In Alex M. McDonald’s article Plantar Fasciitis: Overview, Prevention and Treatment, we’re given a brief overview of what exactly plantar fasciitis is and how to treat it and prevent it from coming back. First of all, Dr. McDonald explains that plantar fasciitis is an irritation of the fascia in the bottom of the foot. For those of you who aren’t familiar with the term fascia, dictionary.com gives the following definition:

a band or sheath of connective tissue investing, supporting, or binding together internal organs or parts of the body.

For the purposes of us manual therapists, we usually just think of the fascia in regards to how it effects the afflicted muscles or tendons that it happens to be encasing. In the case of plantar fasciitis, it’s of course, the fascia surrounding the plantar tendon, which is irritated and therefore causing pain. McDonald provides us with some possible causes for the condition:

…Often caused by repeated activity with inefficient rest or increasing activity too quickly. Traditionally this occurs in runners who’s arches collapse during foot strike and/or over pronate as well as lack of flexibility in the muscle of the lower leg. This repetitive flattening of the arch leads to inflammation and irritation.

He also notes just how frustrating the injury can be. I myself suffered from plantar fasciitis for over a year. Like McDonald notes, it has plantar fasciitis is deceiving in that the symptoms are very subtle when you’re in the 70% – 90% healed range. It’s very easy and indeed quite typical for someone with plantar fasciitis to re-injure themselves numerous times because they returned to activity too soon, thinking they were completely recovered. He strongly advises caution in returning to weight bearing activity. I always advise my massage clients and Aikido students that once they feel that they’ve recovered, they should refrain from their sport for one additional week. Dr. McDonald’s advice is as follows:

Duration of plantar fasciitis and presence or absence of pain, can be important indications of when it is appropriate to return to weight bearing activities, in particular running. If you are still experiencing pain at rest running is ill advised. Trying to run while acute inflammation is present can significantly further aggravate the condition and prolong your recovery.

McDonald also discusses some possible treatment, siting rest, ice, and stretching as the “mainstays of the treatment.” He also mentions trigger point therapy applied with massage balls can be beneficial. I found that massage was very beneficial in my recovery. You can use special massage balls or you can just get a golf ball, as well. Put it on the floor and push your foot into it at the spot where the pain is. Many people think they have to move or rub with pressure, much like a rubbing sort of massage, like Swedish massage. This is not the case with trigger point therapy. Simply find a spot where it “hurts so good” and just push on it until either it’s too intense and you’ve had enough or it stops hurting. Also don’t forget to massage your achilles tendon and calf, as plantar fasciitis is often prolonged, if not brought on in the first place, by problems in these areas.

When you do decide to return to your sport or activity, doing so gradually is extremely important. We also see a few great foot exercises in the article:

…with gentle foot exercises that strengthen the muscles in the arch of the foot, such as gentle toe curls, marble pick ups, tapping the big toe while holding the remaining four off the ground and continuing the regimen with [Trigger Point] massage balls . Begin with just a few of each exercise and gradually increase the repetitions. Also, while returning to activity it is important to continue the routine of stretching and ice.

We get a reminder from the doctor to double check our footwear to make sure there’s proper arch support once we’re ready to resume training.

If you have not already done so, make sure your running shoes provide appropriate arch support as well as cushioning. A specialty running store can be very helpful if you are unsure. Commercial insoles or custom orthotics from companies such as Spenco are good options to provide necessary support.

Also we get a word of warning about our return to working out to avoid re-injury, which is so very common with plantar fasciitis:

It is imperative not to over reach your limits, as pain can diminish with warm up and activity but then can be amplified afterward. A good rule of thumb when returning to activity is not more than 50% of your previous uninsured training volume or distance.

He advises to continue the treatment strategies, stretching, trigger point therapy even after recovery, as a preventative measure. It’s reassuring to note that McDonald reports that he usually sees complete recovery in his clients after a few months and repeats that the key is rest in the beginning, followed by a gradual return to weight bearing activity.

Alex M. McDonald, MD, is a professional triathlete, coach and a member of the Timex Multisport Team. His interests lie in coaching endurance athletes, sports medicine and exercise physiology. He obtained his MD degree from the University of Vermont. Prior to medical school, Alex graduated from Connecticut College in 2003 with an emphasis on both the biological and social sciences. He currently lives and trains in Durham, NC.

Read the original article here.

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