LBSM Author: Lewis Raiman
If you’ve ever experienced a sharp, stabbing pain in your heel, particularly first thing in the morning, you might be dealing with plantar fasciitis. It’s a common condition, especially for those who are active, on their feet a lot, or have recently changed their exercise routines. Runners are particularly prone to suffering from it.
As marathon training ramps up in preparation for next year’s race season, it’s essential to take proactive steps to avoid injuries like plantar fasciitis. This condition can derail your training plans and keep you off the road for weeks.
This blog will walk you through what plantar fasciitis is, what causes it, and how you can manage it, through simple exercises and more advanced medical treatments.
We explain how with the right approach to training, footwear, and running form, you can minimise the risk of developing plantar fasciitis and remain strong and active all season.
What is Plantar Fasciitis?
Plantar fasciitis is an overuse injury that affects the plantar fascia—a thick band of tissue that runs along the bottom of your foot, connecting your heel to your toes. This tissue acts like a shock absorber, supporting the arch of your foot as you walk or run. However, when it becomes inflamed, it can lead to significant pain and discomfort, particularly in the heel area.
Anatomy of the Plantar Fascia
To better understand plantar fasciitis, let’s look at the anatomy involved. The plantar fascia is a fibrous tissue that stretches from the heel bone (calcaneus) to the base of the toes. This band supports the arch of your foot and plays a key role in walking and running mechanics by absorbing impact and providing stability. However, when excessive stress is placed on this tissue, microtears can occur, leading to inflammation and pain.
Causes of Plantar Fasciitis
Plantar fasciitis is a multifactorial condition, meaning there’s no single cause. Several contributing factors can make you more susceptible:
1. Changes in Exercise Type or Training Volume
Ramping up your running mileage too quickly, switching to a new workout regimen, or starting a sport that involves repetitive foot impact can overload the plantar fascia. This is especially common in runners and athletes who spend a lot of time on their feet.
2. Weight Gain
Sudden weight gain or carrying excess body weight places additional stress on the plantar fascia, increasing the risk of injury. Pregnant women and individuals who have gained weight rapidly are particularly prone to developing this condition.
3. Occupational Demands
Jobs that require long hours of standing, walking on hard surfaces, or wearing unsupportive shoes can lead to plantar fasciitis. Nurses, doctors, teachers, postman and retail employees are some of the most common groups affected. We also see a number of city workers – too much post work standing at the bar!
4. Footwear Choices
Wearing shoes with inadequate arch support or cushioning can exacerbate the condition. High heels, for example, shift weight toward the front of the foot, stressing the plantar fascia, while flat shoes may not provide the necessary arch support.
5. Foot Anatomy and Biomechanics
Flat feet (pes planus), high arches (pes cavus), and abnormal foot mechanics such as overpronation or supination can contribute to plantar fasciitis. These issues place uneven stress on the plantar fascia, leading to inflammation over time.
6. Medical Conditions
Certain health issues like arthritis, diabetes, and tight calf muscles (Achilles tendon tightness) can predispose someone to plantar fasciitis. These conditions either directly or indirectly affect how the plantar fascia functions.
Symptoms of Plantar Fasciitis
The hallmark symptom of plantar fasciitis is pain in the bottom of the heel. It’s often described as sharp or stabbing and is typically worse with the first steps in the morning or after periods of inactivity. As you move around, the pain might decrease, but it can return after long periods of standing, walking, or exercising.
Common symptoms include:
- Heel pain, particularly with the first steps in the morning
- Tenderness along the arch or at the base of the heel
- Stiffness in the foot, especially after periods of rest
- Pain that worsens after long walks, standing, or running
Aggravating and Easing Factors
Certain activities and situations can make plantar fasciitis worse, while others might help relieve symptoms. Understanding these can help you manage your condition more effectively.
Aggravating Factors:
- Prolonged standing or walking
- Running, especially on hard surfaces
- Wearing unsupportive shoes or high heels
- Rapid changes in exercise or activity levels
Easing Factors:
- Resting and avoiding high-impact activities
- Icing the affected area to reduce inflammation
- Stretching and strengthening exercises (discussed below)
- Wearing supportive footwear or orthotics
Clinical Findings on Examination
During a physical examination, your clinician will assess for tenderness at the base of the heel. The pain is often reproduced by applying pressure to the heel and also along the length of the plantar fascia.
Other clinical findings that we might see, include tightness in the calf muscles or limited ankle mobility, both of which can contribute to the condition.
Biomechanical issues, such as flat feet or overpronation, are often noted as well.
Diagnostic Ultrasound
Diagnostic ultrasound is a valuable tool for identifying plantar fasciitis, offering a clear and real-time image of the plantar fascia. It allows us to assess for inflammation, thickening, or small tears.
Unlike X-rays, which only show bone, ultrasound can visualise soft tissues, making it highly effective for diagnosing plantar fasciitis and soft tissue conditions.
At LBSM, we offer in-consultation diagnostic ultrasound as part of our thorough assessment process. This allows for a quick and accurate diagnosis, saving our patients time and added cost.
Imaging
X-rays can sometime show a bony spur, however this can be misleading, as many people have non-symptomatic bone spurs.
Treatment Options for Plantar Fasciitis
Treatment for plantar fasciitis ranges from conservative self-care measures to more advanced medical interventions. Most cases can be managed without surgery, and the goal is to reduce inflammation, improve foot mechanics, and prevent recurrence.
Physiotherapy
Physiotherapy can be highly effective in treating plantar fasciitis.
A physiotherapist will typically recommend stretching aimed at improving the flexibility of the plantar fascia, Achilles tendon, the big toe joints, and the calf muscles, and strengthening exercises which focus on the whole of the lower limb and core.
The Importance of a Strong Posterior Chain for Runners
Your posterior chain consists of the muscles along the back of your body, including your glutes, hamstrings, and calves. These muscles are critical for stabilising your hips, knees, and feet during running.
When these muscles are weak, more load is transferred to your feet, increasing the risk of plantar fasciitis.
Weakness in the glutes or hamstrings can lead to poor running form, forcing your plantar fascia to bear more of the shock from each step. This imbalance can eventually lead to overuse and inflammation of the fascia.
Strengthening your posterior chain through exercises like deadlifts, lunges, glute bridges, and hamstring curls can significantly reduce the load on your feet, therefore helping reduce your symptoms and lowering your risk for further injuries.
Foot Intrinsics and Their Role in Plantar Fasciitis
Foot intrinsic muscles are the small muscles located within the foot that help with balance, stability, and arch support.
These muscles play a vital role in absorbing shock during running and maintaining the structure of your foot. When these muscles are weak or underdeveloped, your foot may collapse inward (overpronate), putting more strain on the plantar fascia.
To keep these muscles strong, incorporate exercises like toe curls, towel scrunches, and picking up small objects with your toes into your routine.
These simple but effective movements can help improve your foot’s natural shock-absorbing capabilities, reducing symptoms of plantar fasciitis.
First MTP Joint (Big Toe) Flexibility and Plantar Fasciitis
The first metatarsophalangeal joint (MTPJ) is the joint at the base of your big toe. Flexibility and mobility in this joint are crucial for a smooth running gait. The big toe helps push off the ground during running, and if the joint lacks flexibility, the plantar fascia has to work extra hard to compensate, leading to overuse and inflammation.
Limited first MTPJ flexibility—sometimes caused by stiffness or arthritis—can alter your running mechanics and contribute to plantar fasciitis.
Stretching and mobilising the big toe joint through exercises like toe stretches or using a resistance band, scarf or towel to gently pull the big toe into extension can improve joint mobility and reduce strain on the plantar fascia.
Other exercises that can be useful:
- Calf stretches: Stretching the calf muscles reduces tension on the plantar fascia. The best way to do this is off the edge of a step.
- Plantar fascia stretches: Sitting down, pulling your toes toward your shin with a towel or scarf.
- Rolling the arch on a frozen water bottle or ball: This can reduce pain and inflammation and help to stretch out the plantar fascia.
Icing and Anti-Inflammatory Medications
Applying ice to the heel for 10-15 mins 3 times a day and taking over-the-counter anti-inflammatory medications like ibuprofen can help reduce swelling and pain in the short term. It is important to seek professional advice before starting any medication
The Role of Biomechanics and Footwear in Plantar Fasciitis
By Podiatrist Maddie Tait
Foot biomechanics play a critical role in the development and management of plantar fasciitis. Foot and ankle function can play a part in causing the PF to be overused and further irritated, leading to pain and inflammation. Proper footwear is essential in managing these biomechanical issues.
Properly fitted shoes with good arch support and cushioning are also crucial.
Wearing shoes with adequate arch support, a firm heel counter, and cushioned soles can make a huge difference.
Best Footwear Options for Runners
Choosing the right running shoes is one of the most important factors in helping to prevent plantar fasciitis. Look for running trainers that offer:
- Good arch support: Shoes that support the natural shape of your foot help distribute weight more evenly, reducing strain on the plantar fascia.
- Cushioning: Adequate cushioning absorbs the impact of running, especially if you’re logging lots of miles on hard surfaces like pavement.
- Firm heel counters: This helps prevent excessive heel movement, providing stability and reducing stress on the plantar fascia.
- Flexibility in the forefoot: A flexible forefoot allows for a more natural running motion, especially important for the push-off phase of running.
Brands like ASICS, Brooks, and HOKA offer models known for support and cushioning, popular among marathon runners.
It’s important to choose shoes appropriate for you. running trainers are constantly adapting and new models regularly coming out. It is important to replace your shoes every 200-300 miles to maintain their protective qualities.
If you are suffering from plantar fasciitis symptoms it would be wise to see a Podiatrist or sports medicine specialist for an extensive biomechanical assessment and gait analysis. Some running sports shops provide a running analysis but this can be without injury management experience.
Custom orthotics may be useful at times to address foot abnormalities, reduce the strain on plantar fascia and to optimise walking and running posture. It is advised to avoid being in flip-flops, flat-soled shoes or high heels whilst recovering from this injury.
Heel Running vs. Toe Running: What’s the Difference?
Your running style can also play a role in preventing plantar fasciitis. The debate between heel striking and forefoot (toe) running has long been a hot topic among runners, and both can impact your risk for plantar fasciitis in different ways.
- Heel Striking: This is when the heel of your foot makes initial contact with the ground. Heel strikers often have higher impact forces on the plantar fascia, especially if they lack proper cushioning and strength in their lower legs.
- Toe Running (Forefoot Striking): Forefoot strikers tend to put more pressure on the front of the foot, which can overburden the plantar fascia, especially if your calves are weak and tight. This can lead to overuse of the fascia as the foot works harder to absorb the shock of each step. It also increases your risk of developing Achilles Tendinitis
Both styles can contribute to plantar fasciitis if not accompanied by proper foot support, footwear, and muscular strength. Transitioning between running styles can also cause issues, so it’s important to introduce any changes in running technique very gradually, with professional guidance if possible.
Medical Interventions
For those who do not respond to conservative treatment, medical interventions might be necessary.
- Shockwave Therapy
Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that uses sound waves to stimulate healing in the plantar fascia. It’s often recommended when other conservative measures have failed.
- Corticosteroid Injections
Corticosteroid injections can provide temporary pain relief by reducing inflammation. However, repeated injections are not generally recommended due to the risk of weakening the fascia.
- Platelet-Rich Plasma (PRP) Injections
PRP injections use a patient’s own blood platelets to promote healing. While still being researched, this therapy shows promise for treating chronic cases of plantar fasciitis.
In conclusion, plantar fasciitis is a common but manageable condition. By addressing these key factors—footwear, running form, strength in the posterior chain, and foot biomechanics—you can set yourself up for a successful marathon training season, free from the pain of plantar fasciitis.
If you suspect you have plantar fasciitis, please get in touch with our team who will be able to develop a treatment plan and training schedule tailored to your needs.
