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The Injurance Blog pt2 - Plantar Fasciitis and endurance athletes

In addition to our regular Endurance Blog, which covers topics related to endurance coaching and nutrition, we will also be publishing Injurance Blog, which cover common injury topics for endurance athletes.

We work in conjunction with A6 Physiotherapy and Axis Podiatry who contribute their expert advice for each blog post. If you have any questions, post them on THE ENDURANCE STORE Facebook Page, where this blog in posted.

Owning a running store, possibly the most common injury we see is plantar fasciitis, which is pain in the bottom of the foot or under the heel bone. It can prevent you from running altogether and can take a long time to get rid of if not treated correctly. This week Sam and Dr Lindsay give us the low down:

What is plantar fasciitis?

Firstly, it's important to understand that there are several causes of heel pain with similar symptoms to plantar fasciitis, so it's important you see a physio or podiatrist for an accurate diagnosis. The term plantar fasciitis is no longer appropriate as the plantar fascia is a thick band of connective tissue with similar degenerative collagen properties as tendinosis (tendon dysfunction ). As the plantar fascia is actually connective tissue and not a tendon, so the term plantar fasciopathy or plantar fasciosis is more appropriate

Plantar fasciopathy is currently thought to be due to overloading of tissues of the plantar fascia (thick band of connective tissue which runs under the foot from heel bone to toes, forming the arch) that have become swollen and sensitive to load. It presents as heel pain with early morning symptoms (those who have suffered always complain of pain under the heel as soon as they step out of bed!). Recognising the symptoms in its initial stages is the key to managing this. Any early morning heel pain, even if it resolves after a few steps is the first sign there is a problem brewing.

This is not a condition you can simply continue to run on. You can remain active by cross training but repetitive overloading of the plantar fascia will mean a longer period off from running in the long term and a more chronic problem that becomes very difficult to resolve. The key causes are as follows:

1. Poor footwear with incorrect arch support especially for those individuals with high arches, flat feet or a leg length discrepancy. This does not only include your running shoes, it includes footwear you have on during your working hours or activities of daily living as this could be contributing to any running injuries

2. Long hours on your feet including excessive running, standing on hard surfaces for prolonged periods of time.

These factors can be associated with tight calf muscles and achilles tendon tightness which are identified as significant risk factors along with altered running biomechanics. Another risk factor within the literature is high body mass index (BMI) which is more prevalent in the sedentary population rather than endurance athletes.

It is thought that the majority of plantar fasciopathy cases will improve within 6 months with conservative treatment. However, in patients who cannot avoid aggravating the plantar fascia it may take up to 9 months. First line treatment consists of pain relief and management with gradual progression of loading exercises. In view of the plantar fascia seemingly having similar physiological reactions to load as tendons there is now evidence to suggest we treat it like a tendon. Therefore loading exercises are appropriate for effective rehabilitation in plantar fasciopathy. However, it is important to seek guidance from your physiotherapist in order to identify the type of load required that won’t exacerbate symptoms. There is no point doing high repetitions of heel dips on a step if this is an aggravating factor.

1. Back off from running immediately and check that your running shoes are the correct ones for you and that they're not too worn. You also need to check your footwear for a general working day.

2. Gradual loading of the tendon in conjunction with ankle strengthening is beneficial. This should also include stretching the calves and other associated muscles.

3. Podiatry can provide custom made orthotics in the early stages of rehabilitation and guidance on gel heel cups and footwear. Night splints for pain relief in cases which have taken closer to 6 months can even be provided

We'd love to hear from you if you have suffered from plantar fasciopathy. Comment below this post on THE ENDURANCE STORE Facebook page and let us know your experiences and questions!


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