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Load Management and Treatment of Plantar Fasciitis

20 Mar 2017
Darren McMillan
One of the most common causes of heel pain is Plantar Fasciitis. It is a syndrome that typically results from overload and repetitive trauma to the Plantar Fascia, a broad band of connective tissue on the bottom of your foot. Repetitive trauma causes micro-tears within the plantar fascia, usually at the attachment to the heel, which eventually leads to pain and difficulty doing exercise.

A nice analogy of plantar fasciitis is the game "tug of war"…

In this example the plantar fascia is the rope, but instead of pulling against another team the rope is attached to a huge immovable rock (i.e. your heel). If you only have one person pulling on the rope, then its attachment to the rock will be under little stress and not undergo any damage. One person might equate to walking or standing up for long periods of time, but what about running?

Running would be more like having five to six people yanking on the rope. This extra pulling force would put the attachment point (plantar fascia) under additional stress and have the potential to cause damage. If this damage is not allowed time to repair (e.g. you go for another run), then the accumulation of small amounts of damage leads to “sore rope attachment syndrome”, or more commonly referred to as plantar fasciitis.

OK, so the next obvious question is why doesn't everyone have plantar fasciitis if running is so damaging? Well this is where the brilliance of the human body comes in. Unlike the rope attached to rock, the plantar fascia has the ability to repair itself and adapt over time if given the opportunity to do so. By this I mean increasing your running slowly. This allows the plantar fascia tissue to remodel, which in our analogy has the effect of making the ropes attachment to the rock much stronger. Now the rope can easily cope with the extra people tugging on it.

While all of this is very nice information to help prevent plantar fasciitis, most of you will be reading this because you already have plantar fasciitis. If that is the case, it is unlikely the above measures will solve your tug of war problem completely.

So, what should you do if you already have plantar fasciitis?

You will need a period of time with reduced load (i.e. running).

I gave that last sentence its very own paragraph because it is so important. Going back to our analogy, think of the rope (the plantar fascia) once it has become damaged. The rope is frayed and it needs time to repair. If you continue to run and keep tugging that rope, it will stay frayed and your pain will continue.

So, do you have to stop running? Well, no, I am not saying that you have to stop running completely. But you must reduce your running load to the point that you allow your plantar fascia (the rope) the chance to repair. For example, a shorter game of “tug of war” (i.e. going for a 15 minute rather than half an hour run) is going to make a huge difference to the damaged area of rope. Finding what your plantar fascia can tolerate without worsening the damage is crucial if you are not willing to rest it completely (i.e. stop running for a period of time).

So how do you know if you have caused damage and what can be done to repair it? There are ways to judge whether you have caused damage to your plantar fascia and thankfully this is what a Sports Physiotherapist is perfectly suited for. As well as managing your running load, a Sports Physiotherapist is also ideally suited to treat the known risk factors for developing plantar fasciitis, of which, decreased ankle mobility has been shown to be the major risk factor. The decreased ankle range of movement leads to a decrease in the ankle’s ability absorb some of the stress of running (which can be up to 10 times your bodyweight). The stress that the ankle would normally absorb then has to be passed on to other structures, such as the plantar fascia. In our “tug of war” example, this would have the effect of increasing the number of people tugging on the rope to say 8-9 people. More force means more potential for damage. Hands-on therapy and specific exercises can increase your ankle’s range of movement and henceforth reduce your plantar fascia workload.

The next step in the plantar fascia “tug of war” game is strengthening. By increasing the strength of the muscles in your feet and calf you are taking away some of the force pulling on your plantar fascia. This again reduces the chance of continued running causing damage.

Lastly, the evidence states that taping of the midfoot can help with short term pain relief of the plantar fascia. While this is only a temporary solution, if you find it particularly helpful then you could also consider consulting with a podiatrist about having some foot orthoses placed in your shoes.

Well that sums up plantar fasciitis and what you can do about it. If you have any further questions or need an appointment, please don’t hesitate to contact me.

Darren McMillan is an experienced AFL Sports Physiotherapist for the Richmond Football Club and also provides consultations in Melbourne (Brighton East) at "aPhysio" including both evening/weekends sessions. Visit www.aphysio.com.au for more information and online bookings.

References:

Martin, R et al. Heel Pain—Plantar Fasciitis: Revision 2014. J Orthop Sports Phys Ther 2014;44(11):A1-A33. doi:10.2519/jospt.2014.0303

Kosmahl, E. M., & Kosmahl, H. E. (1987). Painful Plantar Heel, Plantar Fasciitis, and Calcaneal Spur: Etiology and Treatment. Journal of Orthopaedic & Sports Physical Therapy, 9(1), 17-24. doi:10.2519/jospt.1987.9.1.17




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