Plantar Fasciitis--A Tragedy in Multiple Acts

        Plantar faciitas is one of the most common of all injuries that plague runners each year. In the seven years that I have been a XC & Track coach, this has been the injury I have seen go from an almost unheard of injury to one that I hear about or deal with on a weekly basis. So much so, that it is beginning to rival the ole' "go-to's": the sprained ankle and shin splints. I know that I am not alone in this because I talk with other coaches and runners and they say about the same thing. I also spend too much time at a menagerie of running websites and if you do a quick search of the injury, you will get more results than you wanted. Performing a simple search on Google will give over 4 million results. And since last October, it is an injury that I, myself, have dealt with and I will easily say it has been the most nagging of any running-related injury I have acquired in the past 10 years that I have been actively into running. It is also an injury that takes a long time to heal and may never do so. If you have it, you know what I'm referring to. If you don't have it or are not sure you do, this blog may be helpful to you. I am hoping it is helpful to all who use their feet for walking or running because they are the victims to this widespread injury. I have done a lot of reading about this injury for both personal use and for information to benefit myself as a coach. I have gotten most of what can be found in this post from five places: personal experience, Running Times & Runner's World magazines, Web MD and the U.S. National Library of Medicine.  So, what is planter fasciitis?

    Very simply, plantar fasciitis is the inflammation of the thick tissue on the bottom of the foot. This tissue is named the plantar fascia and is where the injury acquires its name. This is the tissue that connects the heel bones to the toes and forms the arch that you see in your foot. If you look at the first three pictures I have included, you can see the different key parts of the foot and where the pain is coming from that results in the injury we all know is plantar fasciitis. So, what are some symptoms of the injury? 

     Besides constant pain, soreness, and discomfort, one of the first things most people notice is that it will hurt to walk when you first get out of bed during your first several steps of the day. I know this was and is very true for me. It is as if your foot turns into a stiff object and you have to stretch it in order for it to work. The pain it causes can either be brief or last as long as you are on your feet depending on the severity of the injury. It can also increase if you stand a lot or participate in increase physical activity or climb stairs. And at times, the injury may ache or even burn. Untreated, plantar fascitiis can be so sensitive that it will hurt to even put the slightest amount of pressure on it. The oddest part for me however, was the fact that it would hurt all day, but it would seem to completely disappear while I stretched and actually ran. It would also oddly appear to be completely well and then surface out of the blue after a day of wearing the wrong shoes and standing a lot. So, how does one get plantar fasciitis?

     The most common reasons for acquiring plantar fasciitis are increased levels of physical activity or the genetic disposition for flat feet or high arches. Other reasons can be sudden weight gain, high levels of obesity, poor shoe choice, or a tight or injuried achilles tendon (the tendon that attaches the calf to your heel). There are other reasons, but I have listed the most prevalent ones. I believe my own case of plantar fasciitis can be traced to my pulling or tearing of my achilles tendon over a year and a half ago. I did not allow it to heal as I should have and can still feel a tightness in the tendon and now I have to stretch extra in order to compensate for it. However, most runners get this nagging injury from doing too much too soon. You may disagree with this, but it is true, or it has been true in most cases that I have heard about. Running is a rough sport on your body. No, you aren't tackling 300 lb. guys or getting tackled by them, but you are putting 4 lbs. of compacted pressure per single lb. of body weight on all of your muscles, joints, tendons, and bones. In my case, I am putting 672 lbs. of pressure on my feet and knees for every step I push to the ground. And I do most of my out of season running on concrete surfaces which make the pounding even worse on my body. 

   Another culprit for the spike in plantar fasciitis in the last several years, I believe, is the increase in people's and shoe companies' desire to dive whole-heartedly into the "barefoot" or "minimalist" running fad. You take for instance a guy who weighs 170-200 lbs.,  who wears a "minimalist" shoe and has not been a runner for very long, who is doing his runs mostly on concrete or hard surfaces, and who decides to train for a half marathon or a marathon after only running for a year and what you get is a guy who is putting around 800 lbs of pressure on his body while basically running barefoot on concrete. And this results in that same man being constantly injured and you have a guy who either gives up running entierly or decides he will run at a greatly diminished capacity. This is a fake anecdote, but if you look around, it doesn't seem so unreal. It sounds like something you hear about all the time. I know Christopher McDougall and his legions of converst would disagree, but that is okay. He is a millionaire and an author and I am a running coach and as they say, "down in the trenches" with the common runners. So, now that you think you may have plantar fasciitis, what can you or should you do for it? 

    The simplest answer or remedy is to rest. For simple or minor cases, a week of resting your foot, doing the above-pictured stretches, and icing it several times a week for 15 minutes at a time will be just what you need. For severe cases, resting it for several weeks or even months may be exactly what you need, but don't want to hear. If it is a persistent case, then it may call for you to begin using one of the plethora of medical devices that have been put to market to help with this injury. There are orthotics or inserts, there are socks, there are splints you wear at night, there are heel cups, special shoes, and in the most severe cases, there are steroid shots and boot casts that some I know have had to wear for several months. And as I was advised, it is best to just try one item as a time, that way you can truly say it is a single variable that is either helping or hurting instead of having so many variables going at once that you can't say what is or isn't leading to your recovery. For me personally, I chose to buy the Powerstep insoles or orthotics.  They can usually be found for $40, but most places sell them at a cheaper price. I got mine at our local running store, Run Fit Sports, and I will say that they were a good use of money. My case of plantar fasciitis had gotten so bad that it even hurt for me to stand up, which was bad since I stand for 7.5 to 8 of the 9/10 hours a day that I spend at work. And during XC or Track seasons, I stand, walk, or run for 10-11 of the 12-13 hours I spend a day at work With a combination of rest, ice, stretching, new shoes, and the insoles, I will say that my plantar fasciitis is on the mend. I won't say it has healed, but it only hurts on occasion.     

   

   Well, there is the post. I have not written everything there is to know about plantar fasciitis nor have I explained all the different options for recovery. It has been my desire to write an informational post that contains most of the facts and recovery options. If you think plantar fasciitis is something you may be struggling with, I would advise a lot of what I have suggested, but I would also say to visit a doctor and do some researching of it for yourself.  I hope this post has been helpful to you and I hope your 2013 running or walking plans are injury free.

Happy reading and running,

    David