Summer has arrived with a steaming hot vengeance. That too means the weekend warrior season is upon us. Many of us have taken advantage of the sunny weather to engage in outdoor sports such as running, biking, hiking and climbing or team sports. The days are longer therefore we are more apt to push our bodies to the limits of physical exertion even longer. Such exertion if we are not careful can lead to acute or chronic injuries. This summer, we at legitmassage.com have examined many different injuries that we are all susceptible to and explained how to avoid injury while educating on what measures to take if we encounter an injury. We also have addressed self-care (the kind of care that aids the healing process between massage sessions) as well as different massage techniques that attend to specific muscle and tendon injuries so that you may keep on “keeping on”. This week in our series of inflammatory conditions, we examine plantar fasciitis.
What is plantar fasciitis and what causes it?
Plantar fasciitis is simply inflammation of the plantar fascia and is the most common cause of foot pain in athletes. The plantar (foot) fascia (band) is a thick ligament that runs along the bottom of the foot that extends from the bottom of the calcaneus (heel bone) to the base of the toes. Made to stretch slightly, the plantar fascia acts as a “passive bowstring during the midstance phase of the gait cycle” thus supporting the arch of the foot and facilitating the foot’s movement. [Rattray] Inflammation of the plantar fascia or plantar fasciitis occurs due to overuse and stress on the plantar fascia which results in micro tearing at the calcaneus attachments. Runners and dancers are susceptible because their activities require ankle plantarflexion (pointing the foot) and extension of the toes. Prolonged running/dancing, overtraining, and utilizing poor technique and running surfaces extend the susceptibility. Young athletes and dancers are not the only people who are prone to plantar fasciitis. The majority of sufferers are over 40 years of age, hence the overuse and micro tearing over-time component.
Poor biomechanics are also to blame for plantar fasciitis. The pronated ankle or the ankle that rotates in stretches the plantar fascia and over time the calcaneus attachments tear. The supinated ankle or the ankle that rotates out can lead to a pes cavus condition (high arches) which decreases shock absorption and then requires the plantar fascia to take on more of the stress of movement which in turn begins a vicious cycle of overcompensation by the calf muscle, soleus, which places further stress on the plantar fascia and Achilles tendon. Thus the calf muscles get short and tight and before you know it, the ankle is predisposed to… tada PRONATION!!! Remember pronation leads to micro tearing of the calcaneus attachments of the plantar fascia?
So I run a lot! What can I do to avoid getting plantar fasciitis?
To begin with make sure your footwear is more than adequate and not worn out. Your shoes cannot be too flimsy or flexible and they cannot be too stiff. The general consensus on when to change your running shoes is around 300-500 miles. However, many variables are at play here.
- Body type – are you slender or over weight? Weight gain places more stress on the plantar fascia.
- Type of gait – Do your ankles pronate? Supinate? Does your hip joint excessive outwardly rotate?
- Running terrain – Are you running on hard or soft surfaces? On flat surfaces or hills? Do you run on the same side of the road there and back. Example: running against traffic the whole way on different sides of the road. Recall that roads are graded to your right. In both instances, the going trip and the return trip is graded to the right which means the right leg is more vulnerable to shortness. This in turn alters biomechanics. (I always recommend running both ways on the same side of the road so that the right and the left leg experience the road grade.)
All of these variables determine if shoe life is lengthened or shortened. More importantly, your body will let you know when it is time for a new pair of shoes. Be aware of unusual aches and pains as your miles add up. Remember, pain is your body’s way of telling you something is wrong. In this case, it may be time to hit the local running shop and change your shoes.
Ok I think I may have plantar fasciitis… but how do I know?
Is the pain worse in the morning when you first get out of bed? Plantar fasciitis pain occurs with the first few steps after a non-weight bearing activity like sleeping or sitting. “The symptoms are worse during the pre-swing phase of the gait cycle and during stair climbing.” [Rattray].
- Pain is present on the bottom of the heel and extends along the inner border of the plantar fascia towards the base of the toes.
- Tingling or numbness may be experienced when the arch is compressed.
- Pain is experienced on extension of the toes or hopping on the forefoot.
- The calf muscles will also test for shortness.
However the pain may be a result of a bone spur, contusion of the heel, a stress fracture, or nerve entrapment. The foot muscles may be weak. If you suspect any kind of foot pain, consulting your physician would be wise to differentiate the cause of the pain.
Treatment of plantar fasciitis and how regular massage helps.
Medical treatment may include anti-inflammatories and cortisone injections. Remember that repeated injections can cause atrophy and possible plantar fascia rupture. Rest and ice in the initial stages and heat in the later stages along with healthy doses of massage therapy are conservative, non-invasive care tactics that the vast majority of plantar fasciits sufferers respond positively to. Your massage therapist will be able to address any trigger points that are present in the gastrocnemius and soleus calf muscles as well as deeper calf muscles, tibialis posterior and flexor digitorum longus muscles which refer pain into the plantar surface of the foot.
Between massage sessions, consider stretching the plantar fascia by standing against a wall with the heel on the ground and extending the toes (toes to the nose). Calf stretching is beneficial as well. You may also consider strengthening the intrinsic muscles of the feet by scrunching up a towel with your toes or for the very adventurous, picking up pencils with your toes. As with many tendonitis injuries, be mindful of stretching and strengthening and try not to do too much too soon. While you are taking your time to heal, try altering any predisposing biomechanics that may have contributed to the plantar fasciitis such as examining training surfaces (and grades) and get a new pair of running shoes (take your time breaking these in, too). Changed biomechanics, better equipment, smarter and savvier methods and techniques combined with your massage treatments will get you back on the run in the sun. Don’t forget your sunblock!
Kip Yates, LMT was trained at the Swedish Institute in New York City and is New York State and Texas State licensed. He is owner and operator of Massage Refresh in New York City where he provides Swedish wellness and recuperative Deep Tissue massage that encompasses myofascial release and trigger point therapy. Kip lives in Brooklyn with his wife and three children and also practices at Physiofitness Physical Therapy in Soho.