing yourself to run and should stop running completely until the pain goes below 7. Try some of the strengthening exercises described below.
• 4-6 zone – your gait is changing due to heel pain. You do not have to stop running, but you need to reduce the duration and intensity, which also means no uphill or speed training. Perform the strengthening exercises described below;
• 1-3 zone – you feel minor pain on the bottom of your heel. You can continue running, but some modifications need to be made – reducing intensity and duration and no uphill running. Perform the strengthening exercises described below.  

It Is normal for symptoms to get slightly worse for a few hours after the exercises or runs, however, if your foot feels worse the following day, then you have probably done too much. Better to do less, than to do too much.

STRENGTHENING EXERCISES FOR PLANTAR FASCIA

1. Foot myofascial release.

2. Foot muscle strengthening

3. ​Heel raises

4. ​Toe elevated heel raises

5. ​Calf stretch

SUMMARY

Plantar fasciitis does not react well to prolonged rest. Continuing to run and perform the strengthening exercises will trigger the natural healing response in the plantar fascia.

​However, doing too much will create the opposite effect and create further injury. Try to find the optimal dose of exercise and avoid speed and hill training until your pain subsides.

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Other articles you might be interested in:
- Exercise and low back pain: rehab and conditioning
- Do you have pain while running?
- Sitting too much? How to fix sitting-related aches and pains
- Patellofemoral pain syndrome (runner's knee) - causes and treatment 
- How to prevent running injuries

Heel pain. Plantar fascitis. Foot pain