Plantar Fasciitis in Runners

By Asheesh Bedi, MD

Plantar fasciitis is an inflammation of the thick, supportive tissues on the bottom of the foot, and is one of the most common causes of heel pain.

As many as 2 million Americans are affected by plantar fasciitis each year, making it a Plantar Fasciitis problem that affects both competitive and recreational runners alike. While the precise cause remains unknown, it is thought to result from repetitive microtrauma and inadequate stretching of the plantar fascia, a thick supportive band of connective tissues running between the heel bone and the toes. Plantar fasciitis can affect athletes of virtually every sport, but is particularly common among runners. Overweight people are at a greater risk as well.

This article explores the signs and symptoms of Plantar Fasciitis, as well as preventive measures and treatment options that can reduce the likelihood of further damage and discomfort. Understanding Plantar Fasciitis Symptoms is an essential part of living pain free and allowing your feet to reach their full potential.


Understanding Plantar Fasciitis Symptoms

Runners with plantar fasciitis symptoms will complain of heel pain that is often worst in the first few steps in the morning, and gradually improves with walking throughout the day. There is also often discomfort along the inner aspect of the foot with flexing the toes upward towards the shin bone (“tibia”). The region at the inner aspect of the heelbone where the plantar fascia attaches is often tender to palpation as well. Plain x-rays may sometimes show a spur in the bone at this location, although they are often normal. MRI or ultrasound of the plantar fascia is usually much more effective in confirming the diagnosis.


Causes of Plantar Fascitis in Runners

Risk factors for developing Plantar Fasciitis can vary, but commonly include having high arches or flat feet, poor foot alignment, obesity, and working jobs that require a great deal of foot movement. Certain footwear can also contribute to the risk, such as shoes without good arch support or proper cushioning, as well as shoes with soles that have little to no shock absorption.   Runners should note that over-exertion can increase the risk of developing Plantar Fasciitis. Tight calf muscles and Achilles tendons can cause strain on the plantar fascia, as can foot tilting, and running on hard surfaces or hills. Other conditions, such as shin splints, may heighten a person’s susceptibility to this injury.


Treatments to Relieve Plantar Fasciitis Pain

There are several treatments and strategies that can help relieve plantar fasciitis pain in runners. It’s important to note that while these treatments can be effective, it’s essential to consult with a healthcare professional for a proper diagnosis and personalized treatment plan. Here are some common treatments for plantar fasciitis in runners:

  1. Rest and Reduced Activity:
    • Resting the affected foot is crucial. Avoid running or any activities that put excess strain on the plantar fascia.
  2. Icing:
    • Apply ice to the painful area for 15-20 minutes several times a day to reduce inflammation.
  3. Stretching and Strengthening Exercises:
    • Stretching exercises for the calf muscles and Achilles tendon can help reduce tension on the plantar fascia.
    • Towel curls and marble pickups are exercises that can help strengthen the muscles in the arch of the foot.
  4. Orthotics and Supportive Footwear:
    • Custom or over-the-counter shoe inserts (orthotics) can provide arch support and help distribute pressure more evenly on the foot.
    • Wearing shoes with proper cushioning and arch support is important. Avoid flat, unsupportive shoes.
  5. Night Splints:
    • Night splints keep the foot in a dorsiflexed position (toes pointing up) while sleeping, which can help prevent the plantar fascia from tightening during the night.
  6. Taping or Strapping:
    • Athletic tape or special kinesiology tape can be applied to the foot to provide support and relieve tension on the plantar fascia.
  7. Anti-Inflammatory Medications:
    • Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain and inflammation. Consult a healthcare professional before using any medications.
  8. Physical Therapy:
    • A physical therapist can provide a tailored exercise and stretching program to improve strength and flexibility in the foot and lower leg.
  9. Extracorporeal Shockwave Therapy (ESWT):
    • ESWT is a non-invasive treatment that uses shockwaves to stimulate healing in the affected area.
  10. Corticosteroid Injections:
    • In some cases, a healthcare provider may recommend corticosteroid injections to reduce inflammation and pain. Corticosteroid injections must be done so judiciously, as their overuse can increase the risk of rupture of the plantar fascia and loss of its support in maintaining the arches of the foot.
  11. Platelet-Rich Plasma (PRP) Therapy:
    • PRP therapy involves injecting a concentrated solution of the patient’s own blood platelets to promote healing. It is sometimes used in refractory cases.
  12. Ultrasound Therapy:
    • Ultrasound can be used to promote blood flow and reduce inflammation in the affected area.
  13. Activity Modification:
    • Runners may need to modify their running technique, decrease mileage, or switch to lower-impact activities during the recovery period.
  14. Surgical procedures:
    • Surgical procedures such as cutting or removing the plantar fascia are reserved for only those refractory cases which have failed to respond to all other interventions.

It’s important to follow a gradual return-to-running plan and continue with preventive measures even after symptoms improve to avoid a recurrence of plantar fasciitis. Additionally, maintaining good foot hygiene, appropriate footwear, and regular stretching and strengthening exercises can help prevent this condition in the first place. Always consult with a healthcare professional for a proper diagnosis and treatment plan tailored to your specific needs.


Preventing Flare-ups and Further Injury

Taking preventative measures to protect and heal from Plantar Fasciitis is essential for runners to have long-term relief and recovery. Without proper precautions, flare-ups and further injury can occur, setting an individual’s progress back and leading to more pain and suffering. With the right steps and techniques, however, flare-ups and further damage can be avoided. From wearing the right footwear to performing regular calf stretches, an assortment of precautionary measures can help protect against irritating flare-ups and further injury.


Stretching and Physical Activity

Exercise is an essential component of any healthy lifestyle, particularly for individuals suffering from plantar fasciitis. Stretching is an essential aspect of physical activity that can help improve range of motion in the feet, legs, hips, and lower back.

Stretching can be beneficial for runners with plantar fasciitis to help relieve tension in the plantar fascia, Achilles tendon, and calf muscles. Here are some of the best stretches for runners with plantar fasciitis:

  1. Calf Stretch:
    • Stand facing a wall with your hands against it for support.
    • Step one foot back, keeping it straight, and bend the front knee.
    • Lean forward slightly to feel a stretch in the calf of the back leg.
    • Hold for 30 seconds and repeat on the other leg.
  2. Plantar Fascia Stretch:
    • Sit down and cross one ankle over the opposite knee.
    • Gently pull back on your toes to stretch the plantar fascia.
    • Hold for 30 seconds and switch to the other foot.
  3. Towel Stretch:
    • Sit on the floor with your legs extended.
    • Place a towel or resistance band around the ball of your foot.
    • Hold the ends of the towel and gently pull it toward you to flex your toes.
    • Hold for 30 seconds on each foot.
  4. Achilles Tendon Stretch:
    • Stand facing a wall with your hands on it.
    • Step one foot back, keeping it straight, and bend the front knee.
    • Lean forward slightly to feel a stretch in the Achilles tendon.
    • Hold for 30 seconds and repeat on the other leg.
  5. Heel Drop:
    • Stand on a step or sturdy elevated surface with your heels hanging off the edge.
    • Slowly lower your heels to stretch the calf muscles.
    • Hold for 30 seconds, and then rise up on your toes.
    • Repeat 10-15 times.
  6. Foot Flexor Stretch:
    • Sit on a chair and place one ankle on the opposite knee.
    • Gently press down on your toes to stretch the foot flexors.
    • Hold for 30 seconds and switch to the other foot.
  7. Standing Wall Calf Stretch:
    • Stand facing a wall and place your hands on it at shoulder height.
    • Step one foot back, keeping it straight, and the other foot forward.
    • Lean into the wall to feel a stretch in the calf of the back leg.
    • Hold for 30 seconds and repeat on the other leg.

It’s important to perform these stretches gently and consistently. If you experience pain during any stretch, stop immediately. You can gradually increase the duration of each stretch as your flexibility improves. In addition to stretching, it’s essential to wear appropriate footwear and consider other treatments recommended by a healthcare professional, such as ice, orthotics, and physical therapy, to manage plantar fasciitis.


Tips for Living With Plantar Fasciitis

Living with Plantar Fasciitis can be a challenge, but there are steps you can take to reduce discomfort and promote healing. By following the proper advice and taking appropriate precautions, it is possible to lessen the severity of Plantar Fasciitis symptoms, allowing you to continue to lead a productive and active life. Here are some tips to consider if you are dealing with Plantar Fasciitis:

  1. Wear supportive shoes with a stiff and stable sole. Having a supportive shoe with a rigid sole and deep heel can be beneficial in providing support and helping to spread out the strain on the Plantar Fascia. Ensure the shoe is properly fitted and fits snugly and comfortably with adequate cushioning.
  2. Increase your activity level gradually. Progressing slowly ahead with your activity level by starting low and gradually increasing will help you to limit the strain placed upon your feet and help prevent flare up from overuse.
  3. Manage painful symptoms with rest and ice. Taking regular time off your feet and reducing your activity level can help to reduce the pain and inflammation associated with Plantar Fasciitis. Applying ice for short intervals can also help to lessen symptoms.
  4. Do stretching exercises designed to target the Plantar Fascia. Stretching and strengthening the Plantar Fascia can help to reduce the tension on it, improve mobility and reduce strain. However, it is important to perform the exercises correctly in order to experience real benefits.
  5. Use orthotic foot supports. Wearing supportive insoles, compression socks or stretching splints can help to reduce the pain and tension on the Plantar Fascia. Over the counter orthotics or customized orthotics may be beneficial depending on your individual needs.

Living with Plantar Fasciitis can be a difficult journey, but being mindful of certain strategies can help make this challenge a bit more manageable. Taking steps to ensure your feet are adequately supported, maintaining an appropriate activity level, managing painful symptoms with rest and ice, performing targeted stretching exercises and possibly utilize orthotics will make a world of difference in reducing discomfort and promoting healing.



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